Contractor-priced
44238 · PFS Q2 2024 · Historical
No national PFS rate in Q2 2024
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
PFS status evidence
Inspect PFS status evidence
- Code
- 44238
- Release
- Q2 2024, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU24BApril 1 – June 30, 2024
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU24_APR.csv row 10,857 in rvu24b-updated-03-18-2024.zip
In the CMS file
Loading rows 10,855–10,859 of PPRRVU24_APR.csv…
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9acf98f4d515fb61037a7404940c363a795b0209d9c64268dd8e5962fb9e4a91
CPT 44238 has no published national rate. It carries status C (carrier-priced) in the Q2 2024 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 44238?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 44238: GLOB DAYS YYY (contractor decides) · BILAT SURG 1 (150% bilateral adjustment applies) · MULT PROC 2 (standard reduction applies) · ASST SURG 2 (payable) · CO SURG 1 (payable with documentation) · TEAM SURG 1 (payable with documentation).
Contractor decides
GLOB DAYS
YYY
Your Medicare Administrative Contractor decides whether a global period applies and sets its length when it prices the code. The result is 0, 10, or 90 days.
150% bilateral adjustment applies
BILAT SURG
1
Billed bilaterally (modifier 50, or on both sides), Medicare pays 150% of the single-side fee schedule amount.
Standard reduction applies
MULT PROC
2
When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.
-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.
Payable
ASST SURG
2
An assistant at surgery may be separately paid for this procedure, typically as a percentage of the fee schedule amount.
Payable with documentation
CO SURG
1
Co-surgeons may be paid, but only with supporting documentation establishing the medical necessity of two surgeons.
Payable with documentation
TEAM SURG
1
A surgical team may be paid, but only with supporting documentation establishing medical necessity.
Why would a Medicare claim for 44238 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is C (carrier-priced)—Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
- Co-surgeons: payable with documentation. See billing policy
- Team surgery: payable with documentation. See billing policy
- Multiple procedures: standard reduction applies. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
CMS RVU24BApril 1 – June 30, 2024
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 44238 Copy link
What to check (5)
There is no national allowed amount for 44238, so every reconciliation of this line runs against the MAC fee schedule that was in force for the date of service rather than against a national baseline.
- Compare the paid amount against the MAC fee schedule in force for the date of service; there is no national allowed amount here to reconcile against.
- Ask the MAC which global period it assigned: the contractor sets the follow-up window for this code, so whether a post-operative visit should have paid depends on the contractor that priced it.
- Rank the claim’s procedure lines before calling a reduced line short-paid—under the standard multiple-procedure rule only the highest-valued one prices in full.
- Look for modifier 50 or a second-side line before comparing: billed for both sides, this procedure should price at 150% of the single-side amount.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04).
Source & method Copy link
The PFS file shows this code is priced by the contractor. Its amounts come from the MAC-published schedules and effective dates shown above.
-
01 PPRRVU24_APR.csv · Q2 2024 (RVU24B) · row 10,857—priced by the contractor
- Effective
- April 1 – June 30, 2024
- Locator
- PPRRVU24_APR.csv in rvu24b-updated-03-18-2024.zip · row 10,857 of 18,534 · via CMS
- Fields read
-
Status C (col 4)SHA-256 9acf98f4d515fb61…
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02 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q2 2024 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 44238 National PFS baseline: No national PFS rate (Q2 2024; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU24B, PPRRVU24_APR.csv row 10,857. Localis. https://localishealth.com/cpt/44238/2024/B
Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON
How has it changed? Copy link
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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Usage and related codes Copy link
In CY2024, 44238 ranked #2,585 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 2,057
- Allowed
- $1.7M
- Beneficiaries
- 1,656
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).