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CPT 95709 Medicare carrier-priced amounts

Contractor-priced

95709 · PFS Q2 2023 · Historical

Contractor-published range

$861.30

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 3 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q2 2023

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

Check for a published amount in your locality.

View contractor sources and effective dates

Amount evidence: MAC-published fee schedules and effective dates. The PFS row shows this code is priced by the contractor.

Inspect PFS status evidence
Code
95709
Release
Q2 2023, revision 1
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU23BApril 1 – June 30, 2023

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

    PPRRVU23_APR.csv row 17,396 in rvu23b-updated-02-27-2023.zip

    In the CMS file

    Loading rows 17,394–17,398 of PPRRVU23_APR.csv…

    Download rvu23b-updated-02-27-2023.zip from CMS File fingerprint 6a47fe38620fee5aff0fbba61f50983de3a9733e23acc7373c453261da6f0cd7

Report a problem

CPT 95709 carries status C (carrier-priced) in the Q2 2023 release, so there is no single national rate—Medicare contractors publish their own amounts. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Contractor-published amounts on file range $861.30 across 3 localities; enter a ZIP for the exact local amount.

Why is there no national PFS amount for 95709?

Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Find the local Medicare amount for 95709 Copy link

Medicare sets this price locally

95709 has no single national Physician Fee Schedule amount. Use the ZIP, modifier, setting, and participation fields above to match it to a Medicare locality and the contractor amount we have on file.

Your practical estimate will appear here

We hold files from First_coast across JN, most recently effective Jan 1, 2023. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.

This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.

Contractor-published source figures, not a national rate. Par = participating-provider amount Non-par = nonparticipating-provider amount C = technical component capped at the OPPS amount # = facility-setting amount
View all 3 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JN · Florida, Area 03 CMS 09102-03 — — $861.30 $818.24 $940.98 Jan 1, 2023 Contractor file
JN · Florida, Area 04 CMS 09102-04 — — $861.30 $818.24 $940.98 Jan 1, 2023 Contractor file
JN · Florida, Area 99 CMS 09102-99 — — $861.30 $818.24 $940.98 Jan 1, 2023 Contractor file

The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust 95709's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 95709 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

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 RVU23BApril 1 – June 30, 2023

Can you bill it with another code? Copy link

This code

95709

See every current NCCI pair for 95709 →

Reconciling a contractor-priced payment for 95709 Copy link

Checking a paid 95709 line?

Check an actual payment Model this code in a contract
What to check (3)

There is no national allowed amount for 95709, 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.
  • 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); 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 PPRRVU23_APR.csv · Q2 2023 (RVU23B) · row 17,396—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q2 2023 release
    Effective
    April 1 – June 30, 2023
    Locator
    PPRRVU23_APR.csv in rvu23b-updated-02-27-2023.zip · row 17,396 of 18,037 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 6a47fe38620fee5a…
  2. 02 MAC-published fee schedules · 3 on file—the contractor amounts
    Source
    MAC-published fee schedules
    Effective
    Effective dates shown above
  3. 03 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 2023 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 95709 National PFS baseline: No national PFS rate (Q2 2023; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU23B, PPRRVU23_APR.csv row 17,396. Localis. https://localishealth.com/cpt/95709/2023/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, 95709 ranked #2,975 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
1,435
Allowed
$1.1M
Beneficiaries
595

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