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CPT 77610 Medicare rate in Q1 2013

Office (non-facility) & facility

Historical · Q1 2013
$1,094.52

National (GPCI 1.000)

Office-only: CMS developed no facility practice-expense RVUs for 77610 (NA indicator), so the file’s facility amount repeats the Office (non-facility) one.

$757.72–$1,318.69 across payment localities · Office (non-facility)

Participating physician · Before sequestration

Special payment instructions: Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. Review applicable payment rules.

CMS evidence · Q1 2013 release

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The national PFS baseline was $1,094.52 for CPT 77610 in the Office (non-facility) setting and $1,094.52 in a facility under the Q1 2013 Physician Fee Schedule, effective January 2013. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Contract rate as % of Medicare Copy link

Applies to your locality's allowed amount, not the $1,094.52 national baseline. How to find your contract's percentage.

Need rates from another insurer? Join the waitlist →

Arbitration outcomes for 77610 are coming Join the waitlist →

Allowed amount, Medicare's share, and patient share Copy link

A physician's $1,094.52 Office (non-facility) allowed amount: Medicare pays $858.11 after sequestration and the patient owes $218.90, once the Part B deductible is met.

Adjust for your locality →
77610: allowed amount and each party's share by who bills it, Office (non-facility), national baseline
Billed by Allowed amount Participating claim If not participating
What Medicare pays Patient coinsurance Non-participating amount Limiting charge
Physician (MD/DO) 100% Calculator $1,094.52 $858.11 $875.62 − $17.51 $218.90 $1,039.79 $1,195.76

National Q1 2013, GPCI 1.000. Each % applies before the 80/20 split and sequestration.

Is $1,094.52 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($875.62) and the patient owes 20% coinsurance ($218.90). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 77610?

$1,039.79 in the Office (non-facility) setting—95% of the $1,094.52 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 77610?

$1,195.76 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $1,094.52 amount above. The non-participating amount is 95% of the fee schedule rate ($1,039.79), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

CMS RVU13AJanuary 1 – March 31, 2013revision 2 See file rows

Which billing rules and modifiers apply? Copy link

CMS indicators that apply to 77610: PCTC 1 (splits into professional and technical).

Professional/technical split

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.

77610 billed whole or split (-26 and -TC), national amounts by setting
Billed as Office (non-facility) Facility
77610 $1,094.52 $1,094.52
77610-26 $76.55 $76.55
77610-TC $1,017.97 $1,017.97

Global surgery period XXX (does not apply). Assistant at surgery, only if documented: -80/81/82 $175.12 · -AS $148.85. Not payable with 77610: -50 · -62 · -66.

Modifier amounts are derived, not a CMS column: Localis applies the standard MPFS percentage to the national Office (non-facility) amount. Check them against the Claims Processing Manual. If documented means paid only when documentation of medical necessity is submitted. Locality-adjusted amounts.

Why would a Medicare claim for 77610 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is R (restricted)—Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. See status indicators
  • 77610 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 RVU13AJanuary 1 – March 31, 2013revision 2 See file rows

Can you bill it with another code? Copy link

This code

77610

See every current NCCI pair for 77610 →

Payment review for 77610 Copy link

Checking a paid 77610 line?

Check an actual payment Model this code in a contract
What to check (4)

Three published payment rules can change what 77610 allows on a claim: status R coverage instructions, the professional/technical split and documentation-restricted assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

  • Treat the published amount as conditional—status R carries special coverage instructions, so a payable fee-schedule amount does not by itself establish that this line should have paid.
  • 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.

How location and RVUs set the amount Copy link

Office (non-facility) and facility: 32.17 RVUs × $34.0230 = $1,094.52 national PFS baseline. Local GPCIs move it from $757.72 in Puerto Rico, PR to $1,318.69 in NYC Suburbs/Long Island, NY.

