Contractor-priced
G0399 · PFS Q1 2015 · Historical
No national PFS rate in Q1 2015
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- G0399
- Release
- Q1 2015, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU15AJanuary 1 – March 31, 2015
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU15_V1223c.csv row 1,469 in rvu15a.zip
In the CMS file
Loading rows 1,467–1,471 of PPRRVU15_V1223c.csv…
Download rvu15a.zip from CMS File fingerprint
d600c52a7d5f75737599c9a879cc0ffc8c85766bee82e9e2eadf49af364314d2
HCPCS G0399 has no published national rate. It carries status C (carrier-priced) in the Q1 2015 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 G0399?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
About this code
Home sleep test/type 3 porta
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to G0399: PCTC 1 (splits into professional and technical).
Splits into professional and technical
PCTC
1
This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable.
Global surgery period XXX (does not apply).
Why would a Medicare claim for G0399 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
- G0399 splits into a professional component (modifier 26) and a technical component (modifier TC)—a claim for only one part needs that modifier to price correctly. See billing policy
- 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 RVU15AJanuary 1 – March 31, 2015
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for G0399 Copy link
What to check (4)
There is no national allowed amount for G0399, 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.
- Confirm which component the line carried before comparing anything: the same code prices three ways—globally, as a professional component with modifier 26, and as a technical component with modifier TC.
- 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); CMS Medicare Claims Processing Manual (Pub. 100-04); 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 PPRRVU15_V1223c.csv · Q1 2015 (RVU15A) · row 1,469—priced by the contractor
- Effective
- January 1 – March 31, 2015
- Locator
- PPRRVU15_V1223c.csv in rvu15a.zip · row 1,469 of 16,083 · via CMS
- Fields read
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Status C (col 4)SHA-256 d600c52a7d5f7573…
Cite this rate
HCPCS G0399 National PFS baseline: No national PFS rate (Q1 2015; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU15A, PPRRVU15_V1223c.csv row 1,469. Localis. https://localishealth.com/hcpcs/G0399/2015/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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Usage and related codes Copy link
Localis groups related codes for payment research; the grouping isn't the AMA's code families.