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CPT 64463 Medicare rate in Q3 2025

Historical · Q3 2025
$215.43

National (GPCI 1.000)

$192.10–$284.02 across payment localities

Participating physician · Before sequestration

CMS evidence · Q3 2025 release

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The national PFS baseline was $215.43 for CPT 64463 in the Office (non-facility) setting and $78.28 in a facility under the Q3 2025 Physician Fee Schedule, effective July 2025. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Why are the facility and non-facility amounts different?

Only the practice-expense RVU changes with the setting. For 64463 it's 4.60 RVUs in the Office (non-facility) setting versus 0.36 in a facility—the whole $137.15 gap between $215.43 and $78.28. In the Office (non-facility) setting the practice bears the overhead, so the allowed amount is higher; in a hospital or ASC the facility bills its own fee, so the professional amount is lower. See facility vs non-facility.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).

Contract rate as % of Medicare Copy link

Applies to your locality's allowed amount, not the $215.43 national baseline. How to find your contract's percentage.

Need rates from another insurer? Join the waitlist →

Allowed amount, Medicare's share, and patient share Copy link

A physician's $215.43 Office (non-facility) allowed amount: Medicare pays $168.89 after sequestration and the patient owes $43.09, once the Part B deductible is met.

Adjust for your locality →
64463: allowed amount and each party's share by who bills it, Office (non-facility), national baseline
Billed by Allowed amount Participating claim If not participating
What Medicare pays Patient coinsurance Non-participating amount Limiting charge
Physician (MD/DO) 100% Calculator $215.43 $168.89 $172.34 − $3.45 $43.09 $204.66 $235.36

National Q3 2025, GPCI 1.000. Rows are provider types with at least 1% of 64463’s Medicare services in CMS’s CY2024 Physician & Other Practitioners data; each % applies before the 80/20 split and sequestration.

Is $215.43 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($172.34) and the patient owes 20% coinsurance ($43.09). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 64463?

$204.66 in the Office (non-facility) setting—95% of the $215.43 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 64463?

$235.36 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $215.43 amount above. The non-participating amount is 95% of the fee schedule rate ($204.66), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

CMS RVU25CJuly 1 – September 30, 2025 See file rows

Which billing rules and modifiers apply? Copy link

National modifier amounts for 64463: -50 $323.15.

Global surgery period

Same day only

GLOB DAYS

000

The fee covers pre-operative and post-operative work on the day of the procedure only—there is no follow-up window afterward. A visit the next day is separately payable.

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.

-50 Bilateral procedure · 150% $323.15

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.

Not payable with 64463: -26/TC · -80/81/82 · -AS · -62 · -66.

Modifier amounts are derived, not a CMS column: Localis applies the standard MPFS percentage to the national Office (non-facility) amount. Check them against the Claims Processing Manual. Locality-adjusted amounts.

Why would a Medicare claim for 64463 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

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 RVU25CJuly 1 – September 30, 2025 See file rows

Can you bill it with another code? Copy link

This code

64463

See every current NCCI pair for 64463 →

Payment review for 64463 Copy link

Checking a paid 64463 line?

Check an actual payment Model this code in a contract
What to check (5)

Four published payment rules can change what 64463 allows on a claim: the office/facility differential, the same-day global package, the standard multiple-procedure reduction and the 150% bilateral adjustment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

  • Check the place-of-service code before attributing the gap to the payer: office and facility pricing differ by $137.15 nationally at GPCI 1.000, before any locality adjustment.
  • Check the visit date: this code carries no follow-up window, so a related visit the day after the procedure is separately payable and should not have bundled.
  • Rank the claim’s procedure lines before calling this one short-paid: billed with a higher-valued procedure on the same date, its allowed amount is $107.72 instead of $215.43 (national, GPCI 1.000). That is the rule, not a payer error.
  • 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 Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04).

How location and RVUs set the amount Copy link

Office (non-facility): 6.66 RVUs × $32.3465 = $215.43 national PFS baseline. Local GPCIs move it from $192.10 in Arkansas, AR to $284.02 in San Jose-Sunnyvale-Santa Clara (San Benito County), CA.

