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CPT 99359 Medicare payment status

Unable to determine from available CMS sources

99359 · PFS Q2 2023 · Historical

Status I is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU23BApril 1 – June 30, 2023

PFS status evidence

Physician relative value file (Q2 2023) · rvu23b-updated-02-27-2023.zip (PPRRVU23_APR.csv row 17,929)
Inspect PFS status evidence
Code
99359
Release
Q2 2023, 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 RVU23BApril 1 – June 30, 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_APR.csv row 17,929 in rvu23b-updated-02-27-2023.zip

    In the CMS file

    Loading rows 17,927–17,931 of PPRRVU23_APR.csv…

    Download rvu23b-updated-02-27-2023.zip from CMS File fingerprint 6a47fe38620fee5aff0fbba61f50983de3a9733e23acc7373c453261da6f0cd7

Report a problem

CPT 99359 has no published national rate. It carries status I (not valid) in the Q2 2023 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 99359?

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 indicators that apply to 99359: GLOB DAYS ZZZ (add-on code).

Global surgery period

Add-on code

GLOB DAYS

ZZZ

This code is always billed alongside another service and carries no follow-up period of its own. The primary procedure's global period governs; this indicator does not determine whether either line is payable.

Why would a Medicare claim for 99359 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

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 RVU23BApril 1 – June 30, 2023

Can you bill it with another code? Copy link

This code

99359

See every current NCCI pair for 99359 →

Why a 99359 line may not pay separately Copy link

Checking a paid 99359 line?

Check an actual payment Model this code in a contract
What to check (4)

CMS publishes no separately payable amount for 99359 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.
  • Reconcile this line together with the primary procedure on the same claim—it is an add-on that is never billed alone and carries no global period of its own.
  • 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); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Source & method Copy link

  1. 01 PPRRVU23_APR.csv · Q2 2023 (RVU23B) · row 17,929—status I, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q2 2023 release
    Effective
    April 1 – June 30, 2023
    Locator
    PPRRVU23_APR.csv in rvu23b-updated-02-27-2023.zip · row 17,929 of 18,037 · via CMS
    Fields read
    Status I (col 4)
    SHA-256 6a47fe38620fee5a…
    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 99359 National PFS baseline: No national PFS rate (Q2 2023; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU23B, PPRRVU23_APR.csv row 17,929. Localis. https://localishealth.com/cpt/99359/2023/B

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, 2023. -1.0% decrease since Q1 2017; peak $55.58 in Q1 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, 2023 – present

    Q1 2023

    Still in effect · 16 releases at this rate Status I
    Office
    —
    Facility
    —

    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, 2022 – Dec 31, 2022

    Q1 2022

    4 releases at this rate
    Office
    $53.99 (+$0.60, +1.1% increase)
    Facility
    $53.99 (+$0.60, +1.1% increase)

    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

  4. Jan 1, 2021 – Dec 31, 2021

    Q1 2021

    4 releases at this rate
    Office
    $53.39 (−$2.19, -3.9% decrease)
    Facility
    $53.39 (−$2.19, -3.9% decrease)

    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

  5. Jan 1, 2020 – Dec 31, 2020

    Q1 2020

    4 releases at this rate
    Office
    $55.58 (+$0.80, +1.5% increase)
    Facility
    $55.58 (+$0.80, +1.5% increase)

    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

  6. Jan 1, 2019 – Dec 31, 2019

    Q1 2019

    4 releases at this rate
    Office
    $54.78 (+$0.06, +0.1% increase)
    Facility
    $54.78 (+$0.06, +0.1% increase)

    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

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.

The 99359 rate last moved in Q1 2022. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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