CPT 45999
No national payment amount
Carrier-priced: no national payment amount.
Did Medicare pay separately for CPT 45999 in Q2 2025?
Not at a published national rate. CPT 45999 carries status C (carrier-priced) in the Q2 2025 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Treat the blank amount as unpriced, not as $0.
How often 45999 is billed
Across Original Medicare in CY2024, 45999 ranked #5,453 of the 7,879 CPT codes billed to Medicare that year, ranked by patients served or total allowed dollars.
2024 Medicare fee-for-service only, national totals — Medicare Advantage, Medicaid and commercial volume are excluded, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q2 2025 fee schedule the rates above come from.
Common questions
Why is there no payment amount for 45999?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for 45999 be denied or paid less?
Each item below comes from a CMS indicator 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
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- 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.
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.
Saw this code on your bill?
What is a 45999 visit in patient-friendly terms?
We haven't written the plain-language description for CPT 45999 yet — ask your provider's billing office what service it covers in the meantime.
How this amount is computed
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | blank |
| Practice expense RVU (non-facility) | blank |
| Practice expense RVU (facility) | blank |
| Malpractice RVU | blank |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
Billing policy
What 45999's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| Co-surgeons | 1 | Payable with documentation. Co-surgeons may be paid, but only with supporting documentation establishing the medical necessity of two surgeons. |
| Team surgery | 1 | Payable with documentation. A surgical team may be paid, but only with supporting documentation establishing medical necessity. |
| Multiple procedures | 2 | Standard reduction applies. The same standard ranking-and-reduction rule as indicator 1 applies to this procedure when billed with others on the same date. |
| Professional/technical split | 0 | No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service. |
Rate history by release
National non-facility amount for 45999 across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jun 30, 2026 – present | C | — | — |
| Q2 2026 Mar 10, 2026 – Jun 29, 2026 | C | — | — |
| Q1 2026 Dec 29, 2025 – Mar 9, 2026 | C | — | — |
| Q4 2025 Sep 11, 2025 – Dec 28, 2025 | C | — | — |
| Q3 2025 Jun 5, 2025 – Sep 10, 2025 | C | — | — |
| Q2 2025 Jun 5, 2025 – Jun 4, 2025 | C | — | — |
| Q1 2025 Dec 23, 2024 – Jun 4, 2025 | C | — | — |
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Source & method
This is computed from CMS's Medicare Physician Fee Schedule Q2 2025 release (schedule pfs, effective April 2025). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them.
Conversion factor $32.3465 read from the same file, row 11, column 25.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q2 2025 figures, even after a newer release lands.
CPT 45999 Medicare Physician Fee Schedule rate (Q2 2025). Localis. https://localishealth.com/cpt/45999/2025/B