HCPCS G0460

Contractor-priced

G0460 · PFS Q2 2014 · Historical

No national PFS rate in Q2 2014

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

View applicable payment rules

HCPCS G0460 has no published national rate. It carries status C (carrier-priced) in the Q2 2014 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 (Q2 2014) · rvu14b.zip (PPRRVU14_V0324.csv row 1,524)

Inspect PFS status evidence

Code: G0460
Release: Q2 2014, revision 1
Result: Contractor-priced

Citations

Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)
Q2 2014 · revision 1

Latest revision of this release

Release period: April 1 – June 30, 2014

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
PPRRVU14_V0324.csv in rvu14b.zip (row 1,524)

hcpcs (col 1)

G0460

modifier (col 2)

blank

status_code (col 4)

C

SHA-256: 7b855eaa1a9d047a0da04d561d43f7b3aad95b73f58b1e5c04e67df267722a0f

Original source file

Plain-text summary

Why is there no national PFS amount for G0460?

Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

About this code

Autologous prp for ulcers

Payment considerations Copy link

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

Global surgery Context required Contractor pricing Applies

Other payment indicators (8)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: 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 G0460 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
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.

Reconciling a contractor-priced payment for G0460 Copy link

There is no national allowed amount for G0460, 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.
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 Q2 2014 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code	Office	Facility
G0459 Priced as active rather than carrier-priced	$48.72	$48.72
G0458 Priced as excluded rather than carrier-priced	—	—
G0457 Nearby medicare G-code services line in the same release	—	—

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 G0460'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 G0460 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	0	No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure.
Co-surgeons	0	Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure.
Team surgery	0	Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure.
Multiple procedures	0	No reduction. No multiple-procedure reduction applies when this procedure is billed with others on the same date; each is paid at its full fee schedule amount.
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 G0460 →

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.

The G0460 rate last moved in Q1 2020. See its rate history.

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.