CPT 95170
National PFS baseline · Q4 2025
95170 · HistoricalGPCIs 1.000 · Participating · Before sequestration
Find the locality-adjusted allowed amount
Status A Medicare calculates a national payment amount for this code and pays it separately when the service is covered. Full definition → Nationally priced under PFS, using the RVU formula.
- Code
- 95170
- DOS
- Release-period baseline; no service date selected
- Locality
- National PFS baseline (GPCI 1.000)
- Setting
- Office (non-facility)
- Participation
- Participating
- Modifiers
- None
- Units
- 1
- Release
- Q4 2025, revision 1
- Sequestration
- Excluded
Formula
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
Localis-derived calculation from published inputs. Select an underlined input to inspect its source field.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 0.06 | × 1.000 | 0.0600 |
| Practice expense · Office (non-facility) | 0.25 | × 1.000 | 0.2500 |
| Malpractice | 0.01 | × 1.000 | 0.0100 |
| Sum of adjusted RVUs | 0.3200 | ||
| × 32.3465 conversion factor = formula amount | $10.35 | ||
Component subtotals are displayed to four decimals. The engine rounds the formula amount to cents before subsequent adjustments.
Citations
-
Supplies the RVUs and PFS status for this code and component.
Physician relative value file (PPRRVU)Q4 2025 · revision 1
Latest revision of this release
Release period: October 1 – December 31, 2025
Record details
PPRRVU2025_Oct.csv in rvu25d-updated-09-11-2025.zip (row 12,287)- hcpcs (col 1)
- 95170
- modifier (col 2)
- blank
- status_code (col 4)
- A
- work_rvu (col 6)
- 0.06
- pe_rvu_nonfacility (col 7)
- 0.25
- pe_rvu_facility (col 9)
- 0.03
- mp_rvu (col 11)
- 0.01
SHA-256: 8af460f38bf982b79b07269fbc8b7256a8ef3bd3aa025a9c5cb71c1e52523c56
-
Supplies the dollar conversion factor used in the formula.
Physician relative value file (PPRRVU)Q4 2025 · revision 1
Latest revision of this release
Release period: October 1 – December 31, 2025
Record details
PPRRVU2025_Oct.csv in rvu25d-updated-09-11-2025.zip (row 11)- conversion_factor (col 25)
- 32.3465
SHA-256: 8af460f38bf982b79b07269fbc8b7256a8ef3bd3aa025a9c5cb71c1e52523c56
- Code
- 95170
- DOS
- Release-period baseline; no service date selected
- Locality
- National PFS baseline (GPCI 1.000)
- Setting
- Facility
- Participation
- Participating
- Modifiers
- None
- Units
- 1
- Release
- Q4 2025, revision 1
- Sequestration
- Excluded
Formula
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
Localis-derived calculation from published inputs. Select an underlined input to inspect its source field.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 0.06 | × 1.000 | 0.0600 |
| Practice expense · Facility | 0.03 | × 1.000 | 0.0300 |
| Malpractice | 0.01 | × 1.000 | 0.0100 |
| Sum of adjusted RVUs | 0.1000 | ||
| × 32.3465 conversion factor = formula amount | $3.23 | ||
Component subtotals are displayed to four decimals. The engine rounds the formula amount to cents before subsequent adjustments.
Citations
-
Supplies the RVUs and PFS status for this code and component.
Physician relative value file (PPRRVU)Q4 2025 · revision 1
Latest revision of this release
Release period: October 1 – December 31, 2025
Record details
PPRRVU2025_Oct.csv in rvu25d-updated-09-11-2025.zip (row 12,287)- hcpcs (col 1)
- 95170
- modifier (col 2)
- blank
- status_code (col 4)
- A
- work_rvu (col 6)
- 0.06
- pe_rvu_nonfacility (col 7)
- 0.25
- pe_rvu_facility (col 9)
- 0.03
- mp_rvu (col 11)
- 0.01
SHA-256: 8af460f38bf982b79b07269fbc8b7256a8ef3bd3aa025a9c5cb71c1e52523c56
-
Supplies the dollar conversion factor used in the formula.
Physician relative value file (PPRRVU)Q4 2025 · revision 1
Latest revision of this release
Release period: October 1 – December 31, 2025
Record details
PPRRVU2025_Oct.csv in rvu25d-updated-09-11-2025.zip (row 11)- conversion_factor (col 25)
- 32.3465
SHA-256: 8af460f38bf982b79b07269fbc8b7256a8ef3bd3aa025a9c5cb71c1e52523c56
The national PFS baseline was $10.35 for CPT 95170 in the office (non-facility) setting and $3.23 in a facility under the Q4 2025 Physician Fee Schedule, effective October 2025. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.
