CPT 11406
Global 010 ActiveExc tr-ext b9+marg >4.0 cm
CPT 11406 Billing & Documentation Guide
CPT code 11406 (Exc tr-ext b9+marg >4.0 cm) is classified under Anesthesia with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.43, a non-facility practice expense RVU of 5.92, and a malpractice RVU of 0.64, a total non-facility RVU of 9.99 and facility RVU of 6.82. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $341.57, though rates vary from $295.43 to $423.76 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 11406, 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 11406 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 11406 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 11406
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.43 | 3.43 |
| Practice Expense RVU | 5.92 | 2.75 |
| Malpractice RVU | 0.64 | 0.64 |
| Total RVU | 9.99 | 6.82 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 11406
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 | $364.24 | $238.95 | $344.69 - $423.76 | 29 |
| Florida | $354.57 | $248.34 | $335.73 - $374.47 | 3 |
| Georgia | $328.95 | $227.94 | $316.42 - $341.48 | 2 |
| Illinois | $346.88 | $244.57 | $328.51 - $363.15 | 4 |
| Michigan | $330.33 | $230.9 | $319.23 - $341.42 | 2 |
| North Carolina | $312.71 | $213.92 | $312.71 - $312.71 | 1 |
| New York | $369.65 | $251.53 | $317.44 - $396.7 | 5 |
| Ohio | $316.64 | $219.97 | $316.64 - $316.64 | 1 |
| Pennsylvania | $332.13 | $228.42 | $316.29 - $347.97 | 2 |
| Texas | $329.72 | $225.48 | $314.36 - $342.94 | 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 11406
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 11406 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 11406
What does CPT code 11406 mean? +
CPT code 11406 represents: Exc tr-ext b9+marg >4.0 cm. It's in the Anesthesia category with a global period of 010.
What is the Medicare reimbursement for CPT 11406? +
The 2026 Medicare national average non-facility payment for CPT 11406 is $341.57. Rates range from $295.43 to $423.76 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 11406? +
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 11406? +
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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