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Medicare Physician Fee Schedule Effective CMS RVU21D Updated

CPT 86803 Medicare payment status

CPT 86803 has no published national rate. It carries status X (statutory exclusion) in the Q4 2021 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

Priced under CLFS

86803 · PFS Q4 2021 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU21DOctober 1 – December 31, 2021

CPT 86803 has no published national rate. It carries status X (statutory exclusion) in the Q4 2021 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

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PFS status evidence

Physician relative value file (Q4 2021) · rvu21d.zip (PPRRVU21_OCT.csv row 15,141)
Inspect PFS status evidence
Code
86803
Release
Q4 2021, revision 1
Result
Priced under CLFS

Citations

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

    Physician relative value file (PPRRVU)CMS RVU21DOctober 1 – December 31, 2021

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

    PPRRVU21_OCT.csv row 15,141 in rvu21d.zip

    In the CMS file

    Loading rows 15,139–15,143 of PPRRVU21_OCT.csv…

    Download rvu21d.zip from CMS File fingerprint f1972bd23bdc51795ceba7d536bb413a0ba0b47fad8c2ed594e7ee7799877297

Plain-text summary

Why is there no national PFS amount for 86803?

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 86803 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 86803'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 86803 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 86803 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 86803 is billed Copy link

Across Original Medicare in CY2024, 86803 ranked #329 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries
460,185
Office + facility beneficiaries combined
Services
498,329
Times it was billed
Allowed
$6.9M
Total Medicare allowed dollars
Compare: ↑ #328 more popular · 95811 ↓ #330 less popular · 93308

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 2021 fee schedule above.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2021 release (effective October 2021). 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 2021) · rvu21d.zip (PPRRVU21_OCT.csv row 15,141)

Cite this rate

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

CPT 86803 National PFS baseline: No national PFS rate (Q4 2021; participating; whole service; GPCI 1.000; sequestration excluded). CMS RVU21D, PPRRVU21_OCT.csv row 15,141. Localis. https://localishealth.com/cpt/86803/2021/D