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CPT 99255 Medicare payment status

Unable to determine from available CMS sources

99255 · PFS Q1 2022 · Historical

Status I is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU22AJanuary 1 – March 31, 2022

PFS status evidence

Physician relative value file (Q1 2022) · rvu22a.zip (PPRRVU22_JAN.csv row 17,449)
Inspect PFS status evidence
Code
99255
Release
Q1 2022, 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 RVU22AJanuary 1 – March 31, 2022

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

    PPRRVU22_JAN.csv row 17,449 in rvu22a.zip

    In the CMS file

    Loading rows 17,447–17,451 of PPRRVU22_JAN.csv…

    Download rvu22a.zip from CMS File fingerprint 10258dd1f6966657ef18c0f2c85ff446c9d799406974c4b536139a327c43799e

Report a problem

CPT 99255 has no published national rate. It carries status I (not valid) in the Q1 2022 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 99255?

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 99255's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 99255 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.

CMS RVU22AJanuary 1 – March 31, 2022

Can you bill it with another code? Copy link

This code

99255

See every current NCCI pair for 99255 →

Why a 99255 line may not pay separately Copy link

Checking a paid 99255 line?

Check an actual payment Model this code in a contract
What to check (3)

CMS publishes no separately payable amount for 99255 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 the place of service: CMS marks this code facility-only (an NA in the non-facility NA indicator) and developed no Office (non-facility) practice-expense RVUs for it; the file’s non-facility column repeats the facility value.
  • 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); CMS Practice Expense methodology (cms.gov).

Source & method Copy link

  1. 01 PPRRVU22_JAN.csv · Q1 2022 (RVU22A) · row 17,449—status I, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q1 2022 release
    Effective
    January 1 – March 31, 2022
    Locator
    PPRRVU22_JAN.csv in rvu22a.zip · row 17,449 of 17,600 · via CMS
    Fields read
    Status I (col 4)
    SHA-256 10258dd1f6966657…
    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 99255 National PFS baseline: No national PFS rate (Q1 2022; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU22A, PPRRVU22_JAN.csv row 17,449. Localis. https://localishealth.com/cpt/99255/2022/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, 2013.

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

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    —
    Facility
    —

  2. Jan 1, 2013 – present

    Q1 2013

    Still in effect · 53 releases at this rate
    Office
    —
    Facility
    —

    Q1 2013 Jan 1, 2013 – Mar 31, 2013 · Q2 2013 Apr 1, 2013 – Jun 30, 2013 · Q2 2014 Apr 1, 2014 – Jun 30, 2014 · Q3 2014 Jul 1, 2014 – Sep 30, 2014 · Q4 2014 Oct 1, 2014 – Dec 31, 2014 · Q1 2015 Jan 1, 2015 – Mar 31, 2015 · Q2 2015 Apr 1, 2015 – Jun 30, 2015 · Q3 2015 Jul 1, 2015 – Sep 30, 2015 · Q4 2015 Oct 1, 2015 – Dec 31, 2015 · Q1 2016 Jan 1, 2016 – Mar 31, 2016 · Q2 2016 Apr 1, 2016 – Jun 30, 2016 · Q3 2016 Jul 1, 2016 – Sep 30, 2016 · Q4 2016 Oct 1, 2016 – Dec 31, 2016 · 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 · 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

    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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Usage and related codes Copy link

Localis groups related codes for payment research; the grouping isn't the AMA's code families.