2025 CMS CPT Query


 


2025 CMS CPT Query
(2024 Query) | (2023 Query) | (2022 Query) | (2021 Query)

Select Location:   

Select ASC Location:   

CPT:   

             

*Updated 1/1/2025 to reflect 2025 CMS fee schedule changes.
**To correctly calculate ASC facility payments based upon CMS payment rate and wage index values you need select two locations (1 for professional fees and 1 for ASC facility fees).
- Information is obtained from CMS tables and is only as accurate as the information CMS provided in data files - Physician Fee Schedule, ASC Schedule, RVUs, IPO Addenda (Addendum E) and ASC Wage Index

----> * CMS DME Query * <----              (CMS DME Files)

 
CPT Code / Description - Location:
CMS Reimbursement $0.00
Work RVU wRVUs
Global Period (DAYS) Days No global period.
Asst Surg No Assistant Surgeon Allowed.
Bilateral Not Allowed.
Multiple No Multiprocedure Allowed.


0 = Add on code (ZZZ) do not use Modifier 51 , Bill by units one line up to max units, 2nd line additional units over MUE;  
1 = CPT code needs Lt, RT or 50 =bill on 1 line with a 50 modifier (not used on hands),  
2 = Use modifier 51, paid 100%, 50%, 50%, 50% and by report, to unbundle use 59-only if appropriate.  
3 = add modifier 59 or XS,   XE Separate encounter, XP separate dr, XS separate structure, XU unusual non-overlapping service.  Endoscopy base will not be paid with another endo;  
4 = TC Diagnostic imaging ;      
9 = concept does not apply.  
Co-Surgeon No Co-Surgeon Allowed.
Status Code No Status Code.
Status Code B is not payable under any circumstances - (Medicare/Medicaid). Some insurance may pay.  
ASC Case Not an ASC case.
-
ASC CMS Reimbursement $0.00 *Includes patient's responsibility. **Medicare national base rate = $0.00.
IPO Case Not an IPO case.
* Updated 1/1/2025 with 2025 CMS files.
** Website is not for commercial use and may contain errors. Data is from CMS current as of the date above **