Unable to determine from available CMS sources
98003 · PFS Q1 2025 · Historical
Status I is not separately payable under the PFS.
CMS RVU25AJanuary 1 – March 31, 2025
PFS status evidence
Inspect PFS status evidence
- Code
- 98003
- Release
- Q1 2025, revision 1
- Result
- Unable to determine from available CMS sources
Citations
-
Shows this code’s PFS status (I). Result: Unable to determine from available CMS sources.
Physician relative value file (PPRRVU)CMS RVU25AJanuary 1 – March 31, 2025
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU25_JAN.csv row 18,623 in rvu25a-updated-01-10-2025.zip
In the CMS file
Loading rows 18,621–18,625 of PPRRVU25_JAN.csv…
Download rvu25a-updated-01-10-2025.zip from CMS File fingerprint
c0539b47cbc042fd1b69798e6dd911219f4893bb5be793ae1d1771e7a7151a54
CPT 98003 has no published national rate. It carries status I (not valid) in the Q1 2025 release. Medicare uses a different code to report and pay for this service. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 98003?
Its status indicator is I (not valid). Medicare uses a different code to report and pay for this service. Status I 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 98003's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 98003 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is I (not valid)—Medicare uses a different code to report and pay for this service. 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 RVU25AJanuary 1 – March 31, 2025
Can you bill it with another code? Copy link
Why a 98003 line may not pay separately Copy link
What to check (3)
CMS publishes no separately payable amount for 98003 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 PPRRVU25_JAN.csv · Q1 2025 (RVU25A) · row 18,623—status I, RVUs limits
- Effective
- January 1 – March 31, 2025
- Locator
- PPRRVU25_JAN.csv in rvu25a-updated-01-10-2025.zip · row 18,623 of 18,865 · via CMS
- Fields read
-
Status I (col 4)SHA-256 c0539b47cbc042fd…
- 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 98003 National PFS baseline: No national PFS rate (Q1 2025; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU25A, PPRRVU25_JAN.csv row 18,623. Localis. https://localishealth.com/cpt/98003/2025/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, 2025.
-
Jan 1, 2025 – present
Q1 2025
Still in effect · 8 releases at this rate- Office
- —
- Facility
- —
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
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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