Office (non-facility) and facility

Office (non-facility) and facility: each RVU times its GPCI, summed, times the conversion factor
Component RVU × GPCI =
Work 1.56 1.000 1.56
Practice expense 30.51 1.000 30.51
Malpractice 0.10 1.000 0.10
Total RVUs 32.17
× Conversion factor $34.0230
= National PFS baseline $1,094.52

Rates by locality Copy link

Maine: no locality amount on file for this code ME Wisconsin: no locality amount on file for this code WI Vermont: no locality amount on file for this code VT New Hampshire: no locality amount on file for this code NH Montana: $1,094.87 MT North Dakota: $1,092.88 ND Minnesota: no locality amount on file for this code MN Michigan: $1,014.83–$1,122.33 across 2 localities MI New York: $1,029.71–$1,318.69 across 5 localities NY Massachusetts: no locality amount on file for this code MA Rhode Island: no locality amount on file for this code RI Washington: $1,106.50–$1,244.92 across 2 localities WA Idaho: $983.14 ID Wyoming: $1,095.31 WY South Dakota: $1,092.59 SD Iowa: $975.37 IA Illinois: no locality amount on file for this code IL Indiana: $1,013.27 IN Ohio: $1,019.56 OH Pennsylvania: $1,004.63–$1,158.63 across 2 localities PA New Jersey: $1,226.58–$1,290.08 across 2 localities NJ Connecticut: $1,210.78 CT Oregon: $1,053.80–$1,139.18 across 2 localities OR Nevada: no locality amount on file for this code NV Utah: $1,007.67 UT Colorado: $1,098.24 CO Nebraska: $992.56 NE Missouri: $939.93–$1,057.37 across 3 localities MO Kentucky: $959.77 KY West Virginia: $916.76 WV Virginia: $1,069.73 VA Maryland: $1,131.39–$1,197.34 across 2 localities MD Delaware: $1,139.71 DE California: no locality amount on file for this code CA Arizona: $1,071.73 AZ New Mexico: $1,007.31 NM Kansas: $984.34 KS Oklahoma: $944.14 OK Arkansas: $952.51 AR Tennessee: no locality amount on file for this code TN North Carolina: $1,017.71 NC South Carolina: $998.43 SC District of Columbia: $1,303.10 DC Texas: $986.30–$1,112.08 across 8 localities TX Louisiana: $965.97–$1,069.34 across 2 localities LA Mississippi: $954.61 MS Alabama: no locality amount on file for this code AL Georgia: no locality amount on file for this code GA Florida: $1,063.18–$1,156.75 across 3 localities FL Alaska: $1,189.45 AK Hawaii: no locality amount on file for this code HI
$758–$849 $849–$940 $940–$1,030 $1,030–$1,121 $1,121–$1,212 $1,212–$1,303 No amount on file

