49507

Prp i/hern init block >5 yr

Add to my model
Code typePrimary
Payment statusActive (A)
Global period90-day

Whole-Procedure Pricing

Line
Qty
Global fee
Pro fee
Primary49507Prp i/hern init block >5 yr
1
$568.15
$568.15

RVU Breakdown

Component
Office
Facility
Work
8.86
8.86
Practice expense
5.83
5.83
Malpractice
2.32
2.32
Total RVU
17.01
17.01

Payment Policy & Modifiers

Allowed adjustments
Bilateral -50150%
With modifier 50 (both sides), payment is 150% of the single-side amount. $852.22 office.
Multiple procedure MPPRApplies
When billed with other procedures the same day: highest-valued paid 100%, the rest 50%.
Assistant surgeon -80/81/8216%
Assistant at surgery (mod 80/81/82) is paid at 16% of the fee schedule amount.
Co-surgeons -6262.5% each
Co-surgeons paid (62.5% each) if medical necessity is documented.
Not applicable to this code
Team surgeon -66Prof / tech split

Global surgery package

Major surgery: payment covers the day before, the day of, and 90 days after. Of the total payment, 9% is attributed to pre-operative care, 81% to the procedure itself, and 10% to post-operative visits.