localis
Calculator

Describe a service in plain words, or type a CPT/HCPCS code.

HCPCS Q9960 Medicare payment status

Excluded from PFS

Q9960 · PFS Q4 2026

Status E is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU26DOctober 1 – December 31, 2026revision 2

PFS status evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 18,617)
Inspect PFS status evidence
Code
Q9960
Release
Q4 2026, revision 2
Result
Excluded from PFS

Citations

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

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

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

    PPRRVU2026_Oct_nonQPP.csv row 18,617 in rvu26d-updated-08-26-2026.zip

    In the CMS file

    Loading rows 18,615–18,619 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

Plain-text summaryReport a problem

HCPCS Q9960 has no published national rate. It carries status E (excluded) in the Q4 2026 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 Q9960?

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

Hocm 200-249mg/ml iodine,1ml

Payment considerations Copy link

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

NCCI same-day edits Applies MUE behavior 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, Global surgery: Does not apply, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Why would a Medicare claim for Q9960 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
  • 3 codes form NCCI pairs with Q9960 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 7 codes pair with Q9960 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
  • More than 250 units per patient per date of service exceeds Q9960's Medically Unlikely Edit (MUE) limit. See billing together

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 Q9960'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 Q9960 →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with Q9960 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

Q9951 Q9951 denies
Q9959 Q9959 denies
Q9964 Q9964 denies

Separately payable with Q9960 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

Q9958 Q9958 denies
Q9961 Q9960 denies
Q9962 Q9960 denies

Showing 3 of 7.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 10 NCCI pairs →

Medically Unlikely Edit (MUE) limit: 250 units per patient per date of service.

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for Q9960 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.

Did this answer your question about HCPCS Q9960?

Tell us what you were trying to work out and we'll answer you or build the page that does.

Did this page answer your question?

Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). 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 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 18,617)

Cite this rate

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

HCPCS Q9960 National PFS baseline: No national PFS rate (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 18,617. Localis. https://localishealth.com/hcpcs/Q9960/2026/D