CPT 90953
Contractor-priced — your Medicare Administrative Contractor sets the amount, not a national fee schedule.
No national payment amount
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Contractor-published range
$319.19–$349.74
Enter your ZIP above for the exact amount. Contractor files on record cover 15 of 119 payment localities — a locality we don't hold means our coverage is incomplete, not that Medicare pays $0.
How much does Medicare pay for CPT 90953? Copy link
CPT 90953 carries status C (carrier-priced) in the Q3 2024 release, so there is no single national rate — Medicare contractors publish their own amounts. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Contractor-published amounts on file range $319.19–$349.74 across 15 localities; enter a ZIP for the exact local amount.
Source: Physician relative value file (Q3 2024) · effective July 2024 · materially updated Aug 11, 2026 · compact facts
Why isn't there a national PFS amount?
- Status C (Carrier-priced): Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
- Carrier-priced: no national payment amount.
CMS evidence · 2 sources
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Find the local Medicare amount for 90953 Copy link
Medicare sets this price locally
90953 has no single national Physician Fee Schedule amount. Use the ZIP, modifier, setting, and participation fields above to match it to a Medicare locality and the contractor amount we have on file.
Your practical estimate will appear here
We hold files from Novitas across JH, most recently effective Jan 1, 2024. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.
This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.
View all 15 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JH · Arkansas, Area 13 CMS 07102-13 | — | — | $327.32 | $310.95 | $357.59 | Jan 1, 2024 | Contractor file |
| JH · Colorado, Area 01 CMS 04112-01 | — | — | $345.84 | $328.55 | $377.83 | Jan 1, 2024 | Contractor file |
| JH · Louisiana, Area 01 CMS 07202-01 | — | — | $344.53 | $327.30 | $376.40 | Jan 1, 2024 | Contractor file |
| JH · Louisiana, Area 99 CMS 07202-99 | — | — | $332.18 | $315.57 | $362.91 | Jan 1, 2024 | Contractor file |
| JH · Mississippi, Area 00 CMS 07302-00 | — | — | $331.26 | $314.70 | $361.91 | Jan 1, 2024 | Contractor file |
| JH · New Mexico, Area 05 CMS 04212-05 | — | — | $336.49 | $319.67 | $367.62 | Jan 1, 2024 | Contractor file |
| JH · Oklahoma, Area 00 CMS 04312-00 | — | — | $319.19 | $303.23 | $348.71 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 09 CMS 04412-09 | — | — | $347.77 | $330.38 | $379.94 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 11 CMS 04412-11 | — | — | $349.74 | $332.25 | $382.09 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 15 CMS 04412-15 | — | — | $349.44 | $331.97 | $381.77 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 18 CMS 04412-18 | — | — | $349.30 | $331.84 | $381.62 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 20 CMS 04412-20 | — | — | $329.56 | $313.08 | $360.04 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 28 CMS 04412-28 | — | — | $343.43 | $326.26 | $375.20 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 31 CMS 04412-31 | — | — | $342.08 | $324.98 | $373.73 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 99 CMS 04412-99 | — | — | $331.67 | $315.09 | $362.35 | Jan 1, 2024 | Contractor file |
The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.
Common questions Copy link
Why is there no payment amount for 90953?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for 90953 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is C (carrier-priced) — Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
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.
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.
Applicable payment rules Copy link
Only the rules that can matter for 90953, each linking to its detail on this page.
Global period: what 90953's fee already covers Copy link
The global surgery concept does not apply to this code.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Billing policy Copy link
What 90953's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 0 | No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date — each is treated as unrelated. |
| Professional/technical split | 0 | No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service. |
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 90953.
Did this answer your question about CPT 90953?
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q3 2024 release (schedule pfs, effective July 2024). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that 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 link keeps pointing at the Q3 2024 figures, even after a newer release lands.
CPT 90953 Medicare Physician Fee Schedule rate (Q3 2024). Localis. https://localishealth.com/cpt/90953/2024/C