Contractor-priced
62380 · PFS Q1 2017 · Historical
No national PFS rate in Q1 2017
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 62380
- Release
- Q1 2017, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU17AJanuary 1 – March 31, 2017
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU17_V1219.csv row 10,668 in rvu17a.zip
In the CMS file
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fda64dc114c31e9002889c5847fcdcdc1c1ee8a1d8b26765b55e1f5da6e61bab
CPT 62380 has no published national rate. It carries status C (carrier-priced) in the Q1 2017 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 62380?
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 62380: GLOB DAYS 090 (90-day follow-up) · BILAT SURG 1 (150% bilateral adjustment applies) · MULT PROC 2 (standard reduction applies) · ASST SURG 2 (payable) · CO SURG 2 (payable).
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.
150% bilateral adjustment applies
BILAT SURG
1
Billed bilaterally (modifier 50, or on both sides), Medicare pays 150% of the single-side fee schedule amount.
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
CO SURG
2
Co-surgeons may be separately paid for this procedure, each typically at a percentage of the fee schedule amount.
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
- 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.
CMS RVU17AJanuary 1 – March 31, 2017
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 62380 Copy link
What to check (5)
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.
- 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).
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 PPRRVU17_V1219.csv · Q1 2017 (RVU17A) · row 10,668—priced by the contractor
- Effective
- January 1 – March 31, 2017
- Locator
- PPRRVU17_V1219.csv in rvu17a.zip · row 10,668 of 16,478 · via CMS
- Fields read
-
Status C (col 4)SHA-256 fda64dc114c31e90…
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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 2017 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 62380 National PFS baseline: No national PFS rate (Q1 2017; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU17A, PPRRVU17_V1219.csv row 10,668. Localis. https://localishealth.com/cpt/62380/2017/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, 62380 ranked #3,225 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 602
- Allowed
- $887,692
- Beneficiaries
- 375
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).