99255
Not valid for MedicareGlobal n/aIp/obs consltj new/est hi 80
Not valid for Medicare: Medicare uses a different code to report and pay for this service.
2026 Medicare payment
Estimated allowed amounts. Pick a locality or enter a ZIP; toggle modifiers to see how the payment rules change the number; add the add-on codes to price the whole procedure.
| Line | Qty | Non-facility (office) | Facility (hospital/ASC) |
|---|---|---|---|
| 99255 | 1 | $0.00 | $0.00 |
| add-on90833 | 0 | $81.50/ unit | $65.80/ unit |
| add-on90836 | 0 | $103.21/ unit | $83.17/ unit |
| add-on90838 | 0 | $136.61/ unit | $110.22/ unit |
| add-on96160 | 0 | $3.01/ unit | $3.01/ unit |
| add-on96161 | 0 | $3.34/ unit | $3.34/ unit |
| add-on99418 | 0 | $0.00/ unit | $0.00/ unit |
| add-onG0545 | 0 | $48.43/ unit | $40.42/ unit |
How these numbers were computed
- status=IThis code is not separately payable under the Physician Fee Schedule (status I) — amounts shown are $0.
RVU breakdown (national)
Relative value units before geographic adjustment. Payment = (work×GPCIw + PE×GPCIpe + MP×GPCImp) × CF
| Row | Work RVU | PE RVU (office) | PE RVU (facility) | MP RVU | Total (office) |
|---|---|---|---|---|---|
| 99255 | 3.86 | 1.44 | 1.44 | 0.23 | 5.53 |
Payment policy for 99255
CMS's indicator fields, translated. These control which modifiers are payable and how.
Professional/technical (PC/TC)
pctc=9Not applicable
The professional/technical concept does not apply.
Multiple procedures
mult_surg=9Not applicable
The multiple-procedure concept does not apply.
Bilateral (modifier 50)
bilt_surg=9Not applicable
The bilateral concept does not apply.
Assistant surgeon (80/81/82)
asst_surg=9Not applicable
The assistant-at-surgery concept does not apply.
Co-surgeons (modifier 62)
co_surg=9Not applicable
The co-surgeon concept does not apply.
Team surgery (modifier 66)
team_surg=9Not applicable
The team-surgery concept does not apply.
Source: pfs.data.cms.gov "Indicators for 2026", retrieved 2026-07-16; conversion factors $33.4009 / $33.5675 (QP) per CMS-1832-F. Estimated amounts — not billing or coding advice.