localis

Describe a service in plain words, or type a CPT/HCPCS code.

Calculator

CPT 74263

Excluded from PFS

74263 · PFS Q1 2013 · Historical

No national PFS rate in Q1 2013

Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

View applicable payment rules
View CMS source and method

Not at a published national rate. CPT 74263 carries status N (non-covered) in the Q1 2013 release. Medicare covers no part of this service. Treat the blank amount as unpriced, not as $0.

PFS status evidence

Physician relative value file (Q1 2013) · rvu13a.zip (PPRRVU13.csv row 11,304)
Inspect PFS status evidence
Code
74263
Release
Q1 2013, revision 1
Result
Excluded from PFS

Citations

  • Establishes the PFS status (N) and the resulting pathway for this code: excluded from pfs.

    Physician relative value file (PPRRVU)

    Q1 2013 · revision 1

    Latest revision of this release

    Release period: January 1 – March 31, 2013

    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 PPRRVU13.csv in rvu13a.zip (row 11,304)
    hcpcs (col 1)
    74263
    modifier (col 2)
    blank
    status_code (col 4)
    N

    SHA-256: a84cdae37ebaadbaf680d8ea6051f442d6e61fb44436ca61dc94a43051d877e8

    Original source file

Compact facts

Why is there no national PFS amount for 74263?

Its status indicator is N (non-covered). Medicare covers no part of this service. Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

Payment considerations Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Professional/technical component Applies
Other payment indicators (9)

Facility/non-facility: Not determined, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Why a 74263 line may not pay separately Copy link

CMS publishes no separately payable amount for 74263 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.

What to reconcile

  • Confirm the status that governed the date of service before working this line as a short payment—CMS publishes no separately payable fee-schedule amount for it in this release.
  • Confirm which component the line carried before comparing anything: the same code prices three ways—globally, as a professional component with modifier 26, and as a technical component with modifier TC.
  • 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.

Nearby payment lines

National Q1 2013 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Why compare Office Facility
74262 Priced as active rather than non-covered $443.01 $443.01
74270 Priced as active rather than non-covered $119.75 $119.75
74261 Priced as active rather than non-covered $401.26 $401.26
Check an actual payment Model this code in a contract

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).

Payment rules

Global period: what 74263's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Billing policy Copy link

What 74263's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.

Policy Value What it means
Professional/technical split 1 Splits into professional and technical. This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable.

Can you bill it with another code? 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 between it and 74263.

See every current NCCI pair for 74263 →

Common payment questions Copy link

Why would a Medicare claim for 74263 be denied or paid less?

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

  • Its status indicator is N (non-covered)—Medicare covers no part of this service. See status indicators
  • 74263 splits into a professional component (modifier 26) and a technical component (modifier TC)—a claim for only one part needs that modifier to price correctly. 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.

History

Rate history by release Copy link

National non-facility amount for 74263 across quarterly releases. +19.3% increase since Q1 2025 · high $835.02 in Q1 2026

$835 $801 $768 $734 $700 Q1 2025 · $699.98 Q2 2025 · $699.98 (0.0%) Q3 2025 · $699.98 (0.0%) Q4 2025 · $699.98 (0.0%) Q1 2026 · $835.02 (+19.3%) Q2 2026 · $835.02 (0.0%) Q3 2026 · $835.02 (0.0%) Q4 2026 · $835.02 (0.0%) Q1 2013 Q3 2016 Q2 2019 Q4 2021 Q2 2024 Q4 2026
Non-facility Facility
Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 A $835.02 (0.0% no change ) $835.02 (0.0% no change )
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 74263 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Usage & related

Did this answer your question about CPT 74263?

We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.

Did this page answer your question?

Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q1 2013 release (effective January 2013). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q1 2013) · rvu13a.zip (PPRRVU13.csv row 11,304)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 74263 National PFS baseline: No national PFS rate (Q1 2013; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/74263/2013/A