Office (non-facility)

Office (non-facility): each RVU times its GPCI, summed, times the conversion factor
Component RVU × GPCI =
Work 1.90 1.000 1.90
Practice expense 4.60 1.000 4.60
Malpractice 0.16 1.000 0.16
Total RVUs 6.66
× Conversion factor $32.3465
= National PFS baseline $215.43

Facility

Facility: each RVU times its GPCI, summed, times the conversion factor
Component RVU × GPCI =
Work 1.90 1.000 1.90
Practice expense 0.36 1.000 0.36
Malpractice 0.16 1.000 0.16
Total RVUs 2.42
× Conversion factor $32.3465
= National PFS baseline $78.28

Rates by locality Copy link

Maine: $200.67–$215.43 across 2 localities ME Wisconsin: $205.57 WI Vermont: $211.89 VT New Hampshire: $219.96 NH Montana: $215.31 MT North Dakota: $212.93 ND Minnesota: $215.52 MN Michigan: $203.08–$217.24 across 2 localities MI New York: $206.45–$253.90 across 5 localities NY Massachusetts: $224.49–$246.77 across 2 localities MA Rhode Island: $221.99 RI Washington: $220.79–$250.04 across 2 localities WA Idaho: $198.95 ID Wyoming: $214.08 WY South Dakota: $212.23 SD Iowa: $199.67 IA Illinois: $204.31–$225.88 across 4 localities IL Indiana: $201.16 IN Ohio: $202.36 OH Pennsylvania: $204.18–$225.70 across 2 localities PA New Jersey: $234.14–$245.12 across 2 localities NJ Connecticut: $231.39 CT Oregon: $211.50–$229.94 across 2 localities OR Nevada: $214.62 NV Utah: $205.10 UT Colorado: $222.91 CO Nebraska: $199.48 NE Missouri: $194.31–$208.25 across 3 localities MO Kentucky: $196.68 KY West Virginia: $196.62 WV Virginia: $211.90 VA Maryland: $218.41–$229.86 across 2 localities MD Delaware: $214.53 DE California: $227.85–$284.02 across 29 localities CA Arizona: $210.95 AZ New Mexico: $202.63 NM Kansas: $199.06 KS Oklahoma: $198.24 OK Arkansas: $192.10 AR Tennessee: $197.59 TN North Carolina: $202.68 NC South Carolina: $201.54 SC District of Columbia: $248.37 DC Texas: $200.72–$221.83 across 8 localities TX Louisiana: $197.63–$206.56 across 2 localities LA Mississippi: $192.21 MS Alabama: $193.74 AL Georgia: $198.67–$215.64 across 2 localities GA Florida: $208.92–$227.21 across 3 localities FL Alaska: $256.10 AK Hawaii: $235.33 HI
$192–$203 $203–$213 $213–$224 $224–$235 $235–$245 $245–$256

