HCPCS G0186

Contractor-priced

G0186 · 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.

View applicable payment rules

HCPCS G0186 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.

PFS status evidence

Physician relative value file (Q1 2013) · rvu13ar.zip (PPRRVU13_V1226_UP0.csv row 1,332)

Inspect PFS status evidence

Code: G0186
Release: Q1 2013, revision 2
Result: Contractor-priced

Citations

Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)
Q1 2013 · revision 2

Latest revision of this release

Release period: January 1 – March 31, 2013

This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

Record details
PPRRVU13_V1226_UP0.csv in rvu13ar.zip (row 1,332)

hcpcs (col 1)

G0186

modifier (col 2)

blank

status_code (col 4)

C

SHA-256: 79b1988bb9cbab6a61634b6463d26ce88cca431c3e36fa3b73792f29882d95b4

Original source file

Plain-text summary

Why is there no national PFS amount for G0186?

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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Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Bilateral adjustment Applies Multiple-procedure reduction Context required Assistant/co-surgeon treatment Context required Global surgery Context required Contractor pricing Applies

Other payment indicators (5)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply.

Why would a Medicare claim for G0186 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
Assistant at surgery: restricted without documentation. See billing policy
Co-surgeons: payable with documentation. See billing policy
Team surgery: payable with documentation. See billing policy
Multiple procedures: standard reduction applies. 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.

Reconciling a contractor-priced payment for G0186 Copy link

There is no national allowed amount for G0186, 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.

What to check

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.
Ask the MAC which global period it assigned: the contractor sets the follow-up window for this code, so whether a post-operative visit should have paid depends on the contractor that priced it.
Rank the claim’s procedure lines before calling a reduced line short-paid—under the standard multiple-procedure rule only the highest-valued one prices in full.
Look for modifier 50 or a second-side line before comparing: billed for both sides, this procedure should price at 150% of the single-side amount.
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.

Codes to compare

National Q1 2013 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code	Office	Facility
G0182 Priced as active rather than carrier-priced	$106.49	$106.49
G0202 Priced as active rather than carrier-priced	$138.81	$138.81
G0181 Priced as active rather than carrier-priced	$105.81	$105.81

Check an actual payment Model this code in a contract

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04).

Which billing rules and modifiers apply? Copy link

Global period: what G0186's fee already covers Copy link

YYY Contractor decides

Your Medicare Administrative Contractor decides whether a global period applies and sets its length when it prices the code. The result is 0, 10, or 90 days.

Billing policy Copy link

These billing-policy indicators explain how G0186 is treated. They apply whether the code is nationally priced or carrier-priced: a restriction like "bilateral not allowed" still matters on a carrier-priced code.

Policy	Value	What it means
Bilateral surgery	1	150% bilateral adjustment applies. Billed bilaterally (modifier 50, or on both sides), Medicare pays 150% of the single-side fee schedule amount.
Assistant at surgery	0	Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity.
Co-surgeons	1	Payable with documentation. Co-surgeons may be paid, but only with supporting documentation establishing the medical necessity of two surgeons.
Team surgery	1	Payable with documentation. A surgical team may be paid, but only with supporting documentation establishing medical necessity.
Multiple procedures	2	Standard reduction applies. When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.
Professional/technical split	0	No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service.

Can you bill it with another code? Copy link

Check a pair of codes 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 for the pair.

See every current NCCI pair for G0186 →

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.

Usage and related codes Copy link

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Source & method

Show sources

Contractor amounts come from the MAC-published schedules and effective dates shown above. The PFS file shows this code is priced by the contractor. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. CMS owns the code description shown for HCPCS Level II codes. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.