CPT 87154 Medicare payment status

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust 87154's amount.

CMS RVU23D · October 1 – December 31, 2023

Can you bill it with another code? Copy link

Source & method Copy link

1. 01 PPRRVU23_OCT.csv · Q4 2023 (RVU23D) · row 15,950—status X, RVUs limits

   Source

   Physician relative value file (PPRRVU), Q4 2023 release

   Effective

   October 1 – December 31, 2023

   Locator

   PPRRVU23_OCT.csv in rvu23d.zip · row 15,950 of 18,168 · via CMS

   Fields read

   Status X (col 4)

   SHA-256 6558dc4fa634f462…

   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.

2. 02 Physician & Other Practitioners · CY2024—volume and who bills it limits

   Source

   CMS Physician & Other Practitioners dataset

   Effective

   Calendar-year snapshot, on a different cycle from the Q4 2023 fee schedule

   Doesn’t establish

   Medicare Advantage, Medicaid or commercial volume.

   Note

   The dataset suppresses rows under 11 beneficiaries.

How has it changed? Copy link

— Office (non-facility) and — Facility since Jan 1, 2022.

Usage and related codes Copy link

In CY2024, 87154 ranked #5,832 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).