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CPT 86596

Priced under CLFS

86596 · PFS Q4 2024 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU24DOctober 1 – December 31, 2024

CPT 86596 has no published national rate. It carries status X (statutory exclusion) in the Q4 2024 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

PFS status evidence

Physician relative value file (Q4 2024) · rvu24d.zip (PPRRVU24_OCT.csv row 16,272)
Inspect PFS status evidence
Code
86596
Release
Q4 2024, revision 1
Result
Priced under CLFS

Citations

Every input comes from a published CMS file. Open the same file at the row shown and the values match.

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

    Physician relative value file (PPRRVU)CMS RVU24DOctober 1 – December 31, 2024

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

    PPRRVU24_OCT.csv row 16,272 in rvu24d.zip

    A HCPCS
    86596
    B Modifier
    blank
    D Status code
    X
    In the CMS file

    Loading rows 16,270–16,274 of PPRRVU24_OCT.csv…

    Download rvu24d.zip from CMS File fingerprint 8ff8133723cdaa4d6d2b1680ff97286ffa7ab38dcd54b9108fc6020e633ef20b

Plain-text summary

Why is there no national PFS amount for 86596?

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.

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Other fee-schedule routing Applies
Other payment indicators (9)

Facility/non-facility: Not determined, 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 determined, MUE behavior: Not determined, Contractor pricing: Does not apply.

Why would a Medicare claim for 86596 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.

Which billing rules and modifiers apply? Copy link

Global period: what 86596's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Check a pair of codes 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 for the pair.

See every current NCCI pair for 86596 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 86596 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present X — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
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.

Usage and related codes Copy link

How often 86596 is billed Copy link

Across Original Medicare in CY2024, 86596 ranked #2,434 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries
8,708
Office + facility beneficiaries combined
Services
11,668
Times it was billed
Allowed
$137,685
Total Medicare allowed dollars
Compare: ↑ #2,433 more popular · 33510 ↓ #2,436 less popular · 79101

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 Q4 2024 fee schedule above.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2024 release (effective October 2024). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q4 2024) · rvu24d.zip (PPRRVU24_OCT.csv row 16,272)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

CPT 86596 National PFS baseline: No national PFS rate (Q4 2024; participating; whole service; GPCI 1.000; sequestration excluded). CMS RVU24D, PPRRVU24_OCT.csv row 16,272. Localis. https://localishealth.com/cpt/86596/2024/D