CPT 46999
Contractor-priced — your Medicare Administrative Contractor sets the amount, not a national fee schedule.
No national payment amount
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Did Medicare pay separately for CPT 46999 in Q2 2025? Copy link
Not at a published national rate. CPT 46999 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.
Source: Physician relative value file (Q2 2025) · effective April 2025 · materially updated Aug 4, 2026 · compact facts
Why isn't there a national PFS amount?
- Status C (Carrier-priced): Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
- Carrier-priced: no national payment amount.
CMS evidence · 2 sources
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Common questions Copy link
Why is there no payment amount for 46999?
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 46999 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
- 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.
Applicable payment rules Copy link
Only the rules that can matter for 46999, each linking to its detail on this page.
Global period: what 46999's fee already covers Copy link
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.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Billing policy Copy link
What 46999'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. |
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 46999.
How often 46999 is billed Copy link
Across Original Medicare in CY2024, 46999 ranked #5,369 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, 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 above.
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Source & method
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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. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
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 46999 Medicare Physician Fee Schedule rate (Q2 2025). Localis. https://localishealth.com/cpt/46999/2025/B