HCPCS G0460
Autolog prp not diab ulcer
Contractor-priced — your Medicare Administrative Contractor sets the amount, not a national fee schedule.
No national payment amount
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Contractor-published range
$788.39–$865.59
Enter your ZIP above for the exact amount. Contractor files on record cover 3 of 119 payment localities — a locality we don't hold means our coverage is incomplete, not that Medicare pays $0.
How much does Medicare pay for HCPCS G0460? Copy link
HCPCS G0460 carries status C (carrier-priced) in the Q3 2022 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 $788.39–$865.59 across 3 localities; enter a ZIP for the exact local amount.
Source: Physician relative value file (Q3 2022) · effective July 2022 · materially updated Aug 7, 2026 · compact facts
Why isn't there a national PFS amount?
- Status C (Carrier-priced): Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
- Carrier-priced: no national payment amount.
CMS evidence · 2 sources
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Find the local Medicare amount for G0460 Copy link
Medicare sets this price locally
G0460 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, 2022. 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 6 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JN · Florida, Area 03 CMS 09102-03 | — | — | $839.53 | $797.55 | $917.18 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | — | # | $135.97 | $129.17 | $148.55 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | — | $865.59 | $822.31 | $945.66 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | # | $146.57 | $139.24 | $160.13 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | — | $788.39 | $748.97 | $861.32 | Jan 1, 2022 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | # | $128.41 | $121.99 | $140.29 | Jan 1, 2022 | 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.
Common questions Copy link
Why is there no payment amount for G0460?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. 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 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
- Assistant at surgery: never separately payable. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. 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.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. The G0460 rate last moved in Q1 2020 (-0.4% non-facility) — see its rate history or 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 G0460, each linking to its detail on this page.
Global period: what G0460'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.
Billing policy Copy link
What G0460's billing-policy indicators mean. These show for every code, priced or not: 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. |
| Assistant at surgery | 1 | Never separately payable. An assistant at surgery may never be separately paid for this procedure — a statutory restriction. |
| 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 | 2 | Standard reduction applies. The same standard ranking-and-reduction rule as indicator 1 applies to this procedure when billed with others on the same date. |
| 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
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 G0460.
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q3 2022 release (schedule pfs, effective July 2022). 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 Q3 2022 figures, even after a newer release lands.
HCPCS G0460 Medicare Physician Fee Schedule rate (Q3 2022). Localis. https://localishealth.com/hcpcs/G0460/2022/C