Contractor-priced
62380 · PFS Q4 2026
Contractor-published range
$943.11–$1,302.58
Participating · Office (non-facility) · Whole service
MAC-published fee schedules available in Localis: 5 of 144 payment localities. Missing data does not establish a $0 allowance.
No national PFS rate in Q4 2026
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
Amount evidence: MAC-published fee schedules and effective dates. The PFS row shows this code is priced by the contractor.
Inspect PFS status evidence
- Code
- 62380
- Release
- Q4 2026, revision 2
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU2026_Oct_nonQPP.csv row 6,987 in rvu26d-updated-08-26-2026.zip
In the CMS file
Loading rows 6,985–6,989 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626
CPT 62380 carries status C (carrier-priced) in the Q4 2026 release, so there is no single national rate—Medicare contractors publish their own amounts. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Contractor-published amounts on file range $943.11–$1,302.58 across 5 localities; enter a ZIP for the exact local amount.
Why is there no national PFS amount for 62380?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Find the local Medicare amount for 62380 Copy link
Medicare sets this price locally
62380 has no single national Physician Fee Schedule amount. Use the ZIP, modifier, setting, and participation fields above to match it to a Medicare locality and the contractor amount we have on file.
Your practical estimate will appear here
We hold files from First_coast across JN, most recently effective Jan 1, 2026. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.
This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.
View all 5 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JN · Florida, Area 03 CMS 09102-03 | — | — | $1,180.72 | $1,121.68 | $1,289.93 | Jan 1, 2026 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | — | $1,302.58 | $1,237.45 | $1,423.07 | Jan 1, 2026 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | — | $1,090.14 | $1,035.63 | $1,190.97 | Jan 1, 2026 | Contractor file |
| JN · Puerto Rico, Area 20 CMS 09202-20 | — | — | $943.11 | $895.95 | $1,030.34 | Jan 1, 2026 | Contractor file |
| JN · U.S. Virgin Islands, Area 50 CMS 09202-50 | — | — | $1,058.20 | $1,005.29 | $1,156.08 | Jan 1, 2026 | Contractor file |
The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.
Which billing rules and modifiers apply? Copy link
Payment rules for 62380 Copy link
Other payment indicators (3)
Why would a Medicare claim for 62380 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
- 111 codes form NCCI pairs with 62380 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
- 214 codes pair with 62380 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
- More than 2 units per patient per date of service exceeds 62380's Medically Unlikely Edit (MUE) limit. See billing together
- 62380 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
- 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.
Global period: what 62380's fee already covers Copy link
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.
Billing a related follow-up visit inside the 90-day window is the most common way this code gets denied—the payment for that care is already inside the 62380 fee.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
| -57 | The E/M at which the decision to operate was made. Major surgery only—a minor procedure has no day-before pre-operative period. |
| -24 | An E/M during the follow-up window that is unrelated to this surgery, so it is paid separately. |
| -58 | A staged or more extensive follow-on procedure during the window. Starts a new follow-up period. |
| -78 | An unplanned return to the operating room for a related procedure during the window. Does not start a new follow-up period. |
| -79 | An unrelated procedure by the same physician during the window. Starts a new follow-up period. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Billing policy Copy link
These billing-policy indicators explain how 62380 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 | 1 | 150% bilateral adjustment applies. Billed bilaterally (modifier 50, or on both sides), Medicare pays 150% of the single-side fee schedule amount. |
| Assistant at surgery | 2 | Payable. An assistant at surgery may be separately paid for this procedure, typically as a percentage of the fee schedule amount. |
| Co-surgeons | 2 | Payable. Co-surgeons may be separately paid for this procedure, each typically at a percentage of the fee schedule amount. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| 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.
Billing together (NCCI edits) Copy link
NCCI Q4 2026Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.
Not separately payable with 62380 on the same date of service—no modifier bypasses the edit (modifier indicator 0)
Showing 3 of 111.
Separately payable with 62380 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)
Showing 3 of 214.
Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.
Check a paired code or view all 325 NCCI pairs →
Medically Unlikely Edit (MUE) limit: 2 units per patient per date of service.
Reconciling a contractor-priced payment for 62380 Copy link
There is no national allowed amount for 62380, 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.
- 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.
- 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).
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 62380 is billed Copy link
Across Original Medicare in CY2024, 62380 ranked #3,225 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 1.6 times on average that year.
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 Q4 2026 fee schedule above.
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Source & method
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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.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 62380 National PFS baseline: No national PFS rate (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 6,987. Localis. https://localishealth.com/cpt/62380/2026/D