CPT 62380
Contractor-priced
62380 · PFS Q4 2018 · Historical
No national PFS rate in Q4 2018
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
CPT 62380 has no published national rate. It carries status C (carrier-priced) in the Q4 2018 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
Inspect PFS status evidence
- Code
- 62380
- Release
- Q4 2018, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)Q4 2018 · revision 1
Latest revision of this release
Release period: October 1 – December 31, 2018
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
PPRRVU18_OCT.csv in rvu18d.zip (row 10,864)- hcpcs (col 1)
- 62380
- modifier (col 2)
- blank
- status_code (col 4)
- C
SHA-256: c6312c12acd1b8ed78b409e8508357929aa7e764e333ec568ebb9c0774b7dc4d
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.
Payment considerations Copy link
Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.
Other payment indicators (5)
Facility/non-facility: Not determined, Professional/technical component: 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 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.
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.
Codes to compare
National Q4 2018 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
None of the comparison codes are in this release.
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).
Which billing rules and modifiers apply? Copy link
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.
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 2018 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.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
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 2018; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/62380/2018/D