Contractor-priced
A9540 · PFS Q1 2016 · Historical
No national PFS rate in Q1 2016
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
PFS status evidence
Inspect PFS status evidence
- Code
- A9540
- Release
- Q1 2016, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU16AJanuary 1 – March 31, 2016
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU16_V0122.csv row 614 in rvu16a.zip
In the CMS file
Loading rows 612–616 of PPRRVU16_V0122.csv…
Download rvu16a.zip from CMS File fingerprint
e7973024293c4f8bd19119f0479a6b7bdc36435376c6b05a22fd3cd3cec5b13c
HCPCS A9540 has no published national rate. It carries status C (carrier-priced) in the Q1 2016 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 A9540?
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 maa
Which billing rules and modifiers apply? Copy link
CMS's surgical and split-billing indicators don't adjust A9540's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for A9540 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 RVU16AJanuary 1 – March 31, 2016
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for A9540 Copy link
What to check (3)
There is no national allowed amount for A9540, 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.
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01 PPRRVU16_V0122.csv · Q1 2016 (RVU16A) · row 614—priced by the contractor
- Effective
- January 1 – March 31, 2016
- Locator
- PPRRVU16_V0122.csv in rvu16a.zip · row 614 of 16,289 · via CMS
- Fields read
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Status C (col 4)SHA-256 e7973024293c4f8b…
Cite this rate
HCPCS A9540 National PFS baseline: No national PFS rate (Q1 2016; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU16A, PPRRVU16_V0122.csv row 614. Localis. https://localishealth.com/hcpcs/A9540/2016/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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