CPT 99358
Unable to determine from available CMS sources
99358 · PFS Q3 2026
Status I is not separately payable under the PFS.
Not at a published national rate. CPT 99358 carries status I (not valid) in the Q3 2026 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
Inspect PFS status evidence
- Code
- 99358
- Release
- Q3 2026, 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)Q3 2026 · revision 1
Latest revision of this release
Release period: July 1 – September 30, 2026
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
PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 13,001)- hcpcs (col 1)
- 99358
- modifier (col 2)
- blank
- status_code (col 4)
- I
SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21
Why is there no national PFS amount for 99358?
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 (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: Does not apply, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Why a 99358 line may not pay separately Copy link
CMS publishes no separately payable amount for 99358 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 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.
Nearby payment lines
National Q3 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
No comparison lines are present in this release.
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.
Global period: what 99358's fee already covers Copy link
The global surgery concept does not apply to this code.
Billing policy Copy link
What 99358's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 0 | No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date—each is treated as unrelated. |
| Professional/technical split | 0 | No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service. |
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 99358.
Billing together (NCCI edits) Copy link
NCCI Q3 2026Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.
Not separately payable with 99358 on the same date of service—no modifier bypasses the edit (modifier indicator 0)
Showing 3 of 427.
Separately payable with 99358 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)
Showing 3 of 196.
Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.
Common payment questions Copy link
Why would a Medicare claim for 99358 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
- 427 codes form NCCI pairs with 99358 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
- 196 codes pair with 99358 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
- 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.
Rate history by release Copy link
National non-facility amount for 99358 across quarterly releases. -2.4% decrease since Q1 2017 · high $113.76 in Q1 2018
| 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 | — | — |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | I | — | — |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | I | — | — |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | I | — | — |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | I | — | — |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | I | — | — |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | I | — | — |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | I | — | — |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | I | — | — |
| Q1 2024 Mar 9, 2024 – Mar 31, 2024 | I | — | — |
| Q1 2024 Jan 1, 2024 – Mar 8, 2024 | I | — | — |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | I | — | — |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | I | — | — |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | I | — | — |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | I | — | — |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | A | $110.74 (0.0% no change ) | $110.74 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | A | $110.74 (0.0% no change ) | $110.74 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | A | $110.74 (0.0% no change ) | $110.74 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | A | $110.74 (-0.8% decrease ) | $110.74 (-0.8% decrease ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | A | $111.66 (0.0% no change ) | $111.66 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | A | $111.66 (0.0% no change ) | $111.66 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | A | $111.66 (0.0% no change ) | $111.66 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | A | $111.66 (-1.8% decrease ) | $111.66 (-1.8% decrease ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | A | $113.68 (0.0% no change ) | $113.68 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | A | $113.68 (0.0% no change ) | $113.68 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | A | $113.68 (0.0% no change ) | $113.68 (0.0% no change ) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | A | $113.68 (+0.1% increase ) | $113.68 (+0.1% increase ) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | A | $113.52 (0.0% no change ) | $113.52 (0.0% no change ) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | A | $113.52 (0.0% no change ) | $113.52 (0.0% no change ) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | A | $113.52 (0.0% no change ) | $113.52 (0.0% no change ) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | A | $113.52 (-0.2% decrease ) | $113.52 (-0.2% decrease ) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | A | $113.76 (0.0% no change ) | $113.76 (0.0% no change ) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | A | $113.76 (0.0% no change ) | $113.76 (0.0% no change ) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | A | $113.76 (0.0% no change ) | $113.76 (0.0% no change ) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | A | $113.76 (+0.3% increase ) | $113.76 (+0.3% increase ) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | A | $113.41 (0.0% no change ) | $113.41 (0.0% no change ) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | A | $113.41 (0.0% no change ) | $113.41 (0.0% no change ) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | A | $113.41 (0.0% no change ) | $113.41 (0.0% no change ) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | A | $113.41 | $113.41 |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | B | — | — |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | B | — | — |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | B | — | — |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | B | — | — |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | B | — | — |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | B | — | — |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | B | — | — |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | B | — | — |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | B | — | — |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | B | — | — |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | B | — | — |
| Q1 2013 Jan 1, 2013 – Mar 31, 2013 | B | — | — |
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.
The 99358 rate last moved in Q1 2022. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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Source & method
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This page uses CMS's Medicare Physician Fee Schedule Q3 2026 release (effective July 2026). 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.
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 99358 National PFS baseline: No national PFS rate (Q3 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/99358/2026/C