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CPT 62380 Medicare carrier-priced amounts

Contractor-priced

62380 · PFS Q3 2026 · Historical

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 Q3 2026

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

Check for a published amount in your locality.

View contractor sources and effective dates

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
Q3 2026, revision 1
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU26CJuly 1 – September 30, 2026

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

    PPRRVU2026_Jul_nonQPP.csv row 6,927 in rvu26c-updated-06-30-2026.zip

    In the CMS file

    Loading rows 6,925–6,929 of PPRRVU2026_Jul_nonQPP.csv…

    Download rvu26c-updated-06-30-2026.zip from CMS File fingerprint b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

Report a problem

CPT 62380 carries status C (carrier-priced) in the Q3 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.

Contractor-published source figures, not a national rate. Par = participating-provider amount Non-par = nonparticipating-provider amount C = technical component capped at the OPPS amount # = facility-setting amount
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

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
  • 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
  • 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 RVU26CJuly 1 – September 30, 2026

Can you bill it with another code? Copy link

62380 has 325 NCCI pairs (Q3 2026).

This code

62380

Modifier indicator 0

111 pairs

No modifier bypasses the edit

Modifier indicator 1

214 pairs

Only with an appropriate, documented modifier

All 325 NCCI pairs 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 PPRRVU2026_Jul_nonQPP.csv · Q3 2026 (RVU26C) · row 6,927—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q3 2026 release
    Effective
    July 1 – September 30, 2026
    Locator
    PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip · row 6,927 of 19,356 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 b7d197e73211ef68…
  2. 02 MAC-published fee schedules · 5 on file—the contractor amounts
    Source
    MAC-published fee schedules
    Effective
    Effective dates shown above
  3. 03 NCCI · Q3 2026—the code-pair edits
    Source
    National Correct Coding Initiative (NCCI)
    Effective
    Same quarter as the Q3 2026 rate
  4. 04 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 Q3 2026 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 (Q3 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26C, PPRRVU2026_Jul_nonQPP.csv row 6,927. Localis. https://localishealth.com/cpt/62380/2026/C

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).