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CPT 87542 Medicare payment status

Priced under CLFS

87542 · PFS Q1 2013 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU13AJanuary 1 – March 31, 2013revision 2

PFS status evidence

Physician relative value file (Q1 2013) · rvu13ar.zip (PPRRVU13_V1226_UP0.csv row 13,719)
Inspect PFS status evidence
Code
87542
Release
Q1 2013, revision 2
Result
Priced under CLFS

Citations

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

    Physician relative value file (PPRRVU)CMS RVU13AJanuary 1 – March 31, 2013revision 2

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

    PPRRVU13_V1226_UP0.csv row 13,719 in rvu13ar.zip

    In the CMS file

    Loading rows 13,717–13,721 of PPRRVU13_V1226_UP0.csv…

    Download rvu13ar.zip from CMS File fingerprint 79b1988bb9cbab6a61634b6463d26ce88cca431c3e36fa3b73792f29882d95b4

Plain-text summaryReport a problem

CPT 87542 has no published national rate. It carries status X (statutory exclusion) in the Q1 2013 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

Why is there no national PFS amount for 87542?

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.

Which billing rules and modifiers apply? Copy link

Payment rules for 87542 Copy link

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 87542 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.

Global period: what 87542'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 87542 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 87542 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 87542 is billed Copy link

Across Original Medicare in CY2024, 87542 ranked #7,090 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries
60
Office + facility beneficiaries combined
Services
68
Times it was billed
Allowed
$2,783
Total Medicare allowed dollars
Compare: ↑ #7,089 more popular · 86510 ↓ #7,092 less popular · 01420

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 2013 fee schedule above.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q1 2013 release (effective January 2013). 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 (Q1 2013) · rvu13ar.zip (PPRRVU13_V1226_UP0.csv row 13,719)

Cite this rate

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

CPT 87542 National PFS baseline: No national PFS rate (Q1 2013; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU13A, PPRRVU13_V1226_UP0.csv row 13,719. Localis. https://localishealth.com/cpt/87542/2013/A