CPT 86920
Priced under CLFS
86920 · PFS Q1 2024 · Historical
Status X is not separately payable under the PFS.
Not at a published national rate. CPT 86920 carries status X (statutory exclusion) in the Q1 2024 release. The statutory definition of physician services does not include this item. Treat the blank amount as unpriced, not as $0.
PFS status evidence
Inspect PFS status evidence
- Code
- 86920
- Release
- Q1 2024, revision 1
- Result
- Priced under CLFS
Citations
-
Establishes the PFS status (X) and the resulting pathway for this code: priced under clfs.
Physician relative value file (PPRRVU)Q1 2024 · revision 1
Superseded revision
Release period: January 1 – March 8, 2024
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
Record details
PPRRVU24_JAN.csv in rvu24a-updated-04-01-2024.zip (row 16,206)- hcpcs (col 1)
- 86920
- modifier (col 2)
- blank
- status_code (col 4)
- X
SHA-256: 034f3aa88a63e6f7ca3859c09b3945dce139171a6fc5a710300fc7b815e9b65b
Why is there no national PFS amount for 86920?
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
Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.
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.
Global period: what 86920's fee already covers Copy link
The global surgery concept does not apply to this code.
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 86920.
Common payment questions Copy link
Why would a Medicare claim for 86920 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.
Rate history by release Copy link
National non-facility amount for 86920 across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q4 2026 takes effect Oct 1, 2026 | X | — | — |
| Q3 2026 Jul 1, 2026 – Sep 30, 2026 | X | — | — |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | X | — | — |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | X | — | — |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | X | — | — |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | X | — | — |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | X | — | — |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | X | — | — |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | X | — | — |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | X | — | — |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | X | — | — |
| Q1 2024 Mar 9, 2024 – Mar 31, 2024 | X | — | — |
| Q1 2024 Jan 1, 2024 – Mar 8, 2024 | X | — | — |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | X | — | — |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | X | — | — |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | X | — | — |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | X | — | — |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | X | — | — |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | X | — | — |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | X | — | — |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | X | — | — |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | X | — | — |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | X | — | — |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | X | — | — |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | X | — | — |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | X | — | — |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | X | — | — |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | X | — | — |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | X | — | — |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | X | — | — |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | X | — | — |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | X | — | — |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | X | — | — |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | X | — | — |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | X | — | — |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | X | — | — |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | X | — | — |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | X | — | — |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | X | — | — |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | X | — | — |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | X | — | — |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | X | — | — |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | X | — | — |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | X | — | — |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | X | — | — |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | X | — | — |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | X | — | — |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | X | — | — |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | X | — | — |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | X | — | — |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | X | — | — |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | X | — | — |
| Q1 2013 Jan 1, 2013 – Mar 31, 2013 | 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.
How often 86920 is billed Copy link
Across Original Medicare in CY2024, 86920 ranked #5,214 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 4.0 times on average that year.
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 Q1 2024 fee schedule above.
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Source & method
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This page uses CMS's Medicare Physician Fee Schedule Q1 2024 release (effective January 2024). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This citation identifies the source release, so its evidence remains reproducible after a newer release lands.
CPT 86920 National PFS baseline: No national PFS rate (Q1 2024; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/86920/2024/A/1