Contractor-priced
A9568 · PFS Q4 2026
Contractor-published range
$1,196.00
Participating · Office (non-facility) · Whole service
MAC-published fee schedules available in Localis: 3 of 144 payment localities. Missing data does not establish a $0 allowance.
No national PFS rate in Q4 2026
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
Amount evidence: MAC-published fee schedules and effective dates. The PFS row shows this code is priced by the contractor.
Inspect PFS status evidence
- Code
- A9568
- Release
- Q4 2026, revision 2
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU2026_Oct_nonQPP.csv row 13,989 in rvu26d-updated-08-26-2026.zip
In the CMS file
Loading rows 13,987–13,991 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626
HCPCS A9568 carries status C (carrier-priced) in the Q4 2026 release, so there is no single national rate—Medicare contractors publish their own amounts. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Contractor-published amounts on file range $1,196.00 across 3 localities; enter a ZIP for the exact local amount.
Why is there no national PFS amount for A9568?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
About this code
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Find the local Medicare amount for A9568 Copy link
Medicare sets this price locally
A9568 has no single national Physician Fee Schedule amount. Use the ZIP, modifier, setting, and participation fields above to match it to a Medicare locality and the contractor amount we have on file.
Your practical estimate will appear here
We hold files from First_coast across JN, most recently effective Jan 1, 2024. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.
This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.
View all 3 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JN · Florida, Area 03 CMS 09102-03 | — | — | $1,196.00 | $1,136.20 | $1,306.63 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | — | $1,196.00 | $1,136.20 | $1,306.63 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | — | $1,196.00 | $1,136.20 | $1,306.63 | Jan 1, 2024 | Contractor file |
The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.
Which billing rules and modifiers apply? Copy link
CMS's surgical and split-billing indicators don't adjust A9568's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for A9568 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
- 11 codes form NCCI pairs with A9568 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
- 1 code pairs with A9568 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
- More than 0 units per patient per date of service exceeds A9568's Medically Unlikely Edit (MUE) limit. 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 RVU26DOctober 1 – December 31, 2026revision 2
Can you bill it with another code? Copy link
A9568 has 12 NCCI pairs (Q4 2026) and an MUE of 0 units per patient per date of service.
Medically Unlikely Edit (MUE) limit
0 units
Per patient per date of service
Reconciling a contractor-priced payment for A9568 Copy link
What to check (3)
There is no national allowed amount for A9568, 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 PPRRVU2026_Oct_nonQPP.csv · Q4 2026 (RVU26D) · row 13,989—priced by the contractor
- Effective
- October 1 – December 31, 2026
- Locator
- PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip · row 13,989 of 19,453 · via CMS
- Fields read
-
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02 MAC-published fee schedules · 3 on file—the contractor amounts
- Source
- MAC-published fee schedules
- Effective
- Effective dates shown above
-
03 NCCI · Q4 2026—the code-pair edits
- Source
- National Correct Coding Initiative (NCCI)
- Effective
- Same quarter as the Q4 2026 rate
Cite this rate
HCPCS A9568 National PFS baseline: No national PFS rate (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 13,989. Localis. https://localishealth.com/hcpcs/A9568/2026/D
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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