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Describe a service in plain words, or type a CPT/HCPCS code.

CPT 86481

Priced under the Clinical Laboratory Fee Schedule (CLFS), not the RVU formula.

No national payment amount

Status X is not separately payable under the PFS.

Did Medicare pay separately for CPT 86481 in Q3 2022? Copy link

Not at a published national rate. CPT 86481 carries status X (statutory exclusion) in the Q3 2022 release. The statutory definition of physician services does not include this item. Treat the blank amount as unpriced, not as $0.

Source: Physician relative value file (Q3 2022) · effective July 2022 · materially updated Aug 4, 2026 · compact facts

Why isn't there a national PFS amount?

  • Status X (Statutory exclusion): The statutory definition of physician services does not include this item.
  • Status X is not separately payable under the PFS.

CMS evidence · 2 sources

Open evidence
Physician relative value file (Q3 2022) · rvu22c-updated-06172022.zip (PPRRVU22_JUL.csv row 15,291)

See full source & method below

Common questions Copy link

Why is there no payment amount for 86481?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.

Why would a Medicare claim for 86481 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.

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.

Payment rules

Applicable payment rules Copy link

Only the rules that can matter for 86481, each linking to its detail on this page.

Facility/non-facility Not modeled Professional/technical component Does not apply Bilateral adjustment Does not apply Multiple-procedure reduction Does not apply Assistant/co-surgeon treatment Does not apply Global surgery Does not apply NCCI same-day edits Not modeled MUE behavior Not modeled Other fee-schedule routing Applies Contractor pricing Does not apply

Global period: what 86481's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Modifiers that report work outside 86481's global period
Modifier Reports
-25 A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 86481.

See every current NCCI pair for 86481 →

History

Rate history by release Copy link

National non-facility amount for 86481 across quarterly releases.

Release Status Non-facility Facility
Q3 2026 Jul 1, 2026 – present X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
Q1 2026 Jan 1, 2026 – Mar 31, 2026 X — —
Usage & related

How often 86481 is billed Copy link

Across Original Medicare in CY2024, 86481 ranked #1,524 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries
30,999
Office + facility patients combined
Services
32,514
Times it was billed
Allowed
$3.1M
Total Medicare allowed dollars
Compare: ↑ #1,523 more popular · 92610 ↓ #1,525 less popular · 00170

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q3 2022 fee schedule above.

Did this answer your question about CPT 86481?

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Source & method

Show sources

This is computed from CMS's Medicare Physician Fee Schedule Q3 2022 release (schedule pfs, effective July 2022). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q3 2022) · rvu22c-updated-06172022.zip (PPRRVU22_JUL.csv row 15,291)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This link keeps pointing at the Q3 2022 figures, even after a newer release lands.

CPT 86481 Medicare Physician Fee Schedule rate (Q3 2022). Localis. https://localishealth.com/cpt/86481/2022/C