HCPCS J1942
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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 J1942 in Q4 2018? Copy link
Not at a published national rate. HCPCS J1942 carries status E (excluded) in the Q4 2018 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 (Q4 2018) · effective October 2018 · 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 J1942?
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 J1942 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 J1942, each linking to its detail on this page.
Global period: what J1942'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 J1942.
Rate history by release Copy link
National non-facility amount for J1942 across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q4 2019 Oct 1, 2019 – present | I | — | — |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | E | — | — |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | E | — | — |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | E | — | — |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | E | — | — |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | E | — | — |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | E | — | — |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | E | — | — |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | E | — | — |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | E | — | — |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | E | — | — |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | E | — | — |
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q4 2018 release (schedule pfs, effective October 2018). 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 Q4 2018 figures, even after a newer release lands.
HCPCS J1942 Medicare Physician Fee Schedule rate (Q4 2018). Localis. https://localishealth.com/hcpcs/J1942/2018/D