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CPT 99252

Unable to determine from available CMS sources

99252 · PFS Q1 2013 · Historical

Status I is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

Not at a published national rate. CPT 99252 carries status I (not valid) in the Q1 2013 release. Medicare uses a different code to report and pay for this service. Treat the blank amount as unpriced, not as $0.

PFS status evidence

Physician relative value file (Q1 2013) · rvu13a.zip (PPRRVU13.csv row 15,491)
Inspect PFS status evidence
Code
99252
Release
Q1 2013, revision 1
Result
Unable to determine from available CMS sources

Citations

  • Establishes the PFS status (I) and the resulting pathway for this code: unable to determine from available cms sources.

    Physician relative value file (PPRRVU)

    Q1 2013 · revision 1

    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.csv in rvu13a.zip (row 15,491)
    hcpcs (col 1)
    99252
    modifier (col 2)
    blank
    status_code (col 4)
    I

    SHA-256: a84cdae37ebaadbaf680d8ea6051f442d6e61fb44436ca61dc94a43051d877e8

    Original source file

Compact facts

Why is there no national PFS amount for 99252?

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.

Payment considerations Copy link

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

Other payment indicators (10)

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

Why a 99252 line may not pay separately Copy link

CMS publishes no separately payable amount for 99252 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.
  • Check the place of service: CMS publishes no office (non-facility) practice-expense amount for this code, so it prices in a facility setting only.
  • 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
99251 Nearby evaluation and management line in the same release — —
99253 Nearby evaluation and management line in the same release — —
99254 Nearby evaluation and management line in the same release — —
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 Practice Expense methodology (cms.gov).

Payment rules

Global period: what 99252's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

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 99252.

See every current NCCI pair for 99252 →

Common payment questions Copy link

Why would a Medicare claim for 99252 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

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 99252 across quarterly releases.

Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 I — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 I — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 I — —
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) · rvu13a.zip (PPRRVU13.csv row 15,491)

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 99252 National PFS baseline: No national PFS rate (Q1 2013; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/99252/2013/A