CPT 84238 Medicare payment status

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust 84238's amount.

CMS RVU19A · January 1 – March 31, 2019

Can you bill it with another code? Copy link

Source & method Copy link

1. 01 PPRRVU19_V1213.csv · Q1 2019 (RVU19A) · row 14,353—status X, RVUs limits

   Source

   Physician relative value file (PPRRVU), Q1 2019 release

   Effective

   January 1 – March 31, 2019

   Locator

   PPRRVU19_V1213.csv in rvu19a.zip · row 14,353 of 16,959 · via CMS

   Fields read

   Status X (col 4)

   SHA-256 027b1b615e25a1c6…

   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 Physician & Other Practitioners · CY2024—volume and who bills it limits

   Source

   CMS Physician & Other Practitioners dataset

   Effective

   Calendar-year snapshot, on a different cycle from the Q1 2019 fee schedule

   Doesn’t establish

   Medicare Advantage, Medicaid or commercial volume.

   Note

   The dataset suppresses rows under 11 beneficiaries.

How has it changed? Copy link

— Office (non-facility) and — Facility since Jan 1, 2013.

Usage and related codes Copy link

In CY2024, 84238 ranked #2,032 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

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.