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CPT 95824 Medicare carrier-priced amounts

Contractor-priced

95824 · PFS Q3 2026 · Historical

Contractor-published range

$52.62–$338.27

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 39 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q3 2026

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
95824
Release
Q3 2026, revision 1
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU26CJuly 1 – September 30, 2026

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

    PPRRVU2026_Jul_nonQPP.csv row 12,504 in rvu26c-updated-06-30-2026.zip

    In the CMS file

    Loading rows 12,502–12,506 of PPRRVU2026_Jul_nonQPP.csv…

    Download rvu26c-updated-06-30-2026.zip from CMS File fingerprint b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

Report a problem

CPT 95824 carries status C (carrier-priced) in the Q3 2026 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 $52.62–$338.27 across 39 localities; enter a ZIP for the exact local amount.

Why is there no national PFS amount for 95824?

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 95824 Copy link

Medicare sets this price locally

95824 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 and Noridian and Novitas across JE and JF and JH and JL and JN, most recently effective Jan 1, 2026. 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 48 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JE · California, Area 05 CMS 01112-05 — — $338.27 $321.36 $369.56 Jan 1, 2026 Contractor file
JE · California, Area 09 CMS 01112-09 — — $309.39 $293.92 $338.01 Jan 1, 2026 Contractor file
JE · California, Area 17 CMS 01182-17 — — $304.09 $288.89 $332.22 Jan 1, 2026 Contractor file
JE · California, Area 18 CMS 01182-18 — — $296.89 $282.05 $324.36 Jan 1, 2026 Contractor file
JE · California, Area 51 CMS 01112-51 — — $301.90 $286.81 $329.83 Jan 1, 2026 Contractor file
JE · California, Area 52 CMS 01112-52 — — $301.90 $286.81 $329.83 Jan 1, 2026 Contractor file
JE · California, Area 53 CMS 01112-53 — — $301.90 $286.81 $329.83 Jan 1, 2026 Contractor file
JE · California, Area 54 CMS 01112-54 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 55 CMS 01112-55 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 56 CMS 01112-56 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 57 CMS 01112-57 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 58 CMS 01112-58 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 59 CMS 01112-59 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 60 CMS 01112-60 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 61 CMS 01112-61 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 62 CMS 01112-62 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 63 CMS 01112-63 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 64 CMS 01112-64 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 65 CMS 01112-65 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 66 CMS 01112-66 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 67 CMS 01112-67 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 68 CMS 01112-68 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 69 CMS 01112-69 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 70 CMS 01112-70 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 71 CMS 01182-71 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 72 CMS 01182-72 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 73 CMS 01182-73 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 74 CMS 01182-74 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · California, Area 75 CMS 01112-75 — — $259.92 $246.92 $283.96 Jan 1, 2026 Contractor file
JE · Hawaii, Area 01 CMS 01212-01 — — $281.25 $267.19 $307.27 Jan 1, 2026 Contractor file
JE · Nevada, Area 00 CMS 01312-00 — — $257.25 $244.39 $281.05 Jan 1, 2026 Contractor file
JF · Idaho, Area 00 CMS 02202-00 — — $53.03 $50.38 $57.94 Jan 1, 2026 Contractor file
JF · Idaho, Area 00 CMS 02202-00 -TC — $16.22 $15.41 $17.72 Jan 1, 2026 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 -26 — $35.65 $33.87 $38.95 Jan 1, 2025 Contractor file
JL · Pennsylvania, Area 01 CMS 12502-01 — — $67.56 $64.18 $73.81 Jan 1, 2026 Contractor file
JL · Pennsylvania, Area 01 CMS 12502-01 -TC — $29.65 $28.17 $32.40 Jan 1, 2026 Contractor file
JL · Pennsylvania, Area 99 CMS 12502-99 — — $60.96 $57.91 $66.60 Jan 1, 2026 Contractor file
JL · Pennsylvania, Area 99 CMS 12502-99 -TC — $25.62 $24.34 $27.99 Jan 1, 2026 Contractor file
JN · Florida, Area 03 CMS 09102-03 — — $113.64 $107.96 $124.15 Jan 1, 2026 Contractor file
JN · Florida, Area 03 CMS 09102-03 -TC — $68.17 $64.76 $74.47 Jan 1, 2026 Contractor file
JN · Florida, Area 04 CMS 09102-04 — — $119.32 $113.35 $130.35 Jan 1, 2026 Contractor file
JN · Florida, Area 04 CMS 09102-04 -TC — $71.60 $68.02 $78.22 Jan 1, 2026 Contractor file
JN · Florida, Area 99 CMS 09102-99 — — $101.34 $96.27 $110.71 Jan 1, 2026 Contractor file
JN · Florida, Area 99 CMS 09102-99 -TC — $60.81 $57.77 $66.44 Jan 1, 2026 Contractor file
JN · Puerto Rico, Area 20 CMS 09202-20 — — $52.62 $49.99 $57.49 Jan 1, 2026 Contractor file
JN · Puerto Rico, Area 20 CMS 09202-20 -TC — $12.82 $12.18 $14.01 Jan 1, 2026 Contractor file
JN · U.S. Virgin Islands, Area 50 CMS 09202-50 — — $52.62 $49.99 $57.49 Jan 1, 2026 Contractor file
JN · U.S. Virgin Islands, Area 50 CMS 09202-50 -TC — $12.82 $12.18 $14.01 Jan 1, 2026 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 indicators that apply to 95824: PCTC 1 (splits into professional and technical).

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.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 95824 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
  • 14 codes form NCCI pairs with 95824 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 29 codes pair with 95824 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
  • 95824 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 RVU26CJuly 1 – September 30, 2026

Can you bill it with another code? Copy link

95824 has 43 NCCI pairs (Q3 2026).

This code

95824

Modifier indicator 0

14 pairs

No modifier bypasses the edit

Modifier indicator 1

29 pairs

Only with an appropriate, documented modifier

All 43 NCCI pairs for 95824 →

Reconciling a contractor-priced payment for 95824 Copy link

Checking a paid 95824 line?

Check an actual payment Model this code in a contract
What to check (4)

There is no national allowed amount for 95824, 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.
  • 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 PPRRVU2026_Jul_nonQPP.csv · Q3 2026 (RVU26C) · row 12,504—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q3 2026 release
    Effective
    July 1 – September 30, 2026
    Locator
    PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip · row 12,504 of 19,356 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 b7d197e73211ef68…
  2. 02 MAC-published fee schedules · 40 on file—the contractor amounts
    Source
    MAC-published fee schedules
    Effective
    Effective dates shown above
  3. 03 NCCI · Q3 2026—the code-pair edits
    Source
    National Correct Coding Initiative (NCCI)
    Effective
    Same quarter as the Q3 2026 rate
  4. 04 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 Q3 2026 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 95824 National PFS baseline: No national PFS rate (Q3 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26C, PPRRVU2026_Jul_nonQPP.csv row 12,504. Localis. https://localishealth.com/cpt/95824/2026/C

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, 95824 ranked #7,162 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
55
Allowed
$2,031
Beneficiaries
53

CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits). Localis groups related codes for payment research; the grouping isn't the AMA's code families.