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CPT 95999 Medicare payment status

Contractor-priced

95999 · PFS Q3 2016 · Historical

No national PFS rate in Q3 2016

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

PFS status evidence

Physician relative value file (Q3 2016) · rvu16c.zip (PPRRVU16_V0517.csv row 15,943)
Inspect PFS status evidence
Code
95999
Release
Q3 2016, revision 1
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU16CJuly 1 – September 30, 2016

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

    PPRRVU16_V0517.csv row 15,943 in rvu16c.zip

    In the CMS file

    Loading rows 15,941–15,945 of PPRRVU16_V0517.csv…

    Download rvu16c.zip from CMS File fingerprint 81464316ee60bdd4aa33b47a636b521a77a73481c795300cbab67f48dbe432d9

Report a problem

CPT 95999 has no published national rate. It carries status C (carrier-priced) in the Q3 2016 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 95999?

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

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust 95999's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 95999 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 RVU16CJuly 1 – September 30, 2016

Can you bill it with another code? Copy link

This code

95999

See every current NCCI pair for 95999 →

Reconciling a contractor-priced payment for 95999 Copy link

Checking a paid 95999 line?

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

There is no national allowed amount for 95999, 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 PPRRVU16_V0517.csv · Q3 2016 (RVU16C) · row 15,943—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q3 2016 release
    Effective
    July 1 – September 30, 2016
    Locator
    PPRRVU16_V0517.csv in rvu16c.zip · row 15,943 of 16,313 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 81464316ee60bdd4…
  2. 02 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 2016 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 95999 National PFS baseline: No national PFS rate (Q3 2016; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU16C, PPRRVU16_V0517.csv row 15,943. Localis. https://localishealth.com/cpt/95999/2016/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, 95999 ranked #6,713 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
95
Allowed
$21,474
Beneficiaries
90

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.