CPT 95131
No national payment amount
Status I is not separately payable under the PFS.
Does Medicare pay separately for CPT 95131 in 2026?
Not at a published national rate. CPT 95131 carries status I (not valid) in the Q3 2026 release. Medicare uses a different code to report and pay for this service. Treat the blank amount as unpriced, not as $0.
Common questions
Why is there no payment amount for 95131?
Its status indicator is I (not valid). Medicare uses a different code to report and pay for this service. 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 95131 be denied or paid less?
Each item below comes from a CMS indicator on this page — not general billing advice.
- Its status indicator is I (not valid) — Medicare uses a different code to report and pay for this service. See status indicators
- 3 codes can never be billed with 95131 on the same date of service — NCCI denies those pairs even with a modifier. See billing together
- 183 codes pair with 95131 only when modifier 59 (or XE, XS, XP, XU) documents a distinct service — billed together without one, a line of the pair denies. See billing together
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.
Saw this code on your bill?
What is a 95131 visit in patient-friendly terms?
We haven't written the plain-language description for CPT 95131 yet — ask your provider's billing office what service it covers in the meantime.
How this amount is computed
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | blank |
| Practice expense RVU (non-facility) | blank |
| Practice expense RVU (facility) | blank |
| Malpractice RVU | blank |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
Rate history by release
National non-facility amount for 95131 across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jun 30, 2026 – present | I | — | — |
| Q2 2026 Mar 10, 2026 – Jun 29, 2026 | I | — | — |
| Q1 2026 Dec 29, 2025 – Mar 9, 2026 | I | — | — |
| Q4 2025 Sep 11, 2025 – Dec 28, 2025 | I | — | — |
| Q3 2025 Jun 5, 2025 – Sep 10, 2025 | I | — | — |
| Q2 2025 Jun 5, 2025 – Jun 4, 2025 | I | — | — |
| Q1 2025 Dec 23, 2024 – Jun 4, 2025 | I | — | — |
Billing together (NCCI edits)
NCCI Q3 2026Based on CMS's National Correct Coding Initiative (NCCI) — hover a code to see how it's used.
Billable with 95131 only with modifier 59, XE, XS, XP, or XU
Showing 3 of 183 — search above to check a specific code.
No match in this list.
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Source & method
This is computed from CMS's Medicare Physician Fee Schedule Q3 2026 release (schedule pfs, effective July 2026). 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. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them.
Conversion factor $33.4009 read from the same file, row 11, column 26.
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 2026 figures, even after a newer release lands.
CPT 95131 Medicare Physician Fee Schedule rate (Q3 2026). Localis. https://localishealth.com/cpt/95131/2026/C