CPT 11042
Global 000 ActiveDbrdmt subq tis 1st 20sqcm/<
CPT 11042 Billing & Documentation Guide
CPT code 11042 (Dbrdmt subq tis 1st 20sqcm/<) is classified under Anesthesia with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.98, a non-facility practice expense RVU of 2.86, and a malpractice RVU of 0.13, a total non-facility RVU of 3.97 and facility RVU of 1.67. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $136.81, though rates vary from $117.03 to $176.41 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 11042, 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 11042 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 11042 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 11042
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.98 | 0.98 |
| Practice Expense RVU | 2.86 | 0.56 |
| Malpractice RVU | 0.13 | 0.13 |
| Total RVU | 3.97 | 1.67 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 11042
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 | $149.29 | $58.39 | $140.31 - $176.41 | 29 |
| Florida | $137.03 | $59.95 | $130.58 - $143.16 | 3 |
| Georgia | $129.11 | $55.82 | $123.12 - $135.1 | 2 |
| Illinois | $133.45 | $59.22 | $126.74 - $138.93 | 4 |
| Michigan | $128.55 | $56.41 | $124.85 - $132.24 | 2 |
| North Carolina | $124.63 | $52.96 | $124.63 - $124.63 | 1 |
| New York | $146.76 | $61.05 | $126.54 - $156.47 | 5 |
| Ohio | $124.33 | $54.19 | $124.33 - $124.33 | 1 |
| Pennsylvania | $131.24 | $55.99 | $124.53 - $137.95 | 2 |
| Texas | $130.99 | $55.36 | $123.7 - $137.71 | 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 11042
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 11042 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0183T | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 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 | Anesthesia service included in surgical procedure |
| 0228T | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0230T | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0552T | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 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 11042
What does CPT code 11042 mean? +
CPT code 11042 represents: Dbrdmt subq tis 1st 20sqcm/<. It's in the Anesthesia category with a global period of 000.
What is the Medicare reimbursement for CPT 11042? +
The 2026 Medicare national average non-facility payment for CPT 11042 is $136.81. Rates range from $117.03 to $176.41 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 11042? +
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 11042? +
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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