CPT 10160
Global 010 ActivePnxr aspir absc hmtma bulla
CPT 10160 Billing & Documentation Guide
CPT code 10160 (Pnxr aspir absc hmtma bulla) is classified under Anesthesia with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.22, a non-facility practice expense RVU of 2.56, and a malpractice RVU of 0.16, a total non-facility RVU of 3.94 and facility RVU of 2.74. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $135.39, though rates vary from $116.95 to $171.4 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 10160, 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 10160 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 10160 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 10160
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.22 | 1.22 |
| Practice Expense RVU | 2.56 | 1.36 |
| Malpractice RVU | 0.16 | 0.16 |
| Total RVU | 3.94 | 2.74 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 10160
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 | $146.28 | $98.86 | $138.02 - $171.4 | 29 |
| Florida | $136.95 | $96.73 | $130.53 - $143.28 | 3 |
| Georgia | $128.78 | $90.54 | $123.39 - $134.16 | 2 |
| Illinois | $133.73 | $95 | $127.17 - $139.23 | 4 |
| Michigan | $128.56 | $90.93 | $124.85 - $132.27 | 2 |
| North Carolina | $123.94 | $86.55 | $123.94 - $123.94 | 1 |
| New York | $145.34 | $100.62 | $125.74 - $154.95 | 5 |
| Ohio | $124.2 | $87.61 | $124.2 - $124.2 | 1 |
| Pennsylvania | $130.58 | $91.33 | $124.29 - $136.87 | 2 |
| Texas | $130.12 | $90.66 | $123.52 - $136.03 | 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 10160
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 10160 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01995 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 10160
What does CPT code 10160 mean? +
CPT code 10160 represents: Pnxr aspir absc hmtma bulla. It's in the Anesthesia category with a global period of 010.
What is the Medicare reimbursement for CPT 10160? +
The 2026 Medicare national average non-facility payment for CPT 10160 is $135.39. Rates range from $116.95 to $171.4 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 10160? +
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 10160? +
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 May 31, 2026.
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