HCPCS G0164
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Excluded from PFS — out of payment scope by statute, regulation, non-coverage, or reporting-only status.
No national payment amount
Status E is not separately payable under the PFS.
Did Medicare pay separately for HCPCS G0164 in Q1 2015? Copy link
Not at a published national rate. HCPCS G0164 carries status E (excluded) in the Q1 2015 release. A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. Treat the blank amount as unpriced, not as $0.
Source: Physician relative value file (Q1 2015) · effective January 2015 · materially updated Aug 4, 2026 · compact facts
Why isn't there a national PFS amount?
- Status E (Excluded): A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead.
- Status E is not separately payable under the PFS.
CMS evidence · 2 sources
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Common questions Copy link
Why is there no payment amount for G0164?
Its status indicator is E (excluded). A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. 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 G0164 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is E (excluded) — A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. 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. See 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 G0164, each linking to its detail on this page.
Global period: what G0164'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 G0164.
Rate history by release Copy link
National non-facility amount for G0164 across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q4 2016 Oct 1, 2016 – present | E | — | — |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | E | — | — |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | E | — | — |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | E | — | — |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | E | — | — |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | E | — | — |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | E | — | — |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | E | — | — |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | E | — | — |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | E | — | — |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | E | — | — |
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q1 2015 release (schedule pfs, effective January 2015). 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. CMS owns the code description shown for HCPCS Level II codes. 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 2015 figures, even after a newer release lands.
HCPCS G0164 Medicare Physician Fee Schedule rate (Q1 2015). Localis. https://localishealth.com/hcpcs/G0164/2015/A