Contractor-priced
74355 · PFS Q2 2014 · Historical
No national PFS rate in Q2 2014
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 74355
- Release
- Q2 2014, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU14BApril 1 – June 30, 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_V0324.csv row 11,564 in rvu14b.zip
In the CMS file
Loading rows 11,562–11,566 of PPRRVU14_V0324.csv…
Download rvu14b.zip from CMS File fingerprint
7b855eaa1a9d047a0da04d561d43f7b3aad95b73f58b1e5c04e67df267722a0f
CPT 74355 has no published national rate. It carries status C (carrier-priced) in the Q2 2014 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 74355?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Contract rate as % of Medicare Copy link
Arbitration outcomes for 74355 are coming Join the waitlist →
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 74355: PCTC 1 (splits into professional and technical).
Splits into professional and technical
PCTC
1
This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 74355 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is C (carrier-priced)—Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
- 74355 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
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. 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.
CMS RVU14BApril 1 – June 30, 2014
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 74355 Copy link
What to check (4)
There is no national allowed amount for 74355, 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.
- 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.
- Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
- 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.
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01 PPRRVU14_V0324.csv · Q2 2014 (RVU14B) · row 11,564—priced by the contractor
- Effective
- April 1 – June 30, 2014
- Locator
- PPRRVU14_V0324.csv in rvu14b.zip · row 11,564 of 15,867 · via CMS
- Fields read
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Status C (col 4)SHA-256 7b855eaa1a9d047a…
Cite this rate
CPT 74355 National PFS baseline: No national PFS rate (Q2 2014; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU14B, PPRRVU14_V0324.csv row 11,564. Localis. https://localishealth.com/cpt/74355/2014/B
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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