CPT 11603
Global 010 ActiveExc tr-ext mal+marg 2.1-3 cm
CPT 11603 Billing & Documentation Guide
CPT code 11603 (Exc tr-ext mal+marg 2.1-3 cm) is classified under Anesthesia with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.75, a non-facility practice expense RVU of 5.19, and a malpractice RVU of 0.33, a total non-facility RVU of 8.27 and facility RVU of 4.89. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $284.08, though rates vary from $246.44 to $357.84 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 11603, 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 11603 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 11603 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 11603
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.75 | 2.75 |
| Practice Expense RVU | 5.19 | 1.81 |
| Malpractice RVU | 0.33 | 0.33 |
| Total RVU | 8.27 | 4.89 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 11603
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 | $306.24 | $172.66 | $289.31 - $357.84 | 29 |
| Florida | $287.24 | $173.96 | $274.14 - $300.19 | 3 |
| Georgia | $270.56 | $162.86 | $259.62 - $281.49 | 2 |
| Illinois | $280.74 | $171.65 | $267.35 - $292.01 | 4 |
| Michigan | $270.15 | $164.14 | $262.57 - $277.72 | 2 |
| North Carolina | $260.63 | $155.3 | $260.63 - $260.63 | 1 |
| New York | $304.58 | $178.63 | $264.28 - $324.31 | 5 |
| Ohio | $261.23 | $158.16 | $261.23 - $261.23 | 1 |
| Pennsylvania | $274.26 | $163.68 | $261.4 - $287.11 | 2 |
| Texas | $273.26 | $162.12 | $259.84 - $285.21 | 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 11603
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 11603 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 |
| 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 |
| 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 |
Frequently Asked Questions, CPT 11603
What does CPT code 11603 mean? +
CPT code 11603 represents: Exc tr-ext mal+marg 2.1-3 cm. It's in the Anesthesia category with a global period of 010.
What is the Medicare reimbursement for CPT 11603? +
The 2026 Medicare national average non-facility payment for CPT 11603 is $284.08. Rates range from $246.44 to $357.84 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 11603? +
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 11603? +
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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