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CPT 96171 Medicare payment status

Excluded from PFS

96171 · PFS Q4 2026

Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

View applicable payment rules
View CMS source and method

CMS RVU26DOctober 1 – December 31, 2026revision 2

PFS status evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 12,774)
Inspect PFS status evidence
Code
96171
Release
Q4 2026, revision 2
Result
Excluded from PFS

Citations

  • Shows this code’s PFS status (N). Result: Excluded from PFS.

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

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

    PPRRVU2026_Oct_nonQPP.csv row 12,774 in rvu26d-updated-08-26-2026.zip

    In the CMS file

    Loading rows 12,772–12,776 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

Plain-text summaryReport a problem

CPT 96171 has no published national rate. It carries status N (non-covered) in the Q4 2026 release. Medicare covers no part of this service. The blank amount means unpriced, not $0.

Why is there no national PFS amount for 96171?

Its status indicator is N (non-covered). Medicare covers no part of this service. Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

NCCI same-day edits Applies MUE behavior Applies
Other payment indicators (8)
Facility/non-facility: Not determined, 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: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Why would a Medicare claim for 96171 be denied or paid less?

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

  • Its status indicator is N (non-covered)—Medicare covers no part of this service. See status indicators
  • 62 codes form NCCI pairs with 96171 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
  • 4 codes pair with 96171 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
  • More than 2 units per patient per date of service exceeds 96171's Medically Unlikely Edit (MUE) limit. 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.

Which billing rules and modifiers apply? Copy link

Global period: what 96171's fee already covers Copy link

ZZZ Add-on code

This code is always billed alongside another service and carries no follow-up period of its own. The primary procedure's global period governs; this indicator does not determine whether either line is payable.

Can you bill it with another code? Copy link

Check a pair of codes 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 for the pair.

See every current NCCI pair for 96171 →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with 96171 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

0362T 0362T denies
0373T 0373T denies
0591T 96171 denies

Showing 3 of 62.

Separately payable with 96171 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

0403T 0403T denies
0488T 0488T denies
G0396 96171 denies

Showing 3 of 4.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 66 NCCI pairs →

Medically Unlikely Edit (MUE) limit: 2 units per patient per date of service.

Why a 96171 line may not pay separately Copy link

CMS publishes no separately payable amount for 96171 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.

What to check

  • Confirm the status that governed the date of service before working this line as a short payment—CMS publishes no separately payable fee-schedule amount for it in this release.
  • Reconcile this line together with the primary procedure on the same claim—it is an add-on that is never billed alone and carries no global period of its own.
  • 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.

Compare against 96170, 96360 and 96168: their amounts are in Related codes.

Check an actual payment Model this code in a contract

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).

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 96171 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present N — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 N — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 N — —
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.

Usage and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 12,774)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

CPT 96171 National PFS baseline: No national PFS rate (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 12,774. Localis. https://localishealth.com/cpt/96171/2026/D