Priced under CLFS
86408 · PFS Q4 2022 · Historical
Status X is not separately payable under the PFS.
CMS RVU22DOctober 1 – December 31, 2022
PFS status evidence
Inspect PFS status evidence
- Code
- 86408
- Release
- Q4 2022, revision 1
- Result
- Priced under CLFS
Citations
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Shows this code’s PFS status (X). Result: Priced under CLFS.
Physician relative value file (PPRRVU)CMS RVU22DOctober 1 – December 31, 2022
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU22_OCT.csv row 15,313 in rvu22d.zip
In the CMS file
Loading rows 15,311–15,315 of PPRRVU22_OCT.csv…
Download rvu22d.zip from CMS File fingerprint
f8774a019545e1fd71536837b20b74674c014b1acef3435d93456857885190ab
CPT 86408 has no published national rate. It carries status X (statutory exclusion) in the Q4 2022 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 86408?
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 86408's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 86408 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 RVU22DOctober 1 – December 31, 2022
Can you bill it with another code? Copy link
Source & method Copy link
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01 PPRRVU22_OCT.csv · Q4 2022 (RVU22D) · row 15,313—status X, RVUs limits
- Effective
- October 1 – December 31, 2022
- Locator
- PPRRVU22_OCT.csv in rvu22d.zip · row 15,313 of 17,726 · via CMS
- Fields read
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Status X (col 4)SHA-256 f8774a019545e1fd…
- 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 86408 National PFS baseline: No national PFS rate (Q4 2022; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU22D, PPRRVU22_OCT.csv row 15,313. Localis. https://localishealth.com/cpt/86408/2022/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
— Office (non-facility) and — Facility since Oct 1, 2020.
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Jan 1, 2024 – Mar 8, 2024 · Superseded revision
Q1 2024 rev 1
Revision 1, later corrected by CMS- Office
- —
- Facility
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Oct 1, 2020 – present
Q4 2020
Still in effect · 25 releases at this rate- Office
- —
- Facility
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Q4 2020 Oct 1, 2020 – Dec 31, 2020 · Q1 2021 Jan 1, 2021 – Mar 31, 2021 · Q2 2021 Apr 1, 2021 – Jun 30, 2021 · Q3 2021 Jul 1, 2021 – Sep 30, 2021 · Q4 2021 Oct 1, 2021 – Dec 31, 2021 · 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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