Contractor-priced
77423 · PFS Q4 2021 · Historical
No national PFS rate in Q4 2021
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
PFS status evidence
Inspect PFS status evidence
- Code
- 77423
- Release
- Q4 2021, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU21DOctober 1 – December 31, 2021
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU21_OCT.csv row 13,513 in rvu21d.zip
In the CMS file
Loading rows 13,511–13,515 of PPRRVU21_OCT.csv…
Download rvu21d.zip from CMS File fingerprint
f1972bd23bdc51795ceba7d536bb413a0ba0b47fad8c2ed594e7ee7799877297
CPT 77423 has no published national rate. It carries status C (carrier-priced) in the Q4 2021 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 77423?
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 77423 are coming Join the waitlist →
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 77423: PCTC 3 (technical component only).
Technical component only
PCTC
3
Only a technical component exists for this code—there is no corresponding professional-component amount to bill.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 77423 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
- Only a technical component exists for 77423—there is no professional-component amount to bill. 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 RVU21DOctober 1 – December 31, 2021
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 77423 Copy link
What to check (4)
There is no national allowed amount for 77423, 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.
- Only a technical-component amount is published for this code, so a professional charge billed on it has no fee-schedule amount behind it.
- 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 PPRRVU21_OCT.csv · Q4 2021 (RVU21D) · row 13,513—priced by the contractor
- Effective
- October 1 – December 31, 2021
- Locator
- PPRRVU21_OCT.csv in rvu21d.zip · row 13,513 of 17,432 · via CMS
- Fields read
-
Status C (col 4)SHA-256 f1972bd23bdc5179…
Cite this rate
CPT 77423 National PFS baseline: No national PFS rate (Q4 2021; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU21D, PPRRVU21_OCT.csv row 13,513. Localis. https://localishealth.com/cpt/77423/2021/D
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.
The 77423 rate last moved in Q4 2015. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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