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Medicare Physician Fee Schedule Effective CMS RVU16C Updated

CPT 74263 Medicare payment status

CPT 74263 has no published national rate. It carries status N (non-covered) in the Q3 2016 release. Medicare covers no part of this service. The blank amount means unpriced, not $0.

Excluded from PFS

74263 · PFS Q3 2016 · Historical

No national PFS rate in Q3 2016

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 RVU16CJuly 1 – September 30, 2016

CPT 74263 has no published national rate. It carries status N (non-covered) in the Q3 2016 release. Medicare covers no part of this service. The blank amount means unpriced, not $0.

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PFS status evidence

Physician relative value file (Q3 2016) · rvu16c.zip (PPRRVU16_V0517.csv row 11,874)
Inspect PFS status evidence
Code
74263
Release
Q3 2016, revision 1
Result
Excluded from PFS

Citations

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

    Physician relative value file (PPRRVU)CMS RVU16CJuly 1 – September 30, 2016

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

    PPRRVU16_V0517.csv row 11,874 in rvu16c.zip

    In the CMS file

    Loading rows 11,872–11,876 of PPRRVU16_V0517.csv…

    Download rvu16c.zip from CMS File fingerprint 81464316ee60bdd4aa33b47a636b521a77a73481c795300cbab67f48dbe432d9

Plain-text summary

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.

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.

Codes to compare

National Q3 2016 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Office Facility
74262 Priced as active rather than non-covered $543.87 $543.87
74270 Priced as active rather than non-covered $151.45 $151.45
74261 Priced as active rather than non-covered $489.09 $489.09
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).

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 →

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

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%)
Office (non-facility) Facility
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.

Usage and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q3 2016 release (effective July 2016). 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 (Q3 2016) · rvu16c.zip (PPRRVU16_V0517.csv row 11,874)

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 (Q3 2016; participating; whole service; GPCI 1.000; sequestration excluded). CMS RVU16C, PPRRVU16_V0517.csv row 11,874. Localis. https://localishealth.com/cpt/74263/2016/C