64463 Office (non-facility) by metro, highest first

San Jose, CA $283.30 Locality 01112-09 San Francisco, CA $280.31 Locality 01112-05 Anchorage, AK $256.10 Locality 02102-01 Long Island, NY $253.90 Locality 13202-02 Queens, NY $250.83 Locality 13292-04 Seattle, WA $250.04 Locality 02402-02
Show 56 more metros
Washington, DC $248.37 Locality 12202-01 New York City, NY $247.52 Locality 13202-01 Boston, MA $246.77 Locality 14212-01 Los Angeles, CA $245.27 Locality 01182-18 Northern New Jersey, NJ $245.12 Locality 12402-01 San Diego, CA $243.35 Locality 01182-72 Ventura County, CA $242.45 Locality 01182-17 Sacramento, CA $238.45 Locality 01112-63 Honolulu, HI $235.33 Locality 01212-01 Hartford, CT $231.39 Locality 13102-00 Portland, OR $229.94 Locality 02302-01 Baltimore, MD $229.86 Locality 12302-01 Riverside, CA $229.57 Locality 01112-62 Bakersfield, CA $228.56 Locality 01112-54 Fresno, CA $227.85 Locality 01112-56 Miami, FL $227.21 Locality 09102-04 Suburban Chicago, IL $225.88 Locality 06102-15 Philadelphia, PA $225.70 Locality 12502-01 Chicago, IL $224.55 Locality 06102-16 Denver, CO $222.91 Locality 04112-01 Providence, RI $221.99 Locality 14412-01 Austin, TX $221.83 Locality 04412-31 Fort Lauderdale, FL $219.12 Locality 09102-03 Houston, TX $218.85 Locality 04412-18 Detroit, MI $217.24 Locality 08202-01 Dallas, TX $216.51 Locality 04412-11 Atlanta, GA $215.64 Locality 10212-01 Minneapolis, MN $215.52 Locality 06202-00 Portland, ME $215.43 Locality 14112-03 Fort Worth, TX $215.30 Locality 04412-28 Las Vegas, NV $214.62 Locality 01312-00 Richmond, VA $211.90 Locality 11302-00 Phoenix, AZ $210.95 Locality 03102-00 Tampa, FL $208.92 Locality 09102-99 St. Louis, MO $208.25 Locality 05302-01 Kansas City, MO $207.65 Locality 05302-02 Metro East, IL $207.28 Locality 06102-12 San Antonio, TX $206.90 Locality 04412-99 New Orleans, LA $206.56 Locality 07202-01 Buffalo, NY $206.45 Locality 13282-99 Milwaukee, WI $205.57 Locality 06302-00 Salt Lake City, UT $205.10 Locality 03502-09 Pittsburgh, PA $204.18 Locality 12502-99 Charlotte, NC $202.68 Locality 11502-00 Albuquerque, NM $202.63 Locality 04212-05 Columbus, OH $202.36 Locality 15202-00 Charleston, SC $201.54 Locality 11202-01 Indianapolis, IN $201.16 Locality 08102-00 Des Moines, IA $199.67 Locality 05102-00 Omaha, NE $199.48 Locality 05402-00 Wichita, KS $199.06 Locality 05202-00 Boise, ID $198.95 Locality 02202-00 Oklahoma City, OK $198.24 Locality 04312-00 Nashville, TN $197.59 Locality 10312-35 Louisville, KY $196.68 Locality 15102-00 Birmingham, AL $193.74 Locality 10112-00
Maine: $75.45–$76.64 across 2 localities ME Wisconsin: $74.32 WI Vermont: $75.70 VT New Hampshire: $78.15 NH Montana: $78.16 MT North Dakota: $75.78 ND Minnesota: $74.95 MN Michigan: $78.14–$82.02 across 2 localities MI New York: $76.30–$89.32 across 5 localities NY Massachusetts: $78.98–$82.61 across 2 localities MA Rhode Island: $79.49 RI Washington: $78.15–$82.72 across 2 localities WA Idaho: $74.42 ID Wyoming: $76.93 WY South Dakota: $75.08 SD Iowa: $74.46 IA Illinois: $79.23–$84.25 across 4 localities IL Indiana: $74.70 IN Ohio: $77.41 OH Pennsylvania: $77.04–$81.29 across 2 localities PA New Jersey: $82.45–$84.38 across 2 localities NJ Connecticut: $81.76 CT Oregon: $76.27–$78.66 across 2 localities OR Nevada: $77.47 NV Utah: $77.14 UT Colorado: $78.49 CO Nebraska: $73.71 NE Missouri: $76.50–$77.69 across 3 localities MO Kentucky: $76.40 KY West Virginia: $78.39 WV Virginia: $76.95 VA Maryland: $79.06–$82.02 across 2 localities MD Delaware: $78.47 DE California: $77.94–$87.21 across 29 localities CA Arizona: $77.23 AZ New Mexico: $78.10 NM Kansas: $74.80 KS Oklahoma: $76.04 OK Arkansas: $74.15 AR Tennessee: $74.71 TN North Carolina: $75.68 NC South Carolina: $76.32 SC District of Columbia: $84.89 DC Texas: $76.87–$81.29 across 8 localities TX Louisiana: $76.80–$78.33 across 2 localities LA Mississippi: $75.35 MS Alabama: $74.55 AL Georgia: $77.56–$78.91 across 2 localities GA Florida: $80.00–$86.36 across 3 localities FL Alaska: $107.84 AK Hawaii: $77.74 HI
$74–$79 $79–$85 $85–$91 $91–$96 $96–$102 $102–$108

