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CPT 62380 Medicare payment status

Contractor-priced

62380 · PFS Q1 2018 · Historical

No national PFS rate in Q1 2018

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

View applicable payment rules
View CMS source and method

PFS status evidence

Physician relative value file (Q1 2018) · rvu18ar1.zip (PPRRVU18_JAN.csv row 10,820)
Inspect PFS status evidence
Code
62380
Release
Q1 2018, revision 3
Result
Contractor-priced

Citations

  • Shows this code’s PFS status (C). Result: Contractor-priced.

    Physician relative value file (PPRRVU)CMS RVU18AJanuary 1 – March 31, 2018revision 3

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

    PPRRVU18_JAN.csv row 10,820 in rvu18ar1.zip

    In the CMS file

    Loading rows 10,818–10,822 of PPRRVU18_JAN.csv…

    Download rvu18ar1.zip from CMS File fingerprint b2c0cf1c065aa6f715438573eb2251381843a90991cf56818aaf33301c43c932

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CPT 62380 has no published national rate. It carries status C (carrier-priced) in the Q1 2018 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).

Global surgery period

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.

Bilateral surgery

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.

Multiple procedures

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.

Assistant at surgery

Payable

ASST SURG

2

An assistant at surgery may be separately paid for this procedure, typically as a percentage of the fee schedule amount.

Co-surgeons

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 RVU18AJanuary 1 – March 31, 2018revision 3

Can you bill it with another code? Copy link

This code

62380

See every current NCCI pair for 62380 →

Reconciling a contractor-priced payment for 62380 Copy link

Checking a paid 62380 line?

Check an actual payment Model this code in a contract
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.

  1. 01 PPRRVU18_JAN.csv · Q1 2018 (RVU18A) · row 10,820—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q1 2018 release
    Effective
    January 1 – March 31, 2018
    Locator
    PPRRVU18_JAN.csv in rvu18ar1.zip · row 10,820 of 16,638 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 b2c0cf1c065aa6f7…
  2. 02 Physician & Other Practitioners · CY2024—volume and who bills it limits
    Source
    CMS Physician & Other Practitioners dataset
    Effective
    Calendar-year snapshot, on a different cycle from the Q1 2018 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 2018; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU18A, PPRRVU18_JAN.csv row 10,820. Localis. https://localishealth.com/cpt/62380/2018/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).