Contractor-priced
54440 · PFS Q1 2013 · Historical
No national PFS rate in Q1 2013
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 54440
- Release
- Q1 2013, revision 2
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU13AJanuary 1 – March 31, 2013revision 2
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU13_V1226_UP0.csv row 9,282 in rvu13ar.zip
In the CMS file
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79b1988bb9cbab6a61634b6463d26ce88cca431c3e36fa3b73792f29882d95b4
CPT 54440 has no published national rate. It carries status C (carrier-priced) in the Q1 2013 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 54440?
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 54440: GLOB DAYS 090 (90-day follow-up) · MULT PROC 2 (standard reduction applies) · ASST SURG 2 (payable) · CO SURG 1 (payable with documentation).
90-day follow-up
GLOB DAYS
090
Major surgery. The fee covers the day before surgery, the day of surgery, and the 90 days after it. Related follow-up care inside that window is not billed separately.
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.
Why would a Medicare claim for 54440 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
- 54440 carries a 90-day global period—routine post-operative care within that window is included in the surgical payment rather than paid on its own claim. See how it's computed
- Bilateral surgery: no bilateral adjustment. See billing policy
- Co-surgeons: payable with documentation. See billing policy
- Team surgery: not permitted. 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 RVU13AJanuary 1 – March 31, 2013revision 2
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 54440 Copy link
What to check (5)
There is no national allowed amount for 54440, 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.
- Check the dates before appealing a denial: related follow-up care in the 90 days after the procedure is already paid in this fee, so a post-operative visit denied in that window was denied correctly.
- 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 that any -80 or -AS line was priced from the same release and locality as the primary line; an assistant at surgery prices at a percentage of the fee-schedule 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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
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 PPRRVU13_V1226_UP0.csv · Q1 2013 (RVU13A) · row 9,282—priced by the contractor
- Effective
- January 1 – March 31, 2013
- Locator
- PPRRVU13_V1226_UP0.csv in rvu13ar.zip · row 9,282 of 15,619 · via CMS
- Fields read
-
Status C (col 4)SHA-256 79b1988bb9cbab6a…
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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 Q1 2013 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 54440 National PFS baseline: No national PFS rate (Q1 2013; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU13A, PPRRVU13_V1226_UP0.csv row 9,282. Localis. https://localishealth.com/cpt/54440/2013/A
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, 54440 ranked #6,851 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 36
- Allowed
- $29,606
- Beneficiaries
- 32
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).