localis

Type a CPT/HCPCS code, a place, a service in plain words, or a whole claim line like 90837 LCSW 94110.

Try

HCPCS A9504 Medicare payment status

Contractor-priced

A9504 · PFS Q3 2026 · Historical

No national PFS rate in Q3 2026

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Check for a published amount in your locality.

View contractor sources and effective dates

PFS status evidence

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 13,871)
Inspect PFS status evidence
Code
A9504
Release
Q3 2026, revision 1
Result
Contractor-priced

Citations

  • Shows this code’s PFS status (C). Result: Contractor-priced.

    Physician relative value file (PPRRVU)CMS RVU26CJuly 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.

    PPRRVU2026_Jul_nonQPP.csv row 13,871 in rvu26c-updated-06-30-2026.zip

    In the CMS file

    Loading rows 13,869–13,873 of PPRRVU2026_Jul_nonQPP.csv…

    Download rvu26c-updated-06-30-2026.zip from CMS File fingerprint b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

Report a problem

HCPCS A9504 has no published national rate. It carries status C (carrier-priced) in the Q3 2026 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.

Why is there no national PFS amount for A9504?

Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

About this code

Tc99m apcitide

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust A9504's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for A9504 be denied or paid less?

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

  • Its status indicator is C (carrier-priced)—Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
  • 6 codes form NCCI pairs with A9504 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
  • 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.

CMS RVU26CJuly 1 – September 30, 2026

Can you bill it with another code? Copy link

A9504 has 6 NCCI pairs (Q3 2026).

This code

A9504

Modifier indicator 0

6 pairs

No modifier bypasses the edit

All 6 NCCI pairs for A9504 →

Reconciling a contractor-priced payment for A9504 Copy link

Checking a paid A9504 line?

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

There is no national allowed amount for A9504, so every reconciliation of this line runs against the MAC fee schedule that was in force for the date of service rather than against a national baseline.

  • Compare the paid amount against the MAC fee schedule in force for the date of service; there is no national allowed amount here to reconcile against.
  • 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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Source & method Copy link

The PFS file shows this code is priced by the contractor. Its amounts come from the MAC-published schedules and effective dates shown above.

  1. 01 PPRRVU2026_Jul_nonQPP.csv · Q3 2026 (RVU26C) · row 13,871—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q3 2026 release
    Effective
    July 1 – September 30, 2026
    Locator
    PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip · row 13,871 of 19,356 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 b7d197e73211ef68…
  2. 02 NCCI · Q3 2026—the code-pair edits
    Source
    National Correct Coding Initiative (NCCI)
    Effective
    Same quarter as the Q3 2026 rate

Cite this rate

HCPCS A9504 National PFS baseline: No national PFS rate (Q3 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26C, PPRRVU2026_Jul_nonQPP.csv row 13,871. Localis. https://localishealth.com/hcpcs/A9504/2026/C

Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. CMS owns the code description shown for HCPCS Level II codes. Methodology · Plain-text summary · JSON

How has it changed? Copy link

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.

Did this answer your question about HCPCS A9504?

Tell us what you were trying to work out and we'll answer you or build the page that does.

Did this page answer your question?