Calculation evidence
Why are the facility and non-facility amounts different?
Only the practice-expense RVU changes with the setting. For 95170 it's 0.25 RVUs in the office versus 0.03 in a facility—the whole $7.12 gap between $10.35 and $3.23. In an office the practice bears the overhead, so Medicare pays more; in a hospital or ASC the facility bills its own fee, so the professional payment is lower. See facility vs non-facility.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).
What could change this amount? Copy link
Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.
Service location and setting · Participation and payment shares
Other payment indicators (9)
Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Compare payment localities
The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.
95170 non-facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Washington, DC
$12.07
Locality 12202-01
Northern New Jersey, NJ
$11.88
Locality 12402-01
Anchorage, AK
$11.84
Locality 02102-01
Honolulu, HI
$11.41
Locality 01212-01
Hartford, CT
$11.20
Locality 13102-00
Denver, CO
$10.74
Locality 04112-01
Providence, RI
$10.67
Locality 14412-01
Show 24 more metros Show fewer metros
Portland, ME
$10.34
Locality 14112-03
Minneapolis, MN
$10.33
Locality 06202-00
Las Vegas, NV
$10.30
Locality 01312-00
Richmond, VA
$10.15
Locality 11302-00
Phoenix, AZ
$10.10
Locality 03102-00
Tampa, FL
$10.02
Locality 09102-99
San Antonio, TX
$9.88
Locality 04412-99
Buffalo, NY
$9.85
Locality 13282-99
Salt Lake City, UT
$9.79
Locality 03502-09
Milwaukee, WI
$9.79
Locality 06302-00
Pittsburgh, PA
$9.74
Locality 12502-99
Albuquerque, NM
$9.66
Locality 04212-05
Charlotte, NC
$9.64
Locality 11502-00
Columbus, OH
$9.64
Locality 15202-00
Charleston, SC
$9.59
Locality 11202-01
Indianapolis, IN
$9.55
Locality 08102-00
Des Moines, IA
$9.47
Locality 05102-00
Omaha, NE
$9.45
Locality 05402-00
Wichita, KS
$9.44
Locality 05202-00
Boise, ID
$9.43
Locality 02202-00
Oklahoma City, OK
$9.41
Locality 04312-00
Nashville, TN
$9.36
Locality 10312-35
Louisville, KY
$9.33
Locality 15102-00
Birmingham, AL
$9.15
Locality 10112-00
95170 facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Anchorage, AK
$4.15
Locality 02102-01
Washington, DC
$3.59
Locality 12202-01
Northern New Jersey, NJ
$3.54
Locality 12402-01
Hartford, CT
$3.43
Locality 13102-00
Tampa, FL
$3.33
Locality 09102-99
Providence, RI
$3.27
Locality 14412-01
Denver, CO
$3.25
Locality 04112-01
Show 24 more metros Show fewer metros
Honolulu, HI
$3.24
Locality 01212-01
Albuquerque, NM
$3.20
Locality 04212-05
Las Vegas, NV
$3.18
Locality 01312-00
Phoenix, AZ
$3.16
Locality 03102-00
Columbus, OH
$3.16
Locality 15202-00
San Antonio, TX
$3.16
Locality 04412-99
Salt Lake City, UT
$3.15
Locality 03502-09
Portland, ME
$3.14
Locality 14112-03
Pittsburgh, PA
$3.14
Locality 12502-99
Richmond, VA
$3.14
Locality 11302-00
Buffalo, NY
$3.10
Locality 13282-99
Louisville, KY
$3.09
Locality 15102-00
Charleston, SC
$3.09
Locality 11202-01
Oklahoma City, OK
$3.07
Locality 04312-00
Charlotte, NC
$3.05
Locality 11502-00
Minneapolis, MN
$3.03
Locality 06202-00
Indianapolis, IN
$2.99
Locality 08102-00
Wichita, KS
$2.99
Locality 05202-00
Nashville, TN
$2.99
Locality 10312-35
Milwaukee, WI
$2.98
Locality 06302-00
Birmingham, AL
$2.97
Locality 10112-00
Boise, ID
$2.97
Locality 02202-00
Des Moines, IA
$2.97
Locality 05102-00
Omaha, NE
$2.93
Locality 05402-00
Q4 2025 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.
