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CPT 97170 Medicare payment status

Excluded from PFS

97170 · PFS Q1 2023 · Historical

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 RVU23AJanuary 1 – March 31, 2023

PFS status evidence

Physician relative value file (Q1 2023) · rvu23a-updated-01-31-2023.zip (PPRRVU23_JAN.csv row 17,749)
Inspect PFS status evidence
Code
97170
Release
Q1 2023, revision 1
Result
Excluded from PFS

Citations

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

    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 17,749 in rvu23a-updated-01-31-2023.zip

    In the CMS file

    Loading rows 17,747–17,751 of PPRRVU23_JAN.csv…

    Download rvu23a-updated-01-31-2023.zip from CMS File fingerprint 6f53a5e460a624cc096065c1eb974e0cc48861d51a30afa919d817c0593af2c9

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CPT 97170 has no published national rate. It carries status N (non-covered) in the Q1 2023 release. Medicare covers no part of this service. The blank amount means unpriced, not $0.

Why is there no national PFS amount for 97170?

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.

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust 97170's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 97170 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

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

This code

97170

See every current NCCI pair for 97170 →

Source & method Copy link

  1. 01 PPRRVU23_JAN.csv · Q1 2023 (RVU23A) · row 17,749—status N, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q1 2023 release
    Effective
    January 1 – March 31, 2023
    Locator
    PPRRVU23_JAN.csv in rvu23a-updated-01-31-2023.zip · row 17,749 of 18,010 · via CMS
    Fields read
    Status N (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.

Cite this rate

CPT 97170 National PFS baseline: No national PFS rate (Q1 2023; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU23A, PPRRVU23_JAN.csv row 17,749. Localis. https://localishealth.com/cpt/97170/2023/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

— Office (non-facility) and — Facility since Jan 1, 2020.

  1. Jan 1, 2024 – Mar 8, 2024 · Superseded revision

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    —
    Facility
    —

  2. Jan 1, 2020 – present

    Q1 2020

    Still in effect · 28 releases at this rate Status N
    Office
    —
    Facility
    —

    Q1 2020 Jan 1, 2020 – Mar 31, 2020 · Q2 2020 Apr 1, 2020 – Jun 30, 2020 · Q3 2020 Jul 1, 2020 – Sep 30, 2020 · Q4 2020 Oct 1, 2020 – Dec 31, 2020 · Q1 2021 Jan 1, 2021 – Mar 31, 2021 · Q2 2021 Apr 1, 2021 – Jun 30, 2021 · Q3 2021 Jul 1, 2021 – Sep 30, 2021 · Q4 2021 Oct 1, 2021 – Dec 31, 2021 · Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022 · 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 · 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 · 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 · 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

  3. Jan 1, 2017 – Dec 31, 2019

    Q1 2017

    12 releases at this rate
    Office
    —
    Facility
    —

    Q1 2017 Jan 1, 2017 – Mar 31, 2017 · Q2 2017 Apr 1, 2017 – Jun 30, 2017 · Q3 2017 Jul 1, 2017 – Sep 30, 2017 · Q4 2017 Oct 1, 2017 – Dec 31, 2017 · Q1 2018 Jan 1, 2018 – Mar 31, 2018 · Q2 2018 Apr 1, 2018 – Jun 30, 2018 · Q3 2018 Jul 1, 2018 – Sep 30, 2018 · Q4 2018 Oct 1, 2018 – Dec 31, 2018 · Q1 2019 Jan 1, 2019 – Mar 31, 2019 · Q2 2019 Apr 1, 2019 – Jun 30, 2019 · Q3 2019 Jul 1, 2019 – Sep 30, 2019 · Q4 2019 Oct 1, 2019 – Dec 31, 2019

    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.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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