77610 Office (non-facility) by metro, highest first

Long Island, NY $1,318.69 Locality 13202-02 Washington, DC $1,303.10 Locality 12202-01 Queens, NY $1,301.90 Locality 13292-04 Northern New Jersey, NJ $1,290.08 Locality 12402-01 New York City, NY $1,266.90 Locality 13202-01 Seattle, WA $1,244.92 Locality 02402-02
Show 34 more metros
Hartford, CT $1,210.78 Locality 13102-00 Baltimore, MD $1,197.34 Locality 12302-01 Anchorage, AK $1,189.45 Locality 02102-01 Philadelphia, PA $1,158.63 Locality 12502-01 Miami, FL $1,156.75 Locality 09102-04 Fort Lauderdale, FL $1,150.80 Locality 09102-03 Portland, OR $1,139.18 Locality 02302-01 Detroit, MI $1,122.33 Locality 08202-01 Dallas, TX $1,112.08 Locality 04412-11 Austin, TX $1,103.02 Locality 04412-31 Denver, CO $1,098.24 Locality 04112-01 Houston, TX $1,096.81 Locality 04412-18 Fort Worth, TX $1,072.13 Locality 04412-28 Phoenix, AZ $1,071.73 Locality 03102-00 Richmond, VA $1,069.73 Locality 11302-00 New Orleans, LA $1,069.34 Locality 07202-01 Tampa, FL $1,063.18 Locality 09102-99 St. Louis, MO $1,057.37 Locality 05302-01 Kansas City, MO $1,046.52 Locality 05302-02 Buffalo, NY $1,029.71 Locality 13282-99 Columbus, OH $1,019.56 Locality 15202-00 Charlotte, NC $1,017.71 Locality 11502-00 Indianapolis, IN $1,013.27 Locality 08102-00 Salt Lake City, UT $1,007.67 Locality 03502-09 Albuquerque, NM $1,007.31 Locality 04212-05 Pittsburgh, PA $1,004.63 Locality 12502-99 San Antonio, TX $1,002.52 Locality 04412-99 Charleston, SC $998.43 Locality 11202-01 Omaha, NE $992.56 Locality 05402-00 Wichita, KS $984.34 Locality 05202-00 Boise, ID $983.14 Locality 02202-00 Des Moines, IA $975.37 Locality 05102-00 Louisville, KY $959.77 Locality 15102-00 Oklahoma City, OK $944.14 Locality 04312-00
Maine: no locality amount on file for this code ME Wisconsin: no locality amount on file for this code WI Vermont: no locality amount on file for this code VT New Hampshire: no locality amount on file for this code NH Montana: $1,094.87 MT North Dakota: $1,092.88 ND Minnesota: no locality amount on file for this code MN Michigan: $1,014.83–$1,122.33 across 2 localities MI New York: $1,029.71–$1,318.69 across 5 localities NY Massachusetts: no locality amount on file for this code MA Rhode Island: no locality amount on file for this code RI Washington: $1,106.50–$1,244.92 across 2 localities WA Idaho: $983.14 ID Wyoming: $1,095.31 WY South Dakota: $1,092.59 SD Iowa: $975.37 IA Illinois: no locality amount on file for this code IL Indiana: $1,013.27 IN Ohio: $1,019.56 OH Pennsylvania: $1,004.63–$1,158.63 across 2 localities PA New Jersey: $1,226.58–$1,290.08 across 2 localities NJ Connecticut: $1,210.78 CT Oregon: $1,053.80–$1,139.18 across 2 localities OR Nevada: no locality amount on file for this code NV Utah: $1,007.67 UT Colorado: $1,098.24 CO Nebraska: $992.56 NE Missouri: $939.93–$1,057.37 across 3 localities MO Kentucky: $959.77 KY West Virginia: $916.76 WV Virginia: $1,069.73 VA Maryland: $1,131.39–$1,197.34 across 2 localities MD Delaware: $1,139.71 DE California: no locality amount on file for this code CA Arizona: $1,071.73 AZ New Mexico: $1,007.31 NM Kansas: $984.34 KS Oklahoma: $944.14 OK Arkansas: $952.51 AR Tennessee: no locality amount on file for this code TN North Carolina: $1,017.71 NC South Carolina: $998.43 SC District of Columbia: $1,303.10 DC Texas: $986.30–$1,112.08 across 8 localities TX Louisiana: $965.97–$1,069.34 across 2 localities LA Mississippi: $954.61 MS Alabama: no locality amount on file for this code AL Georgia: no locality amount on file for this code GA Florida: $1,063.18–$1,156.75 across 3 localities FL Alaska: $1,189.45 AK Hawaii: no locality amount on file for this code HI
$758–$849 $849–$940 $940–$1,030 $1,030–$1,121 $1,121–$1,212 $1,212–$1,303 No amount on file

77610 Facility by metro, highest first

Long Island, NY $1,318.69 Locality 13202-02 Washington, DC $1,303.10 Locality 12202-01 Queens, NY $1,301.90 Locality 13292-04 Northern New Jersey, NJ $1,290.08 Locality 12402-01 New York City, NY $1,266.90 Locality 13202-01 Seattle, WA $1,244.92 Locality 02402-02
Show 34 more metros
Hartford, CT $1,210.78 Locality 13102-00 Baltimore, MD $1,197.34 Locality 12302-01 Anchorage, AK $1,189.45 Locality 02102-01 Philadelphia, PA $1,158.63 Locality 12502-01 Miami, FL $1,156.75 Locality 09102-04 Fort Lauderdale, FL $1,150.80 Locality 09102-03 Portland, OR $1,139.18 Locality 02302-01 Detroit, MI $1,122.33 Locality 08202-01 Dallas, TX $1,112.08 Locality 04412-11 Austin, TX $1,103.02 Locality 04412-31 Denver, CO $1,098.24 Locality 04112-01 Houston, TX $1,096.81 Locality 04412-18 Fort Worth, TX $1,072.13 Locality 04412-28 Phoenix, AZ $1,071.73 Locality 03102-00 Richmond, VA $1,069.73 Locality 11302-00 New Orleans, LA $1,069.34 Locality 07202-01 Tampa, FL $1,063.18 Locality 09102-99 St. Louis, MO $1,057.37 Locality 05302-01 Kansas City, MO $1,046.52 Locality 05302-02 Buffalo, NY $1,029.71 Locality 13282-99 Columbus, OH $1,019.56 Locality 15202-00 Charlotte, NC $1,017.71 Locality 11502-00 Indianapolis, IN $1,013.27 Locality 08102-00 Salt Lake City, UT $1,007.67 Locality 03502-09 Albuquerque, NM $1,007.31 Locality 04212-05 Pittsburgh, PA $1,004.63 Locality 12502-99 San Antonio, TX $1,002.52 Locality 04412-99 Charleston, SC $998.43 Locality 11202-01 Omaha, NE $992.56 Locality 05402-00 Wichita, KS $984.34 Locality 05202-00 Boise, ID $983.14 Locality 02202-00 Des Moines, IA $975.37 Locality 05102-00 Louisville, KY $959.77 Locality 15102-00 Oklahoma City, OK $944.14 Locality 04312-00

