Contractor-priced
78816 · PFS Q3 2014 · Historical
No national PFS rate in Q3 2014
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 78816
- Release
- Q3 2014, revision 1
- Result
- Contractor-priced
Citations
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Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU14CJuly 1 – September 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_V0515.csv row 12,768 in rvu14c.zip
In the CMS file
Loading rows 12,766–12,770 of PPRRVU14_V0515.csv…
Download rvu14c.zip from CMS File fingerprint
c77da0d012ff73dec8680d5f6f50582fc7e72005bc55edb2f131a02f0b1c293c
CPT 78816 has no published national rate. It carries status C (carrier-priced) in the Q3 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 78816?
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 78816 are coming Join the waitlist →
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 78816: 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 78816 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
- 78816 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 RVU14CJuly 1 – September 30, 2014
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 78816 Copy link
What to check (4)
There is no national allowed amount for 78816, 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_V0515.csv · Q3 2014 (RVU14C) · row 12,768—priced by the contractor
- Effective
- July 1 – September 30, 2014
- Locator
- PPRRVU14_V0515.csv in rvu14c.zip · row 12,768 of 15,901 · via CMS
- Fields read
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Status C (col 4)SHA-256 c77da0d012ff73de…
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02 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q3 2014 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 78816 National PFS baseline: No national PFS rate (Q3 2014; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU14C, PPRRVU14_V0515.csv row 12,768. Localis. https://localishealth.com/cpt/78816/2014/C
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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Usage and related codes Copy link
In CY2024, 78816 ranked #296 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 118,607
- Allowed
- $67.6M
- Beneficiaries
- 85,694
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits). Localis groups related codes for payment research; the grouping isn't the AMA's code families.