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CPT 64597 Medicare carrier-priced amounts

Contractor-priced

64597 · PFS Q4 2025 · Historical

Contractor-published range

$516.09–$624.31

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 18 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q4 2025

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
64597
Release
Q4 2025, revision 1
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU25DOctober 1 – December 31, 2025

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

    PPRRVU2025_Oct.csv row 6,990 in rvu25d-updated-09-11-2025.zip

    In the CMS file

    Loading rows 6,988–6,992 of PPRRVU2025_Oct.csv…

    Download rvu25d-updated-09-11-2025.zip from CMS File fingerprint 8af460f38bf982b79b07269fbc8b7256a8ef3bd3aa025a9c5cb71c1e52523c56

Report a problem

CPT 64597 carries status C (carrier-priced) in the Q4 2025 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 $516.09–$624.31 across 18 localities; enter a ZIP for the exact local amount.

Why is there no national PFS amount for 64597?

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 64597 Copy link

Medicare sets this price locally

64597 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 and Novitas across JH and JN, most recently effective Jan 1, 2025. 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 36 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JH · Arkansas, Area 13 CMS 07102-13 — — $518.84 $492.90 $566.84 Jan 1, 2025 Contractor file
JH · Arkansas, Area 13 CMS 07102-13 — # $87.80 $83.41 $95.92 Jan 1, 2025 Contractor file
JH · Colorado, Area 01 CMS 04112-01 — — $624.31 $593.09 $682.05 Jan 1, 2025 Contractor file
JH · Colorado, Area 01 CMS 04112-01 — # $96.54 $91.71 $105.47 Jan 1, 2025 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 — — $562.82 $534.68 $614.88 Jan 1, 2025 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 — # $94.19 $89.48 $102.90 Jan 1, 2025 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 — — $532.90 $506.26 $582.20 Jan 1, 2025 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 — # $91.33 $86.76 $99.77 Jan 1, 2025 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 — — $516.09 $490.29 $563.83 Jan 1, 2025 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 — # $89.06 $84.61 $97.30 Jan 1, 2025 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 — — $584.16 $554.95 $638.19 Mar 1, 2024 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 — # $94.70 $89.97 $103.47 Mar 1, 2024 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 — — $537.21 $510.35 $586.90 Jan 1, 2025 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 — # $90.63 $86.10 $99.02 Jan 1, 2025 Contractor file
JH · Texas, Area 09 CMS 04412-09 — — $599.34 $569.37 $654.78 Jan 1, 2025 Contractor file
JH · Texas, Area 09 CMS 04412-09 — # $95.12 $90.36 $103.91 Jan 1, 2025 Contractor file
JH · Texas, Area 11 CMS 04412-11 — — $600.20 $570.19 $655.72 Jan 1, 2025 Contractor file
JH · Texas, Area 11 CMS 04412-11 — # $95.49 $90.72 $104.33 Jan 1, 2025 Contractor file
JH · Texas, Area 15 CMS 04412-15 — — $596.50 $566.68 $651.68 Jan 1, 2025 Contractor file
JH · Texas, Area 15 CMS 04412-15 — # $95.29 $90.53 $104.11 Jan 1, 2025 Contractor file
JH · Texas, Area 18 CMS 04412-18 — — $601.49 $571.42 $657.13 Jan 1, 2025 Contractor file
JH · Texas, Area 18 CMS 04412-18 — # $98.78 $93.84 $107.92 Jan 1, 2025 Contractor file
JH · Texas, Area 20 CMS 04412-20 — — $544.44 $517.22 $594.80 Jan 1, 2025 Contractor file
JH · Texas, Area 20 CMS 04412-20 — # $91.85 $87.26 $100.35 Jan 1, 2025 Contractor file
JH · Texas, Area 28 CMS 04412-28 — — $595.55 $565.77 $650.64 Jan 1, 2025 Contractor file
JH · Texas, Area 28 CMS 04412-28 — # $95.34 $90.57 $104.16 Jan 1, 2025 Contractor file
JH · Texas, Area 31 CMS 04412-31 — — $620.66 $589.63 $678.07 Jan 1, 2025 Contractor file
JH · Texas, Area 31 CMS 04412-31 — # $96.39 $91.57 $105.31 Jan 1, 2025 Contractor file
JH · Texas, Area 99 CMS 04412-99 — — $566.80 $538.46 $619.23 Jan 1, 2025 Contractor file
JH · Texas, Area 99 CMS 04412-99 — # $93.16 $88.50 $101.78 Jan 1, 2025 Contractor file
JN · Florida, Area 03 CMS 09102-03 — — $600.24 $570.23 $655.76 Jan 1, 2025 Contractor file
JN · Florida, Area 03 CMS 09102-03 — # $100.03 $95.03 $109.28 Jan 1, 2025 Contractor file
JN · Florida, Area 04 CMS 09102-04 — — $620.20 $589.19 $677.57 Jan 1, 2025 Contractor file
JN · Florida, Area 04 CMS 09102-04 — # $105.46 $100.19 $115.22 Jan 1, 2025 Contractor file
JN · Florida, Area 99 CMS 09102-99 — — $567.39 $539.02 $619.87 Jan 1, 2025 Contractor file
JN · Florida, Area 99 CMS 09102-99 — # $96.25 $91.44 $105.16 Jan 1, 2025 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 64597: GLOB DAYS ZZZ (add-on code).

Global surgery period

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.

Why would a Medicare claim for 64597 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 RVU25DOctober 1 – December 31, 2025

Can you bill it with another code? Copy link

This code

64597

See every current NCCI pair for 64597 →

Reconciling a contractor-priced payment for 64597 Copy link

Checking a paid 64597 line?

Check an actual payment Model this code in a contract
What to check (4)

There is no national allowed amount for 64597, 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.
  • Expect an assistant-at-surgery denial here rather than appealing it—a -80 or -AS line on this procedure is never separately payable.
  • 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.

  1. 01 PPRRVU2025_Oct.csv · Q4 2025 (RVU25D) · row 6,990—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q4 2025 release
    Effective
    October 1 – December 31, 2025
    Locator
    PPRRVU2025_Oct.csv in rvu25d-updated-09-11-2025.zip · row 6,990 of 19,090 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 8af460f38bf982b7…
  2. 02 MAC-published fee schedules · 18 on file—the contractor amounts
    Source
    MAC-published fee schedules
    Effective
    Effective dates shown above

Cite this rate

CPT 64597 National PFS baseline: No national PFS rate (Q4 2025; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU25D, PPRRVU2025_Oct.csv row 6,990. Localis. https://localishealth.com/cpt/64597/2025/D

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

Localis groups related codes for payment research; the grouping isn't the AMA's code families.