CPT 12004
Global 000 ActiveRpr s/n/ax/gen/trk7.6-12.5cm
CPT 12004 Billing & Documentation Guide
CPT code 12004 (Rpr s/n/ax/gen/trk7.6-12.5cm) is classified under Anesthesia with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.4, a non-facility practice expense RVU of 3.12, and a malpractice RVU of 0.33, a total non-facility RVU of 4.85 and facility RVU of 2.16. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $165.91, though rates vary from $141.95 to $208.08 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 12004, 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 12004 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 12004 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 12004
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.4 | 1.4 |
| Practice Expense RVU | 3.12 | 0.43 |
| Malpractice RVU | 0.33 | 0.33 |
| Total RVU | 4.85 | 2.16 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 12004
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 | $177.72 | $71.41 | $167.68 - $208.08 | 29 |
| Florida | $172.78 | $82.63 | $162.95 - $183.12 | 3 |
| Georgia | $159.44 | $73.72 | $152.86 - $166.02 | 2 |
| Illinois | $168.68 | $81.87 | $159.13 - $177.12 | 4 |
| Michigan | $160.13 | $75.76 | $154.35 - $165.91 | 2 |
| North Carolina | $151.03 | $67.2 | $151.03 - $151.03 | 1 |
| New York | $180.22 | $79.98 | $153.51 - $194.13 | 5 |
| Ohio | $153.02 | $70.98 | $153.02 - $153.02 | 1 |
| Pennsylvania | $161.04 | $73.03 | $152.84 - $169.24 | 2 |
| Texas | $159.85 | $71.4 | $151.83 - $166.88 | 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 12004
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 12004 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 0543T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0545T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0567T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0568T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 12004
What does CPT code 12004 mean? +
CPT code 12004 represents: Rpr s/n/ax/gen/trk7.6-12.5cm. It's in the Anesthesia category with a global period of 000.
What is the Medicare reimbursement for CPT 12004? +
The 2026 Medicare national average non-facility payment for CPT 12004 is $165.91. Rates range from $141.95 to $208.08 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 12004? +
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 12004? +
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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