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CPT 96376

Priced under CLFS

96376 · PFS Q4 2024 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CPT 96376 has no published national rate. It carries status X (statutory exclusion) in the Q4 2024 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

PFS status evidence

Physician relative value file (Q4 2024) · rvu24d.zip (PPRRVU24_OCT.csv row 18,338)
Inspect PFS status evidence
Code
96376
Release
Q4 2024, revision 1
Result
Priced under CLFS

Citations

  • Shows this code’s PFS status (X). Result: Priced under CLFS.

    Physician relative value file (PPRRVU)

    Q4 2024 · revision 1

    Latest revision of this release

    Release period: October 1 – December 31, 2024

    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 PPRRVU24_OCT.csv in rvu24d.zip (row 18,338)
    hcpcs (col 1)
    96376
    modifier (col 2)
    blank
    status_code (col 4)
    X

    SHA-256: 8ff8133723cdaa4d6d2b1680ff97286ffa7ab38dcd54b9108fc6020e633ef20b

    Original source file

Plain-text summary

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

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

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 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.

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 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.

Codes to compare

National Q4 2024 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Office Facility
96375 Priced as active rather than statutory exclusion $15.31 $15.31
96377 Priced as active rather than statutory exclusion $18.31 $18.31
96374 Priced as active rather than statutory exclusion $36.62 $36.62
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).

Which billing rules and modifiers apply? Copy link

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

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 96376 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 96376 across quarterly releases.

Release Status Office 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 and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2024 release (effective October 2024). 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 2024) · rvu24d.zip (PPRRVU24_OCT.csv row 18,338)

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

Cite this rate

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

CPT 96376 National PFS baseline: No national PFS rate (Q4 2024; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/96376/2024/D