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Medicare Physician Fee Schedule Effective CMS RVU25D Updated

HCPCS Q5122 Medicare payment status

HCPCS Q5122 has no published national rate. It carries status E (excluded) in the Q4 2025 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.

Excluded from PFS

Q5122 · PFS Q4 2025 · Historical

Status E is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU25DOctober 1 – December 31, 2025

HCPCS Q5122 has no published national rate. It carries status E (excluded) in the Q4 2025 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.

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PFS status evidence

Physician relative value file (Q4 2025) · rvu25d-updated-09-11-2025.zip (PPRRVU2025_Oct.csv row 18,195)
Inspect PFS status evidence
Code
Q5122
Release
Q4 2025, revision 1
Result
Excluded from PFS

Citations

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

    Physician relative value file (PPRRVU)CMS RVU25DOctober 1 – December 31, 2025

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

    PPRRVU2025_Oct.csv row 18,195 in rvu25d-updated-09-11-2025.zip

    In the CMS file

    Loading rows 18,193–18,197 of PPRRVU2025_Oct.csv…

    Download rvu25d-updated-09-11-2025.zip from CMS File fingerprint 8af460f38bf982b79b07269fbc8b7256a8ef3bd3aa025a9c5cb71c1e52523c56

Plain-text summary

Why is there no national PFS amount for Q5122?

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

Inj, nyvepria

Payment considerations Copy link

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

Other payment indicators (10)

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, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Why would a Medicare claim for Q5122 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.

Which billing rules and modifiers apply? Copy link

Global period: what Q5122's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

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 Q5122 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for Q5122 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present E — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 E — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 E — —
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.

Usage and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2025 release (effective October 2025). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. 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.

Physician relative value file (Q4 2025) · rvu25d-updated-09-11-2025.zip (PPRRVU2025_Oct.csv row 18,195)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

HCPCS Q5122 National PFS baseline: No national PFS rate (Q4 2025; participating; whole service; GPCI 1.000; sequestration excluded). CMS RVU25D, PPRRVU2025_Oct.csv row 18,195. Localis. https://localishealth.com/hcpcs/Q5122/2025/D