How this amount is computed Copy link
CPT 95170 has a work RVU of 0.06, a non-facility practice expense RVU of 0.25, a facility practice expense RVU of 0.03 and a malpractice RVU of 0.01—for total non-facility RVUs of 0.32 and total facility RVUs of 0.10 in the Q4 2025 release.
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 | 0.06 |
| Practice expense RVU (non-facility) | 0.25 |
| Practice expense RVU (facility) | 0.03 |
| Malpractice RVU | 0.01 |
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.
Payment review for 95170 Copy link
Two published payment rules can change what 95170 allows on a claim: the office/facility differential and documentation-restricted assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.
What to reconcile
- Check the place-of-service code before attributing the gap to the payer: office and facility pricing differ by $7.12 nationally at GPCI 1.000, before any locality adjustment.
- 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.
Nearby payment lines
National Q4 2025 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
Global period: what 95170's fee already covers Copy link
The global surgery concept does not apply to this code.
Billing policy Copy link
What 95170's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.
| 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 | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 0 | No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date—each is treated as unrelated. |
| 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. |
Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link
National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.
| Modifier | What it means | Amount |
|---|---|---|
| -26/TC | Professional/technical split | Not payable |
| -50 | Bilateral procedure | Not payable |
| -80/81/82 | Assistant surgeon (physician) (16%) | $1.66 If documented |
| -AS | Assistant at surgery (PA, NP, or CNS) (13.6%) | $1.41 If documented |
| -62 | Co-surgeons, each | Not payable |
| -66 | Team surgery | Not payable |
These apply standard MPFS percentages—assistant surgeon 16%, co-surgeon 62.5%, bilateral 150%—to the national non-facility amount above, and require both the RVU inputs and the applicable payment rule as evidence. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted—an unpaid claim without that documentation is not an underpayment.
Can you bill it with another code? 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 between it and 95170.
Allowed amount, program payment, and patient share Copy link
These figures use the same national baseline, with different participation and payment assumptions.
Computed from the Q4 2025 CMS release
- Medicare allowed amount
- $10.35
- Medicare's share
- $8.28
- Patient coinsurance
- $2.07
- Limiting charge
- $11.30
What Medicare recognizes as the full price for 95170 in the office (non-facility) setting. Every figure below derives from it.
80% of the allowed amount, before the ~2% sequestration cut.
The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.
The ceiling a non-participating provider can bill a patient on an unassigned claim—109.25% of the allowed amount.
National Q4 2025 figures at GPCI 1.000. Adjust for your locality and sequestration, or expand the explanations below for each figure in full.
Is $10.35 what a practice actually receives?
It's the national allowed amount—the starting point. Medicare pays 80% of it ($8.28) and the patient owes 20% coinsurance ($2.07). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.
Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).
What's the non-participating amount for 95170?
$9.83 in the office (non-facility) setting—95% of the $10.35 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
What's the limiting charge for 95170?
$11.30 in the office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $10.35 amount above. The non-participating amount is 95% of the fee schedule rate ($9.83), and the statutory cap is 115% of that. See limiting charge.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
Common payment questions Copy link
Why would a Medicare claim for 95170 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- 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.
