CPT 90868
Status C No national payment amount. The Medicare Administrative Contractor establishes the price. Full definition →No national payment amount
Carrier-priced: no national payment amount.
No national payment amount. The Medicare Administrative Contractor establishes the price.
Common questions
Why is there no payment amount for 90868?
Its status indicator is C (carrier-priced). No national payment amount. The Medicare Administrative Contractor establishes the price. The blank is deliberate: the amount is unknown or paid another way, not zero.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October). Each release is versioned here, so past quarters stay lookupable — see what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Saw this code on your bill?
What is a 90868 visit in patient-friendly terms?
CPT 90868 is a billing code clinicians use to identify a specific service or procedure on a claim or explanation of benefits (EOB). We don't have a plain-language description on file for this exact code yet — ask your provider's billing office what service it represents, or bring it up at your next visit.
How this amount is computed
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000.
| Component | RVU |
|---|---|
| Work RVU | blank |
| Practice expense RVU (non-facility) | blank |
| Practice expense RVU (facility) | blank |
| Malpractice RVU | blank |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A value of blank means CMS publishes no national number for that part — which is not the same as zero.
Rate history by release
National non-facility amount for 90868 across quarterly releases.
Billing together (NCCI edits)
NCCI Q3 2026Per CMS's National Correct Coding Initiative. Hover a code for when it's used.
Never billable with 90868 on the same date of service
Billable with 90868 only with modifier 59, XE, XS, XP, or XU