CPT 11423
Global 010 ActiveExc h-f-nk-sp b9+marg 2.1-3
CPT 11423 Billing & Documentation Guide
CPT code 11423 (Exc h-f-nk-sp b9+marg 2.1-3) is classified under Anesthesia with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.01, a non-facility practice expense RVU of 3.97, and a malpractice RVU of 0.27, a total non-facility RVU of 6.25 and facility RVU of 4.3. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $214.61, though rates vary from $185.68 to $270.57 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 11423, 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 11423 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 11423 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 11423
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.01 | 2.01 |
| Practice Expense RVU | 3.97 | 2.02 |
| Malpractice RVU | 0.27 | 0.27 |
| Total RVU | 6.25 | 4.3 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 11423
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 | $231.34 | $154.27 | $218.44 - $270.57 | 29 |
| Florida | $217.74 | $152.39 | $207.46 - $227.98 | 3 |
| Georgia | $204.53 | $142.39 | $196.17 - $212.89 | 2 |
| Illinois | $212.73 | $149.8 | $202.3 - $221.57 | 4 |
| Michigan | $204.34 | $143.19 | $198.38 - $210.3 | 2 |
| North Carolina | $196.62 | $135.85 | $196.62 - $196.62 | 1 |
| New York | $230.51 | $157.85 | $199.45 - $245.84 | 5 |
| Ohio | $197.29 | $137.83 | $197.29 - $197.29 | 1 |
| Pennsylvania | $207.27 | $143.47 | $197.39 - $217.14 | 2 |
| Texas | $206.43 | $142.31 | $196.18 - $215.55 | 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 11423
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 11423 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 11423
What does CPT code 11423 mean? +
CPT code 11423 represents: Exc h-f-nk-sp b9+marg 2.1-3. It's in the Anesthesia category with a global period of 010.
What is the Medicare reimbursement for CPT 11423? +
The 2026 Medicare national average non-facility payment for CPT 11423 is $214.61. Rates range from $185.68 to $270.57 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 11423? +
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 11423? +
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