Rate history by release Copy link
National non-facility amount for 95170 across quarterly releases. +47.4% increase since Q1 2013 · high $11.86 in Q1 2021
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q4 2026 takes effect Oct 1, 2026 | A | $10.69 (0.0% no change ) | $2.67 (0.0% no change ) |
| Q3 2026 Jul 1, 2026 – Sep 30, 2026 | A | $10.69 (0.0% no change ) | $2.67 (0.0% no change ) |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | A | $10.69 (0.0% no change ) | $2.67 (0.0% no change ) |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | A | $10.69 (+3.3% increase ) | $2.67 (-17.3% decrease ) |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | A | $10.35 (0.0% no change ) | $3.23 (0.0% no change ) |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | A | $10.35 (0.0% no change ) | $3.23 (0.0% no change ) |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | A | $10.35 (0.0% no change ) | $3.23 (0.0% no change ) |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | A | $10.35 (-5.7% decrease ) | $3.23 (+7.7% increase ) |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | A | $10.98 (0.0% no change ) | $3.00 (0.0% no change ) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | A | $10.98 (0.0% no change ) | $3.00 (0.0% no change ) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | A | $10.98 (0.0% no change ) | $3.00 (0.0% no change ) |
| Q1 2024 Mar 9, 2024 – Mar 31, 2024 | A | $10.98 (+1.6% increase ) | $3.00 (+1.7% increase ) |
| Q1 2024 Jan 1, 2024 – Mar 8, 2024 | A | $10.81 (-6.2% decrease ) | $2.95 (-3.3% decrease ) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | A | $11.52 (0.0% no change ) | $3.05 (0.0% no change ) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | A | $11.52 (0.0% no change ) | $3.05 (0.0% no change ) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | A | $11.52 (0.0% no change ) | $3.05 (0.0% no change ) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | A | $11.52 (-2.1% decrease ) | $3.05 (-1.9% decrease ) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | A | $11.77 (0.0% no change ) | $3.11 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | A | $11.77 (0.0% no change ) | $3.11 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | A | $11.77 (0.0% no change ) | $3.11 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | A | $11.77 (-0.8% decrease ) | $3.11 (-1.0% decrease ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | A | $11.86 (0.0% no change ) | $3.14 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | A | $11.86 (0.0% no change ) | $3.14 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | A | $11.86 (0.0% no change ) | $3.14 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | A | $11.86 (+6.0% increase ) | $3.14 (-3.4% decrease ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | A | $11.19 (0.0% no change ) | $3.25 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | A | $11.19 (0.0% no change ) | $3.25 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | A | $11.19 (0.0% no change ) | $3.25 (0.0% no change ) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | A | $11.19 (+3.5% increase ) | $3.25 (+0.3% increase ) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | A | $10.81 (0.0% no change ) | $3.24 (0.0% no change ) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | A | $10.81 (0.0% no change ) | $3.24 (0.0% no change ) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | A | $10.81 (0.0% no change ) | $3.24 (0.0% no change ) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | A | $10.81 (+7.2% increase ) | $3.24 (0.0% no change ) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | A | $10.08 (0.0% no change ) | $3.24 (0.0% no change ) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | A | $10.08 (0.0% no change ) | $3.24 (0.0% no change ) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | A | $10.08 (0.0% no change ) | $3.24 (0.0% no change ) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | A | $10.08 (+4.0% increase ) | $3.24 (+0.3% increase ) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | A | $9.69 (0.0% no change ) | $3.23 (0.0% no change ) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | A | $9.69 (0.0% no change ) | $3.23 (0.0% no change ) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | A | $9.69 (0.0% no change ) | $3.23 (0.0% no change ) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | A | $9.69 (+0.2% increase ) | $3.23 (+0.3% increase ) |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | A | $9.67 (0.0% no change ) | $3.22 (0.0% no change ) |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | A | $9.67 (0.0% no change ) | $3.22 (0.0% no change ) |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | A | $9.67 (0.0% no change ) | $3.22 (0.0% no change ) |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | A | $9.67 (-0.3% decrease ) | $3.22 (-0.3% decrease ) |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | A | $9.70 (+0.5% increase ) | $3.23 (+0.3% increase ) |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | A | $9.65 (0.0% no change ) | $3.22 (0.0% no change ) |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | A | $9.65 (0.0% no change ) | $3.22 (0.0% no change ) |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | A | $9.65 (-0.2% decrease ) | $3.22 (0.0% no change ) |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | A | $9.67 (0.0% no change ) | $3.22 (0.0% no change ) |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | A | $9.67 (0.0% no change ) | $3.22 (0.0% no change ) |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | A | $9.67 (+33.4% increase ) | $3.22 (+43.1% increase ) |
| Q1 2013 Jan 1, 2013 – Mar 31, 2013 | A | $7.25 | $2.25 |
This price has been unchanged since Q1 2025, when it decreased 5.7%.
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 95170 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Contracted rate: % of Medicare Copy link
Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 95170 pays at that rate—$10.35 is 100%.
We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →
How often 95170 is billed Copy link
Across Original Medicare in CY2024, 95170 ranked #4,603 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 11.7 times on average that year.
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 2025 fee schedule above.
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This page uses CMS's Medicare Physician Fee Schedule Q4 2025 release (effective October 2025). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Conversion factor $32.3465 read from the same file, row 11, column 25.
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Cite this rate
This citation identifies the source release, so its evidence remains reproducible after a newer release lands.
CPT 95170 National PFS baseline: Office (non-facility) $10.35; Facility $3.23 (Q4 2025; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/95170/2025/D