CPT 53899

Contractor-priced

53899 · PFS Q2 2016 · Historical

No national PFS rate in Q2 2016

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Check for a published amount in your locality.

Service-location ZIP

View contractor sources and effective dates

CPT 53899 has no published national rate. It carries status C (carrier-priced) in the Q2 2016 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.

PFS status evidence

Physician relative value file (Q2 2016) · rvu16b.zip (PPRRVU16_April_V0202.csv row 9,759)

Inspect PFS status evidence

Code: 53899
Release: Q2 2016, revision 1
Result: Contractor-priced

Citations

Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)
Q2 2016 · revision 1

Latest revision of this release

Release period: April 1 – June 30, 2016

This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

Record details
PPRRVU16_April_V0202.csv in rvu16b.zip (row 9,759)

hcpcs (col 1)

53899

modifier (col 2)

blank

status_code (col 4)

C

SHA-256: a6f009bac8359a1f7d870e6b668dd2e69d1658423373dbb0ca0c267cdae773b9

Original source file

Plain-text summary

Why is there no national PFS amount for 53899?

Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Multiple-procedure reduction Context required Assistant/co-surgeon treatment Context required Global surgery Context required Contractor pricing Applies

Other payment indicators (6)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply.

Why would a Medicare claim for 53899 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.

Reconciling a contractor-priced payment for 53899 Copy link

There is no national allowed amount for 53899, 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.

What to check

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.
Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
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.

Codes to compare

National Q2 2016 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code	Office	Facility
55000 Priced as active rather than carrier-priced	$119.59	$87.72
53860 Priced as active rather than carrier-priced	$1,562.50	$233.09
55040 Priced as active rather than carrier-priced	$348.02	$348.02

Check an actual payment Model this code in a contract

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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Which billing rules and modifiers apply? Copy link

Global period: what 53899's fee already covers Copy link

YYY Contractor decides

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.

Billing policy Copy link

These billing-policy indicators explain how 53899 is treated. They apply whether the code is nationally priced or carrier-priced: 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. When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.
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

Check a pair of codes 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 for the pair.

See every current NCCI pair for 53899 →

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.

Usage and related codes Copy link

How often 53899 is billed Copy link

Across Original Medicare in CY2024, 53899 ranked #3,869 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries

1,531

Office + facility beneficiaries combined

Services

1,650

Times it was billed

Allowed

$499,137

Total Medicare allowed dollars

Compare: ↑ #3,867 more popular · 58210 ↓ #3,870 less popular · 86632

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 2016 fee schedule above.

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Source & method

Show sources

Contractor amounts come from the MAC-published schedules and effective dates shown above. The PFS file shows this code is priced by the contractor. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.