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Effective Jan 1, 2024 through Mar 8, 2024. This is revision 1—CMS published revision 2 with rates effective Mar 9, 2024 (posted Apr 1, 2024).

CPT 81560 Medicare payment status

Priced under CLFS

81560 · PFS Q1 2024 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU24AJanuary 1 – March 8, 2024

PFS status evidence

Physician relative value file (Q1 2024) · rvu24a-updated-04-01-2024.zip (PPRRVU24_JAN.csv row 15,443)
Inspect PFS status evidence
Code
81560
Release
Q1 2024, revision 1
Result
Priced under CLFS

Citations

  • Shows this code’s PFS status (X). Result: Priced under CLFS.

    Physician relative value file (PPRRVU)CMS RVU24AJanuary 1 – March 8, 2024revision 1, since superseded

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    PPRRVU24_JAN.csv row 15,443 in rvu24a-updated-04-01-2024.zip

    In the CMS file

    Loading rows 15,441–15,445 of PPRRVU24_JAN.csv…

    Download rvu24a-updated-04-01-2024.zip from CMS File fingerprint 034f3aa88a63e6f7ca3859c09b3945dce139171a6fc5a710300fc7b815e9b65b

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CPT 81560 has no published national rate. It carries status X (statutory exclusion) in the Q1 2024 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

Why is there no national PFS amount for 81560?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. Status X is not separately payable under the PFS.

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust 81560's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 81560 be denied or paid less?

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

  • Its status indicator is X (statutory exclusion)—The statutory definition of physician services does not include this item. See status indicators

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 RVU24AJanuary 1 – March 8, 2024

Can you bill it with another code? Copy link

This code

81560

See every current NCCI pair for 81560 →

Source & method Copy link

  1. 01 PPRRVU24_JAN.csv · Q1 2024 (RVU24A) · row 15,443—status X, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q1 2024 release
    Effective
    January 1 – March 8, 2024
    Locator
    PPRRVU24_JAN.csv in rvu24a-updated-04-01-2024.zip · row 15,443 of 18,499 · via CMS
    Fields read
    Status X (col 4)
    SHA-256 034f3aa88a63e6f7…
    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.

Cite this rate

CPT 81560 National PFS baseline: No national PFS rate (Q1 2024; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU24A, PPRRVU24_JAN.csv row 15,443. Localis. https://localishealth.com/cpt/81560/2024/A/1

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

— Office (non-facility) and — Facility since Jan 1, 2022.

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

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    —
    Facility
    —

  2. Jan 1, 2022 – present

    Q1 2022

    Still in effect · 20 releases at this rate
    Office
    —
    Facility
    —

    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 · 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 · 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 · 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 · 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

    Earliest release in this history.

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.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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