Q1 2013, each locality's GPCIs, before sequestration. Multi-locality states are shaded by their mean. Look up your exact locality →

CMS RVU13AJanuary 1 – March 31, 2013revision 2 See file rows

Source & method Copy link

  1. 01 PPRRVU13_V1226_UP0.csv · Q1 2013 (RVU13A) · row 12,095—status R, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q1 2013 release
    Effective
    January 1 – March 31, 2013
    Locator
    PPRRVU13_V1226_UP0.csv in rvu13ar.zip · row 12,095 of 15,619 · via CMS
    Fields read
    Status R (col 4) Work RVU 1.56 (col 6) Office (non-facility) PE RVU 30.51 (col 7) Facility PE RVU 30.51 (col 9) Malpractice RVU 0.1 (col 11)
    SHA-256 79b1988bb9cbab6a…
    Doesn’t establish
    A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
    Note
    Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
  2. 02 Conversion factor · same file · row 12,095 · column 25—$34.0230
    Source
    Conversion factor, read from the same file as the RVUs
  3. 03 Derived Modifier amounts—calculated by Localis from standard MPFS percentages limits
    Source
    Modifier amounts apply standard MPFS percentages to this code’s billing indicators.
    Doesn’t establish
    A CMS-published amount: we derive these rather than read them from CMS. Confirm them against the current Claims Processing Manual before relying on them for payment.

Cite this rate

CPT 77610 National PFS baseline: Office (non-facility) $1,094.52; Facility $1,094.52 (Q1 2013; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU13A, PPRRVU13_V1226_UP0.csv row 12,095. Localis. https://localishealth.com/cpt/77610/2013/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

$673.70 Office (non-facility) and $673.70 Facility since Jan 1, 2026, after a +3.1% increase in the Office (non-facility) amount. -38.4% decrease since Q1 2013; peak $1,094.52 in Q1 2013.

  1. Jan 1, 2026 – present

    Q1 2026

    Still in effect · 4 releases at this rate
    Office
    $673.70 (+$19.98, +3.1% increase)
    Facility
    $673.70 (+$19.98, +3.1% increase)

    Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present

  2. Jan 1, 2025 – Dec 31, 2025

    Q1 2025

    4 releases at this rate
    Office
    $653.72 (−$30.01, -4.4% decrease)
    Facility
    $653.72 (−$30.01, -4.4% decrease)

    Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025

  3. Mar 9, 2024 – Dec 31, 2024

    Q1 2024

    4 releases at this rate
    Office
    $683.73 (+$11.16, +1.7% increase)
    Facility
    $683.73 (+$11.16, +1.7% increase)

    Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024

  4. Jan 1, 2024 – Mar 8, 2024 · Superseded revision

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    $672.57
    Facility
    $672.57

  5. Jan 1, 2023 – Dec 31, 2023

    Q1 2023

    4 releases at this rate
    Office
    $700.11 (−$14.85, -2.1% decrease)
    Facility
    $700.11 (−$14.85, -2.1% decrease)

    Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023

  6. Jan 1, 2022 – Dec 31, 2022

    Q1 2022

    4 releases at this rate
    Office
    $714.96 (−$11.51, -1.6% decrease)
    Facility
    $714.96 (−$11.51, -1.6% decrease)

    Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022

National baseline (GPCI 1.000), before sequestration.

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 77610 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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