64463 Facility by metro, highest first

Anchorage, AK $107.84 Locality 02102-01 Long Island, NY $89.32 Locality 13202-02 New York City, NY $87.60 Locality 13202-01 Queens, NY $86.94 Locality 13292-04 San Jose, CA $86.49 Locality 01112-09 Miami, FL $86.36 Locality 09102-04
Show 56 more metros
San Francisco, CA $85.69 Locality 01112-05 Washington, DC $84.89 Locality 12202-01 Northern New Jersey, NJ $84.38 Locality 12402-01 Chicago, IL $84.25 Locality 06102-16 Seattle, WA $82.72 Locality 02402-02 Boston, MA $82.61 Locality 14212-01 Fort Lauderdale, FL $82.24 Locality 09102-03 Suburban Chicago, IL $82.15 Locality 06102-15 Baltimore, MD $82.02 Locality 12302-01 Detroit, MI $82.02 Locality 08202-01 Hartford, CT $81.76 Locality 13102-00 Los Angeles, CA $81.51 Locality 01182-18 Metro East, IL $81.38 Locality 06102-12 Philadelphia, PA $81.29 Locality 12502-01 Houston, TX $81.29 Locality 04412-18 Ventura County, CA $80.20 Locality 01182-17 San Diego, CA $80.01 Locality 01182-72 Tampa, FL $80.00 Locality 09102-99 Sacramento, CA $79.91 Locality 01112-63 Riverside, CA $79.66 Locality 01112-62 Providence, RI $79.49 Locality 14412-01 Atlanta, GA $78.91 Locality 10212-01 Bakersfield, CA $78.66 Locality 01112-54 Portland, OR $78.66 Locality 02302-01 Denver, CO $78.49 Locality 04112-01 Fort Worth, TX $78.42 Locality 04412-28 Dallas, TX $78.40 Locality 04412-11 Austin, TX $78.37 Locality 04412-31 New Orleans, LA $78.33 Locality 07202-01 Albuquerque, NM $78.10 Locality 04212-05 Fresno, CA $77.94 Locality 01112-56 Honolulu, HI $77.74 Locality 01212-01 St. Louis, MO $77.69 Locality 05302-01 Kansas City, MO $77.63 Locality 05302-02 Las Vegas, NV $77.47 Locality 01312-00 Columbus, OH $77.41 Locality 15202-00 San Antonio, TX $77.30 Locality 04412-99 Phoenix, AZ $77.23 Locality 03102-00 Salt Lake City, UT $77.14 Locality 03502-09 Pittsburgh, PA $77.04 Locality 12502-99 Richmond, VA $76.95 Locality 11302-00 Portland, ME $76.64 Locality 14112-03 Louisville, KY $76.40 Locality 15102-00 Charleston, SC $76.32 Locality 11202-01 Buffalo, NY $76.30 Locality 13282-99 Oklahoma City, OK $76.04 Locality 04312-00 Charlotte, NC $75.68 Locality 11502-00 Minneapolis, MN $74.95 Locality 06202-00 Wichita, KS $74.80 Locality 05202-00 Nashville, TN $74.71 Locality 10312-35 Indianapolis, IN $74.70 Locality 08102-00 Birmingham, AL $74.55 Locality 10112-00 Des Moines, IA $74.46 Locality 05102-00 Boise, ID $74.42 Locality 02202-00 Milwaukee, WI $74.32 Locality 06302-00 Omaha, NE $73.71 Locality 05402-00

Q3 2025, each locality's GPCIs, before sequestration. Multi-locality states are shaded by their mean. Look up your exact locality →

