Contractor-priced
74355 · PFS Q1 2017 · Historical
No national PFS rate in Q1 2017
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 74355
- Release
- Q1 2017, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU17AJanuary 1 – March 31, 2017
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU17_V1219.csv row 12,077 in rvu17a.zip
In the CMS file
Loading rows 12,075–12,079 of PPRRVU17_V1219.csv…
Download rvu17a.zip from CMS File fingerprint
fda64dc114c31e9002889c5847fcdcdc1c1ee8a1d8b26765b55e1f5da6e61bab
CPT 74355 has no published national rate. It carries status C (carrier-priced) in the Q1 2017 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 RVU17AJanuary 1 – March 31, 2017
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.
-
01 PPRRVU17_V1219.csv · Q1 2017 (RVU17A) · row 12,077—priced by the contractor
- Effective
- January 1 – March 31, 2017
- Locator
- PPRRVU17_V1219.csv in rvu17a.zip · row 12,077 of 16,478 · via CMS
- Fields read
-
Status C (col 4)SHA-256 fda64dc114c31e90…
Cite this rate
CPT 74355 National PFS baseline: No national PFS rate (Q1 2017; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU17A, PPRRVU17_V1219.csv row 12,077. Localis. https://localishealth.com/cpt/74355/2017/A
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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