Contractor-priced
93243 · PFS Q2 2022 · Historical
Contractor-published range
$203.27–$221.82
Participating · Office (non-facility) · Whole service
MAC-published fee schedules available in Localis: 3 of 144 payment localities. Missing data does not establish a $0 allowance.
No national PFS rate in Q2 2022
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
Amount evidence: MAC-published fee schedules and effective dates. The PFS row shows this code is priced by the contractor.
Inspect PFS status evidence
- Code
- 93243
- Release
- Q2 2022, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU22BApril 1 – June 30, 2022
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU22_APR.csv row 16,455 in rvu22b.zip
In the CMS file
Loading rows 16,453–16,457 of PPRRVU22_APR.csv…
Download rvu22b.zip from CMS File fingerprint
7a64189403d440641280d5e90c1ebf39bbdc950a292e6d6f2a8bf8dc144ae305
CPT 93243 carries status C (carrier-priced) in the Q2 2022 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 $203.27–$221.82 across 3 localities; enter a ZIP for the exact local amount.
Why is there no national PFS amount for 93243?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Find the local Medicare amount for 93243 Copy link
Medicare sets this price locally
93243 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 First_coast across JN, most recently effective Jan 1, 2022. 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 3 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JN · Florida, Area 03 CMS 09102-03 | — | — | $216.80 | $205.96 | $236.85 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | — | $221.82 | $210.73 | $242.34 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | — | $203.27 | $193.11 | $222.08 | Jan 1, 2022 | 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.
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 93243: PCTC 3 (technical component only) · MULT PROC 6 (cardiovascular reduction applies).
Technical component only
PCTC
3
Only a technical component exists for this code—there is no corresponding professional-component amount to bill.
Cardiovascular reduction applies
MULT PROC
6
The technical component of the second and subsequent ranked diagnostic cardiovascular procedure on the same day is reduced; the professional component is never reduced.
-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 93243 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
- Only a technical component exists for 93243—there is no professional-component amount to bill. See billing policy
- 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.
CMS RVU22BApril 1 – June 30, 2022
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 93243 Copy link
What to check (5)
There is no national allowed amount for 93243, so every reconciliation of this line runs against the MAC fee schedule that was in force for the date of service rather than against a national baseline.
- Compare the paid amount against the MAC fee schedule in force for the date of service; there is no national allowed amount here to reconcile against.
- Only a technical-component amount is published for this code, so a professional charge billed on it has no fee-schedule amount behind it.
- Check for a second cardiovascular diagnostic line on the same date: the lower-ranked technical component is reduced by rule, while the professional component is never reduced.
- Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04); CMS Transmittal R1149OTN: MPPR on the Technical Component of Diagnostic Cardiovascular and Ophthalmology Procedures.
Source & method Copy link
The PFS file shows this code is priced by the contractor. Its amounts come from the MAC-published schedules and effective dates shown above.
-
01 PPRRVU22_APR.csv · Q2 2022 (RVU22B) · row 16,455—priced by the contractor
- Effective
- April 1 – June 30, 2022
- Locator
- PPRRVU22_APR.csv in rvu22b.zip · row 16,455 of 17,630 · via CMS
- Fields read
-
Status C (col 4)SHA-256 7a64189403d44064…
-
02 MAC-published fee schedules · 3 on file—the contractor amounts
- Source
- MAC-published fee schedules
- Effective
- Effective dates shown above
-
03 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q2 2022 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 93243 National PFS baseline: No national PFS rate (Q2 2022; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU22B, PPRRVU22_APR.csv row 16,455. Localis. https://localishealth.com/cpt/93243/2022/B
Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON
How has it changed? Copy link
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.
The 93243 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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Usage and related codes Copy link
In CY2024, 93243 ranked #282 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 255,455
- Allowed
- $71.5M
- Beneficiaries
- 245,293
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).