CPT 11403
Global 010 ActiveExc tr-ext b9+marg 2.1-3cm
CPT 11403 Billing & Documentation Guide
CPT code 11403 (Exc tr-ext b9+marg 2.1-3cm) is classified under Anesthesia with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.79, a non-facility practice expense RVU of 3.94, and a malpractice RVU of 0.25, a total non-facility RVU of 5.98 and facility RVU of 4.06. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $205.5, though rates vary from $177.13 to $260.61 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 11403, 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 11403 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 2 units of 11403 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 11403
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.79 | 1.79 |
| Practice Expense RVU | 3.94 | 2.02 |
| Malpractice RVU | 0.25 | 0.25 |
| Total RVU | 5.98 | 4.06 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 11403
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 | $222.18 | $146.29 | $209.51 - $260.61 | 29 |
| Florida | $208.08 | $143.74 | $198.15 - $217.9 | 3 |
| Georgia | $195.42 | $134.23 | $187.13 - $203.7 | 2 |
| Illinois | $203.12 | $141.15 | $192.99 - $211.63 | 4 |
| Michigan | $195.12 | $134.89 | $189.37 - $200.86 | 2 |
| North Carolina | $187.91 | $128.07 | $187.91 - $187.91 | 1 |
| New York | $220.79 | $149.24 | $190.68 - $235.59 | 5 |
| Ohio | $188.36 | $129.8 | $188.36 - $188.36 | 1 |
| Pennsylvania | $198.16 | $135.34 | $188.49 - $207.82 | 2 |
| Texas | $197.43 | $134.3 | $187.3 - $206.54 | 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 11403
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 11403 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00400 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical 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 | 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 |
| 0419T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0420T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0470T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0471T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 11403
What does CPT code 11403 mean? +
CPT code 11403 represents: Exc tr-ext b9+marg 2.1-3cm. It's in the Anesthesia category with a global period of 010.
What is the Medicare reimbursement for CPT 11403? +
The 2026 Medicare national average non-facility payment for CPT 11403 is $205.5. Rates range from $177.13 to $260.61 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 11403? +
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 11403? +
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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