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CPT 93609 Medicare payment status

Contractor-priced

93609 · PFS Q2 2015 · Historical

No national PFS rate in Q2 2015

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

View applicable payment rules
View CMS source and method

PFS status evidence

Physician relative value file (Q2 2015) · rvu15b.zip (PPRRVU15_V0213_Current.csv row 15,185)
Inspect PFS status evidence
Code
93609
Release
Q2 2015, revision 1
Result
Contractor-priced

Citations

  • Shows this code’s PFS status (C). Result: Contractor-priced.

    Physician relative value file (PPRRVU)CMS RVU15BApril 1 – June 30, 2015

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

    PPRRVU15_V0213_Current.csv row 15,185 in rvu15b.zip

    In the CMS file

    Loading rows 15,183–15,187 of PPRRVU15_V0213_Current.csv…

    Download rvu15b.zip from CMS File fingerprint 61c24302bb17747bddd4aa44ef136d9628930f35dd595e299d9a5370bd394705

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CPT 93609 has no published national rate. It carries status C (carrier-priced) in the Q2 2015 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 93609?

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 93609: GLOB DAYS ZZZ (add-on code) · PCTC 1 (splits into professional and technical).

Global surgery period

Add-on code

GLOB DAYS

ZZZ

This code is always billed alongside another service and carries no follow-up period of its own. The primary procedure's global period governs; this indicator does not determine whether either line is payable.

Professional/technical split

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.

Why would a Medicare claim for 93609 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
  • 93609 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 RVU15BApril 1 – June 30, 2015

Can you bill it with another code? Copy link

This code

93609

See every current NCCI pair for 93609 →

Reconciling a contractor-priced payment for 93609 Copy link

Checking a paid 93609 line?

Check an actual payment Model this code in a contract
What to check (5)

There is no national allowed amount for 93609, 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.
  • Reconcile this line together with the primary procedure on the same claim—it is an add-on that is never billed alone and carries no global period of its own.
  • 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.

  1. 01 PPRRVU15_V0213_Current.csv · Q2 2015 (RVU15B) · row 15,185—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q2 2015 release
    Effective
    April 1 – June 30, 2015
    Locator
    PPRRVU15_V0213_Current.csv in rvu15b.zip · row 15,185 of 16,085 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 61c24302bb17747b…
  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 Q2 2015 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 93609 National PFS baseline: No national PFS rate (Q2 2015; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU15B, PPRRVU15_V0213_Current.csv row 15,185. Localis. https://localishealth.com/cpt/93609/2015/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.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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Usage and related codes Copy link

In CY2024, 93609 ranked #2,364 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
7,524
Allowed
$2.0M
Beneficiaries
7,302

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