Contractor-priced
A9507 · PFS Q1 2013 · Historical
No national PFS rate in Q1 2013
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- A9507
- Release
- Q1 2013, revision 2
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU13AJanuary 1 – March 31, 2013revision 2
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU13_V1226_UP0.csv row 590 in rvu13ar.zip
In the CMS file
Loading rows 588–592 of PPRRVU13_V1226_UP0.csv…
Download rvu13ar.zip from CMS File fingerprint
79b1988bb9cbab6a61634b6463d26ce88cca431c3e36fa3b73792f29882d95b4
HCPCS A9507 has no published national rate. It carries status C (carrier-priced) in the Q1 2013 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 A9507?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
About this code
In111 capromab
Which billing rules and modifiers apply? Copy link
CMS's surgical and split-billing indicators don't adjust A9507's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for A9507 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
- 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 RVU13AJanuary 1 – March 31, 2013revision 2
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for A9507 Copy link
What to check (3)
There is no national allowed amount for A9507, 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.
-
01 PPRRVU13_V1226_UP0.csv · Q1 2013 (RVU13A) · row 590—priced by the contractor
- Effective
- January 1 – March 31, 2013
- Locator
- PPRRVU13_V1226_UP0.csv in rvu13ar.zip · row 590 of 15,619 · via CMS
- Fields read
-
Status C (col 4)SHA-256 79b1988bb9cbab6a…
Cite this rate
HCPCS A9507 National PFS baseline: No national PFS rate (Q1 2013; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU13A, PPRRVU13_V1226_UP0.csv row 590. Localis. https://localishealth.com/hcpcs/A9507/2013/A
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.
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