CMS RVU25CJuly 1 – September 30, 2025 See file rows

Source & method Copy link

  1. 01 PPRRVU2025_Jul.csv · Q3 2025 (RVU25C) · row 6,947—status A, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q3 2025 release
    Effective
    July 1 – September 30, 2025
    Locator
    PPRRVU2025_Jul.csv in rvu25c-updated-06-05-2025.zip · row 6,947 of 19,029 · via CMS
    Fields read
    Status A (col 4) Work RVU 1.9 (col 6) Office (non-facility) PE RVU 4.6 (col 7) Facility PE RVU 0.36 (col 9) Malpractice RVU 0.16 (col 11)
    SHA-256 b7937472967288d5…
    Doesn’t establish
    A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
    Note
    Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
  2. 02 Conversion factor · same file · row 6,947 · column 25—$32.3465
    Source
    Conversion factor, read from the same file as the RVUs
  3. 03 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 2025 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.
  4. 04 Derived Modifier amounts—calculated by Localis from standard MPFS percentages limits
    Source
    Modifier amounts apply standard MPFS percentages to this code’s billing indicators.
    Doesn’t establish
    A CMS-published amount: we derive these rather than read them from CMS. Confirm them against the current Claims Processing Manual before relying on them for payment.

Cite this rate

CPT 64463 National PFS baseline: Office (non-facility) $215.43; Facility $78.28 (Q3 2025; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU25C, PPRRVU2025_Jul.csv row 6,947. Localis. https://localishealth.com/cpt/64463/2025/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

$264.20 Office (non-facility) and $76.49 Facility since Jan 1, 2026, after a +22.6% increase in the Office (non-facility) amount. +60.8% increase since Q1 2016; peak $264.20 in Q1 2026.

  1. Jan 1, 2026 – present

    Q1 2026

    Still in effect · 4 releases at this rate
    Office
    $264.20 (+$48.77, +22.6% increase)
    Facility
    $76.49 (−$1.79, -2.3% decrease)

    Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present

  2. Jan 1, 2025 – Dec 31, 2025

    Q1 2025

    4 releases at this rate
    Office
    $215.43 (−$11.92, -5.2% decrease)
    Facility
    $78.28 (−$1.94, -2.4% decrease)

    Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025

    • −$6.42 the conversion factor
    • −$5.50 practice-expense RVUs

  3. Mar 9, 2024 – Dec 31, 2024

    Q1 2024

    4 releases at this rate
    Office
    $227.35 (+$3.71, +1.7% increase)
    Facility
    $80.22 (+$1.31, +1.7% increase)

    Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024

    • +$3.71 the conversion factor

  4. Jan 1, 2024 – Mar 8, 2024 · Superseded revision

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    $223.64
    Facility
    $78.91

  5. Jan 1, 2023 – Dec 31, 2023

    Q1 2023

    4 releases at this rate
    Office
    $236.19 (−$9.17, -3.7% decrease)
    Facility
    $82.01 (−$1.74, -2.1% decrease)

    Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023

    • −$5.10 the conversion factor
    • −$4.07 practice-expense RVUs

  6. Jan 1, 2022 – Dec 31, 2022

    Q1 2022

    4 releases at this rate
    Office
    $245.36 (+$13.67, +5.9% increase)
    Facility
    $83.75 (+$0.01, 0.0% no change)

    Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022

    • +$14.89 practice-expense RVUs
    • −$1.91 the conversion factor
    • +$0.69 malpractice RVUs

National baseline (GPCI 1.000), before sequestration.

How each change is split
The chips under each change split the Office (non-facility) move into the conversion factor's share, which CMS sets for every code, and 64463's own work, practice-expense and malpractice RVUs. CMS doesn't publish this split; we derive it from each release's RVUs and conversion factor. We apply the new conversion factor to the earlier RVUs first, then price each RVU change at the new conversion factor. Another order would move a few cents between columns, but every total stays the same.
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.

The 64463 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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Usage and related codes Copy link

In CY2024, 64463 ranked #4,589 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
815
Allowed
$68,116
Beneficiaries
787

CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits). Localis groups related codes for payment research; the grouping isn't the AMA's code families.