CPT 12007
Global 000 ActiveRpr s/n/ax/gen/trnk >30.0 cm
CPT 12007 Billing & Documentation Guide
CPT code 12007 (Rpr s/n/ax/gen/trnk >30.0 cm) is classified under Anesthesia with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.83, a non-facility practice expense RVU of 4.21, and a malpractice RVU of 0.62, a total non-facility RVU of 7.66 and facility RVU of 4.01. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $260.94, though rates vary from $225.98 to $318.79 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 12007, 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 12007 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 12007 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 12007
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.83 | 2.83 |
| Practice Expense RVU | 4.21 | 0.56 |
| Malpractice RVU | 0.62 | 0.62 |
| Total RVU | 7.66 | 4.01 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 12007
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 | $275.53 | $131.27 | $261.35 - $318.79 | 29 |
| Florida | $275.92 | $153.6 | $260.08 - $293.28 | 3 |
| Georgia | $253.6 | $137.29 | $244.64 - $262.55 | 2 |
| Illinois | $270.3 | $152.5 | $255.28 - $284.03 | 4 |
| Michigan | $255.71 | $141.24 | $246.29 - $265.14 | 2 |
| North Carolina | $238.95 | $125.21 | $238.95 - $238.95 | 1 |
| New York | $284.03 | $148.03 | $242.67 - $306.22 | 5 |
| Ohio | $243.78 | $132.48 | $243.78 - $243.78 | 1 |
| Pennsylvania | $255.25 | $135.83 | $243.18 - $267.31 | 2 |
| Texas | $252.72 | $132.69 | $241.72 - $263.41 | 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 12007
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 12007 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 12007
What does CPT code 12007 mean? +
CPT code 12007 represents: Rpr s/n/ax/gen/trnk >30.0 cm. It's in the Anesthesia category with a global period of 000.
What is the Medicare reimbursement for CPT 12007? +
The 2026 Medicare national average non-facility payment for CPT 12007 is $260.94. Rates range from $225.98 to $318.79 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 12007? +
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 12007? +
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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