Bundled / not separately paid
96202 · PFS Q1 2023 · Historical
No national PFS rate in Q1 2023
Status B is not separately payable under the PFS.
CMS RVU23AJanuary 1 – March 31, 2023
PFS status evidence
Inspect PFS status evidence
- Code
- 96202
- Release
- Q1 2023, revision 1
- Result
- Bundled / not separately paid
Citations
-
Shows this code’s PFS status (B). Result: Bundled / not separately paid.
Physician relative value file (PPRRVU)CMS RVU23AJanuary 1 – March 31, 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_JAN.csv row 17,646 in rvu23a-updated-01-31-2023.zip
In the CMS file
Loading rows 17,644–17,648 of PPRRVU23_JAN.csv…
Download rvu23a-updated-01-31-2023.zip from CMS File fingerprint
6f53a5e460a624cc096065c1eb974e0cc48861d51a30afa919d817c0593af2c9
CPT 96202 has no published national rate. It carries status B (bundled) in the Q1 2023 release. Medicare folds payment for this code into the service it is incident to, never onto its own line. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 96202?
Its status indicator is B (bundled). Medicare folds payment for this code into the service it is incident to, never onto its own line. Status B is not separately payable under the PFS.
Which billing rules and modifiers apply? Copy link
CMS's surgical and split-billing indicators don't adjust 96202's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 96202 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is B (bundled)—Medicare folds payment for this code into the service it is incident to, never onto its own line. See status indicators
- 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 RVU23AJanuary 1 – March 31, 2023
Can you bill it with another code? Copy link
Why a 96202 line may not pay separately Copy link
What to check (3)
CMS publishes no separately payable amount for 96202 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.
- 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.
- 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
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01 PPRRVU23_JAN.csv · Q1 2023 (RVU23A) · row 17,646—status B, RVUs limits
- Effective
- January 1 – March 31, 2023
- Locator
- PPRRVU23_JAN.csv in rvu23a-updated-01-31-2023.zip · row 17,646 of 18,010 · via CMS
- Fields read
-
Status B (col 4)SHA-256 6f53a5e460a624cc…
- Doesn’t establish
- A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
- Note
- Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
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02 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q1 2023 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 96202 National PFS baseline: No national PFS rate (Q1 2023; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU23A, PPRRVU23_JAN.csv row 17,646. Localis. https://localishealth.com/cpt/96202/2023/A
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
$20.04 Office (non-facility) and $17.37 Facility since Jan 1, 2026, after a -14.0% decrease in the Office (non-facility) amount. -13.8% decrease since Q1 2024; peak $23.63 in Q1 2024.
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Jan 1, 2026 – present
Q1 2026
Still in effect · 4 releases at this rate- Office
- $20.04 (−$3.25, -14.0% decrease)
- Facility
- $17.37 (−$3.33, -16.1% decrease)
Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present
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Jan 1, 2025 – Dec 31, 2025
Q1 2025
4 releases at this rate- Office
- $23.29 (−$0.34, -1.4% decrease)
- Facility
- $20.70 (−$0.27, -1.3% decrease)
Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025
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Mar 9, 2024 – Dec 31, 2024
Q1 2024
4 releases at this rate- Office
- $23.63 (+$0.38, +1.6% increase)
- Facility
- $20.97 (+$0.34, +1.6% increase)
Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024
-
Jan 1, 2024 – Mar 8, 2024 · Superseded revision
Q1 2024 rev 1
Revision 1, later corrected by CMS- Office
- $23.25
- Facility
- $20.63
-
Jan 1, 2023 – Dec 31, 2023
Q1 2023
4 releases at this rate- Office
- —
- Facility
- —
Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023
Earliest release in this history.
National baseline (GPCI 1.000), before sequestration.
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 96202 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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Usage and related codes Copy link
In CY2024, 96202 ranked #6,159 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 661
- Allowed
- $14,114
- Beneficiaries
- 168
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).