CPT 11043
Global 000 ActiveDbrdmt musc&/fsca 1st 20/<
CPT 11043 Billing & Documentation Guide
CPT code 11043 (Dbrdmt musc&/fsca 1st 20/<) is classified under Anesthesia with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.63, a non-facility practice expense RVU of 4.12, and a malpractice RVU of 0.42, a total non-facility RVU of 7.17 and facility RVU of 4.14. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $245.26, though rates vary from $213.28 to $303.46 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 11043, 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 11043 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 11043 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 11043
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.63 | 2.63 |
| Practice Expense RVU | 4.12 | 1.09 |
| Malpractice RVU | 0.42 | 0.42 |
| Total RVU | 7.17 | 4.14 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 11043
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 | $261.43 | $141.68 | $247.68 - $303.46 | 29 |
| Florida | $253.23 | $151.68 | $240.49 - $266.58 | 3 |
| Georgia | $236.05 | $139.5 | $227.32 - $244.77 | 2 |
| Illinois | $247.93 | $150.14 | $235.41 - $258.95 | 4 |
| Michigan | $236.81 | $141.77 | $229.32 - $244.29 | 2 |
| North Carolina | $225.2 | $130.78 | $225.2 - $225.2 | 1 |
| New York | $264.6 | $151.7 | $228.44 - $283.14 | 5 |
| Ohio | $227.62 | $135.22 | $227.62 - $227.62 | 1 |
| Pennsylvania | $238.43 | $139.29 | $227.43 - $249.42 | 2 |
| Texas | $236.84 | $137.2 | $226.1 - $246.04 | 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 11043
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 11043 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 11043
What does CPT code 11043 mean? +
CPT code 11043 represents: Dbrdmt musc&/fsca 1st 20/<. It's in the Anesthesia category with a global period of 000.
What is the Medicare reimbursement for CPT 11043? +
The 2026 Medicare national average non-facility payment for CPT 11043 is $245.26. Rates range from $213.28 to $303.46 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 11043? +
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 11043? +
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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