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CPT 96376

Priced under CLFS

96376 · PFS Q1 2013 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

Not at a published national rate. CPT 96376 carries status X (statutory exclusion) in the Q1 2013 release. The statutory definition of physician services does not include this item. Treat the blank amount as unpriced, not as $0.

PFS status evidence

Physician relative value file (Q1 2013) · rvu13ar.zip (PPRRVU13_V1226_UP0.csv row 15,310)
Inspect PFS status evidence
Code
96376
Release
Q1 2013, revision 2
Result
Priced under CLFS

Citations

  • Establishes the PFS status (X) and the resulting pathway for this code: priced under clfs.

    Physician relative value file (PPRRVU)

    Q1 2013 · revision 2

    Latest revision of this release

    Release period: January 1 – March 31, 2013

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

    Record details PPRRVU13_V1226_UP0.csv in rvu13ar.zip (row 15,310)
    hcpcs (col 1)
    96376
    modifier (col 2)
    blank
    status_code (col 4)
    X

    SHA-256: 79b1988bb9cbab6a61634b6463d26ce88cca431c3e36fa3b73792f29882d95b4

    Original source file

Compact facts

Why is there no national PFS amount for 96376?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. Status X is not separately payable under the PFS.

Payment considerations Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Other fee-schedule routing Applies
Other payment indicators (9)

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, NCCI same-day edits: Not determined, MUE behavior: Not determined, Contractor pricing: Does not apply.

Why a 96376 line may not pay separately Copy link

CMS publishes no separately payable amount for 96376 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 reconcile

  • 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.

Nearby payment lines

National Q1 2013 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Why compare Office Facility
96375 Priced as active rather than statutory exclusion $22.46 $22.46
96374 Priced as active rather than statutory exclusion $57.50 $57.50
96379 Priced as carrier-priced rather than statutory exclusion — —
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).

Payment rules

Global period: what 96376'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

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 96376.

See every current NCCI pair for 96376 →

Common payment questions Copy link

Why would a Medicare claim for 96376 be denied or paid less?

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

  • Its status indicator is X (statutory exclusion)—The statutory definition of physician services does not include this item. See status indicators

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.

History

Rate history by release Copy link

National non-facility amount for 96376 across quarterly releases.

Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 X — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
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 & related

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q1 2013 release (effective January 2013). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q1 2013) · rvu13ar.zip (PPRRVU13_V1226_UP0.csv row 15,310)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 96376 National PFS baseline: No national PFS rate (Q1 2013; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/96376/2013/A