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HCPCS J2403 Medicare payment status

Excluded from PFS

J2403 · PFS Q3 2023 · Historical

Status E is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU23CJuly 1 – September 30, 2023

PFS status evidence

Physician relative value file (Q3 2023) · rvu23c.zip (PPRRVU23_JUL.csv row 3,480)
Inspect PFS status evidence
Code
J2403
Release
Q3 2023, revision 1
Result
Excluded from PFS

Citations

  • Shows this code’s PFS status (E). Result: Excluded from PFS.

    Physician relative value file (PPRRVU)CMS RVU23CJuly 1 – September 30, 2023

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

    PPRRVU23_JUL.csv row 3,480 in rvu23c.zip

    In the CMS file

    Loading rows 3,478–3,482 of PPRRVU23_JUL.csv…

    Download rvu23c.zip from CMS File fingerprint 64251eae48773025b05c6e45a77e1909e7151c421fe8f346124ba9623c491e37

Report a problem

HCPCS J2403 has no published national rate. It carries status E (excluded) in the Q3 2023 release. A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. The blank amount means unpriced, not $0.

Why is there no national PFS amount for J2403?

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. Status E is not separately payable under the PFS.

About this code

Chloroprocaine opht gel, 1mg

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust J2403's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for J2403 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.

CMS RVU23CJuly 1 – September 30, 2023

Can you bill it with another code? Copy link

This code

J2403

See every current NCCI pair for J2403 →

Source & method Copy link

  1. 01 PPRRVU23_JUL.csv · Q3 2023 (RVU23C) · row 3,480—status E, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q3 2023 release
    Effective
    July 1 – September 30, 2023
    Locator
    PPRRVU23_JUL.csv in rvu23c.zip · row 3,480 of 18,132 · via CMS
    Fields read
    Status E (col 4)
    SHA-256 64251eae48773025…
    Doesn’t establish
    A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
    Note
    Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.

Cite this rate

HCPCS J2403 National PFS baseline: No national PFS rate (Q3 2023; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU23C, PPRRVU23_JUL.csv row 3,480. Localis. https://localishealth.com/hcpcs/J2403/2023/C

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

— Office (non-facility) and — Facility since Apr 1, 2023.

  1. Jan 1, 2024 – Mar 8, 2024 · Superseded revision

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    —
    Facility
    —

  2. Apr 1, 2023 – present

    Q2 2023

    Still in effect · 15 releases at this rate
    Office
    —
    Facility
    —

    Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023 · Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024 · Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025 · Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present

    Earliest release in this history.

National baseline (GPCI 1.000), before sequestration.

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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