CPT 10004
Global ZZZ ActiveFna bx w/o img gdn ea addl
CPT 10004 Billing & Documentation Guide
CPT code 10004 (Fna bx w/o img gdn ea addl) is classified under Anesthesia with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.78, a non-facility practice expense RVU of 0.68, and a malpractice RVU of 0.13, a total non-facility RVU of 1.59 and facility RVU of 1.1. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $54.01, though rates vary from $47.8 to $65.66 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 10004, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 10004 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 10004 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 10004
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.78 | 0.78 |
| Practice Expense RVU | 0.68 | 0.19 |
| Malpractice RVU | 0.13 | 0.13 |
| Total RVU | 1.59 | 1.1 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 10004
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $56.22 | $36.85 | $53.72 - $64 | 29 |
| Florida | $57.29 | $40.87 | $54.29 - $60.68 | 3 |
| Georgia | $52.96 | $37.34 | $51.49 - $54.42 | 2 |
| Illinois | $56.39 | $40.58 | $53.58 - $59.03 | 4 |
| Michigan | $53.49 | $38.13 | $51.69 - $55.29 | 2 |
| North Carolina | $50.02 | $34.75 | $50.02 - $50.02 | 1 |
| New York | $58.53 | $40.27 | $50.68 - $62.79 | 5 |
| Ohio | $51.17 | $36.22 | $51.17 - $51.17 | 1 |
| Pennsylvania | $53.18 | $37.14 | $51.01 - $55.35 | 2 |
| Texas | $52.59 | $36.48 | $50.76 - $54.79 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 10004
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 10004 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 10012 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 10035 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 19281 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 19283 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 19285 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 19287 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
Frequently Asked Questions, CPT 10004
What does CPT code 10004 mean? +
CPT code 10004 represents: Fna bx w/o img gdn ea addl. It's in the Anesthesia category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 10004? +
The 2026 Medicare national average non-facility payment for CPT 10004 is $54.01. Rates range from $47.8 to $65.66 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 10004? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 10004? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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