CPT 11404
Global 010 ActiveExc tr-ext b9+marg 3.1-4 cm
CPT 11404 Billing & Documentation Guide
CPT code 11404 (Exc tr-ext b9+marg 3.1-4 cm) is classified under Anesthesia with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.06, a non-facility practice expense RVU of 4.5, and a malpractice RVU of 0.36, a total non-facility RVU of 6.92 and facility RVU of 4.55. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $237.37, though rates vary from $204.11 to $299.56 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 11404, 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 11404 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 11404 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 11404
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.06 | 2.06 |
| Practice Expense RVU | 4.5 | 2.13 |
| Malpractice RVU | 0.36 | 0.36 |
| Total RVU | 6.92 | 4.55 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 11404
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 | $255.64 | $161.97 | $241.15 - $299.56 | 29 |
| Florida | $243.02 | $163.59 | $230.57 - $255.68 | 3 |
| Georgia | $226.69 | $151.17 | $217.21 - $236.16 | 2 |
| Illinois | $237.26 | $160.77 | $224.83 - $247.94 | 4 |
| Michigan | $226.87 | $152.54 | $219.61 - $234.12 | 2 |
| North Carolina | $216.72 | $142.87 | $216.72 - $216.72 | 1 |
| New York | $256.09 | $167.78 | $220.05 - $274.25 | 5 |
| Ohio | $218.15 | $145.88 | $218.15 - $218.15 | 1 |
| Pennsylvania | $229.51 | $151.96 | $218.15 - $240.86 | 2 |
| Texas | $228.33 | $150.4 | $216.75 - $238.62 | 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 11404
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 11404 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 |
| 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 |
| 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 |
Frequently Asked Questions, CPT 11404
What does CPT code 11404 mean? +
CPT code 11404 represents: Exc tr-ext b9+marg 3.1-4 cm. It's in the Anesthesia category with a global period of 010.
What is the Medicare reimbursement for CPT 11404? +
The 2026 Medicare national average non-facility payment for CPT 11404 is $237.37. Rates range from $204.11 to $299.56 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 11404? +
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 11404? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team