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CPT 99442
Excluded from PFS — out of payment scope by statute, regulation, non-coverage, or reporting-only status.
No national payment amount
Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.
Did Medicare pay separately for CPT 99442 in Q1 2019? Copy link
Not at a published national rate. CPT 99442 carries status N (non-covered) in the Q1 2019 release. Medicare covers no part of this service. Treat the blank amount as unpriced, not as $0.
Source: Physician relative value file (Q1 2019) · effective January 2019 · materially updated Aug 13, 2026 · compact facts
Why isn't there a national PFS amount?
- Status N (Non-covered): Medicare covers no part of this service.
- Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.
CMS evidence · 2 sources
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Common questions Copy link
Why is there no payment amount for 99442?
Its status indicator is N (non-covered). Medicare covers no part of this service. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for 99442 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is N (non-covered) — Medicare covers no part of 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.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. The 99442 rate last moved in Q1 2024 (-0.3% non-facility) — see its rate history or what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Applicable payment rules Copy link
Only the rules that can matter for 99442, each linking to its detail on this page.
Global period: what 99442's fee already covers Copy link
The global surgery concept does not apply to this code.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
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 99442.
Rate history by release Copy link
National non-facility amount for 99442 across quarterly releases. +18.9% increase since Q2 2020 · high $92.82 in Q1 2021
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q4 2024 Oct 1, 2024 – present | A | $90.54 (0.0% no change ) | $64.91 (0.0% no change ) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | A | $90.54 (0.0% no change ) | $64.91 (0.0% no change ) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | A | $90.54 (0.0% no change ) | $64.91 (0.0% no change ) |
| Q1 2024 Jan 1, 2024 – Mar 31, 2024 | A | $90.54 (-0.3% decrease ) | $64.91 (-1.8% decrease ) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | A | $90.82 (0.0% no change ) | $66.08 (0.0% no change ) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | A | $90.82 (0.0% no change ) | $66.08 (0.0% no change ) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | A | $90.82 (0.0% no change ) | $66.08 (0.0% no change ) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | A | $90.82 (-1.0% decrease ) | $66.08 (-1.6% decrease ) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | A | $91.71 (0.0% no change ) | $67.14 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | A | $91.71 (0.0% no change ) | $67.14 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | A | $91.71 (0.0% no change ) | $67.14 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | A | $91.71 (-1.2% decrease ) | $67.14 (-1.8% decrease ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | A | $92.82 (0.0% no change ) | $68.39 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | A | $92.82 (0.0% no change ) | $68.39 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | A | $92.82 (0.0% no change ) | $68.39 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | A | $92.82 (+21.9% increase ) | $68.39 (+30.7% increase ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | A | $76.15 (0.0% no change ) | $52.33 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | A | $76.15 (0.0% no change ) | $52.33 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | A | $76.15 | $52.33 |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | N | — | — |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | N | — | — |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | N | — | — |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | N | — | — |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | N | — | — |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | N | — | — |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | N | — | — |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | N | — | — |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | N | — | — |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | N | — | — |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | N | — | — |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | N | — | — |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | N | — | — |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | N | — | — |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | N | — | — |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | N | — | — |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | N | — | — |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | N | — | — |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | N | — | — |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | N | — | — |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | N | — | — |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | N | — | — |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | N | — | — |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | N | — | — |
How often 99442 is billed Copy link
Across Original Medicare in CY2024, 99442 ranked #182 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 1.5 times on average that year.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2019 fee schedule above.
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q1 2019 release (schedule pfs, effective January 2019). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that 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 link keeps pointing at the Q1 2019 figures, even after a newer release lands.
CPT 99442 Medicare Physician Fee Schedule rate (Q1 2019). Localis. https://localishealth.com/cpt/99442/2019/A