Contractor-priced
63043 · PFS Q3 2017 · Historical
No national PFS rate in Q3 2017
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 63043
- Release
- Q3 2017, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU17CJuly 1 – September 30, 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_JULY_V0503.csv row 10,702 in rvu17c.zip
In the CMS file
Loading rows 10,700–10,704 of PPRRVU17_JULY_V0503.csv…
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900a883af582a5aea1ddfbf94ff14f240d036b71a2c76cfeb2f699e487fef5ce
CPT 63043 has no published national rate. It carries status C (carrier-priced) in the Q3 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 63043?
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 63043: GLOB DAYS ZZZ (add-on code) · BILAT SURG 1 (150% bilateral adjustment applies) · ASST SURG 2 (payable) · CO SURG 2 (payable).
Add-on code
GLOB DAYS
ZZZ
This code is always billed alongside another service and carries no follow-up period of its own. The primary procedure's global period governs; this indicator does not determine whether either line is payable.
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.
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 63043 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
- Team surgery: not permitted. 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 RVU17CJuly 1 – September 30, 2017
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 63043 Copy link
What to check (5)
There is no national allowed amount for 63043, 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.
- Reconcile this line together with the primary procedure on the same claim—it is an add-on that is never billed alone and carries no global period of its own.
- 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.
- Check that any -80 or -AS line was priced from the same release and locality as the primary line; an assistant at surgery prices at a percentage of the fee-schedule 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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
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_JULY_V0503.csv · Q3 2017 (RVU17C) · row 10,702—priced by the contractor
- Effective
- July 1 – September 30, 2017
- Locator
- PPRRVU17_JULY_V0503.csv in rvu17c.zip · row 10,702 of 16,498 · via CMS
- Fields read
-
Status C (col 4)SHA-256 900a883af582a5ae…
-
02 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q3 2017 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 63043 National PFS baseline: No national PFS rate (Q3 2017; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU17C, PPRRVU17_JULY_V0503.csv row 10,702. Localis. https://localishealth.com/cpt/63043/2017/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, 63043 ranked #7,181 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 67
- Allowed
- $19,790
- Beneficiaries
- 25
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).