Contractor-priced
93998 · PFS Q4 2022 · Historical
No national PFS rate in Q4 2022
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
PFS status evidence
Inspect PFS status evidence
- Code
- 93998
- Release
- Q4 2022, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU22DOctober 1 – December 31, 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_OCT.csv row 16,925 in rvu22d.zip
In the CMS file
Loading rows 16,923–16,927 of PPRRVU22_OCT.csv…
Download rvu22d.zip from CMS File fingerprint
f8774a019545e1fd71536837b20b74674c014b1acef3435d93456857885190ab
CPT 93998 has no published national rate. It carries status C (carrier-priced) in the Q4 2022 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 93998?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Payment considerations Copy link
Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.
Other payment indicators (8)
Why would a Medicare claim for 93998 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: payable with documentation. See billing policy
- Team surgery: payable with documentation. 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.
Which billing rules and modifiers apply? Copy link
Global period: what 93998's fee already covers Copy link
The global surgery concept does not apply to this code.
Billing policy Copy link
These billing-policy indicators explain how 93998 is treated. They apply whether the code is nationally priced or carrier-priced: 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 | 1 | Payable with documentation. Co-surgeons may be paid, but only with supporting documentation establishing the medical necessity of two surgeons. |
| Team surgery | 1 | Payable with documentation. A surgical team may be paid, but only with supporting documentation establishing medical necessity. |
| Multiple procedures | 0 | No reduction. No multiple-procedure reduction applies when this procedure is billed with others on the same date; each is paid at its full fee schedule amount. |
| 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
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.
Reconciling a contractor-priced payment for 93998 Copy link
There is no national allowed amount for 93998, 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.
What to check
- 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.
- 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.
- Check for documentation supporting two surgeons before appealing a modifier 62 denial—co-surgeon payment on this procedure depends on it.
- 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.
Compare against 93990, 94002 and 93986: their amounts are in Related codes.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery; CMS Medicare Claims Processing Manual (Pub. 100-04).
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.
Usage and related codes Copy link
How often 93998 is billed Copy link
Across Original Medicare in CY2024, 93998 ranked #4,795 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
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 Q4 2022 fee schedule above.
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Source & method
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Contractor amounts come from the MAC-published schedules and effective dates shown above. The PFS file shows this code is priced by the contractor. 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.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 93998 National PFS baseline: No national PFS rate (Q4 2022; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU22D, PPRRVU22_OCT.csv row 16,925. Localis. https://localishealth.com/cpt/93998/2022/D