Contractor-priced
93317 · PFS Q1 2020 · Historical
No national PFS rate in Q1 2020
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 93317
- Release
- Q1 2020, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU20AJanuary 1 – March 31, 2020
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU20_Jan.csv row 16,161 in rvu20a-updated-01312020.zip
In the CMS file
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28d2c1e57daa957d1eef39cb96dc0e0f55fd4e6ab886473e117d9b4f43a9875d
CPT 93317 has no published national rate. It carries status C (carrier-priced) in the Q1 2020 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 93317?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 93317: PCTC 1 (splits into professional and technical).
Splits into professional and technical
PCTC
1
This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 93317 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
- 93317 splits into a professional component (modifier 26) and a technical component (modifier TC)—a claim for only one part needs that modifier to price correctly. 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 RVU20AJanuary 1 – March 31, 2020
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 93317 Copy link
What to check (4)
There is no national allowed amount for 93317, 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.
- Confirm which component the line carried before comparing anything: the same code prices three ways—globally, as a professional component with modifier 26, and as a technical component with modifier TC.
- 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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
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.
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01 PPRRVU20_Jan.csv · Q1 2020 (RVU20A) · row 16,161—priced by the contractor
- Effective
- January 1 – March 31, 2020
- Locator
- PPRRVU20_Jan.csv in rvu20a-updated-01312020.zip · row 16,161 of 17,236 · via CMS
- Fields read
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Status C (col 4)SHA-256 28d2c1e57daa957d…
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02 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q1 2020 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 93317 National PFS baseline: No national PFS rate (Q1 2020; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU20A, PPRRVU20_Jan.csv row 16,161. Localis. https://localishealth.com/cpt/93317/2020/A
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.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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Usage and related codes Copy link
In CY2024, 93317 ranked #5,992 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 211
- Allowed
- $17,757
- Beneficiaries
- 201
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits). Localis groups related codes for payment research; the grouping isn't the AMA's code families.