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CPT 74263 Medicare payment status

Excluded from PFS

74263 · PFS Q4 2014 · Historical

No national PFS rate in Q4 2014

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

CMS RVU14DOctober 1 – December 31, 2014

PFS status evidence

Physician relative value file (Q4 2014) · rvu14d.zip (PPRRVU14_V0815_v5.csv row 11,559)
Inspect PFS status evidence
Code
74263
Release
Q4 2014, revision 1
Result
Excluded from PFS

Citations

  • Shows this code’s PFS status (N). Result: Excluded from PFS.

    Physician relative value file (PPRRVU)CMS RVU14DOctober 1 – December 31, 2014

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

    PPRRVU14_V0815_v5.csv row 11,559 in rvu14d.zip

    In the CMS file

    Loading rows 11,557–11,561 of PPRRVU14_V0815_v5.csv…

    Download rvu14d.zip from CMS File fingerprint 9ff6da39ad421c38c816089ae3bed4bd754a642336efa8e8901e9cc38cca8705

Plain-text summaryReport a problem

CPT 74263 has no published national rate. It carries status N (non-covered) in the Q4 2014 release. Medicare covers no part of this service. The blank amount means unpriced, not $0.

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

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

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 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.

Which billing rules and modifiers apply? Copy link

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

These billing-policy indicators explain how 74263 is treated. They apply whether the code is nationally priced or carrier-priced: 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

Check a pair of codes 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 for the pair.

See every current NCCI pair for 74263 →

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 check

  • 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.

Compare against 74262, 74270 and 74261: their amounts are in Related codes.

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).

How has it changed? Copy link

Rate history by release Copy link

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

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present 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.

What it means outside Medicare Copy link

Usage and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2014 release (effective October 2014). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q4 2014) · rvu14d.zip (PPRRVU14_V0815_v5.csv row 11,559)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

CPT 74263 National PFS baseline: No national PFS rate (Q4 2014; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU14D, PPRRVU14_V0815_v5.csv row 11,559. Localis. https://localishealth.com/cpt/74263/2014/D