CPT 12011
Global 000 ActiveRpr f/e/e/n/l/m 2.5 cm/<
CPT 12011 Billing & Documentation Guide
CPT code 12011 (Rpr f/e/e/n/l/m 2.5 cm/<) is classified under Anesthesia with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.04, a non-facility practice expense RVU of 2.91, and a malpractice RVU of 0.23, a total non-facility RVU of 4.18 and facility RVU of 1.63. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $143.46, though rates vary from $122.19 to $182.83 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 12011, 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 12011 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 12011 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 12011
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.04 | 1.04 |
| Practice Expense RVU | 2.91 | 0.36 |
| Malpractice RVU | 0.23 | 0.23 |
| Total RVU | 4.18 | 1.63 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 12011
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 | $155.16 | $54.37 | $145.97 - $182.83 | 29 |
| Florida | $147.21 | $61.76 | $139.2 - $155.35 | 3 |
| Georgia | $136.7 | $55.45 | $130.59 - $142.82 | 2 |
| Illinois | $143.45 | $61.16 | $135.48 - $150.29 | 4 |
| Michigan | $136.82 | $56.84 | $132.15 - $141.48 | 2 |
| North Carolina | $130.33 | $50.86 | $130.33 - $130.33 | 1 |
| New York | $155.26 | $60.24 | $132.47 - $166.79 | 5 |
| Ohio | $131.22 | $53.46 | $131.22 - $131.22 | 1 |
| Pennsylvania | $138.47 | $55.04 | $131.22 - $145.71 | 2 |
| Texas | $137.75 | $53.9 | $130.32 - $144.45 | 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 12011
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 12011 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 |
| 0545T | Column 1 (primary), can be billed with modifier | 9 | 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 |
| 0569T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0570T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 12011
What does CPT code 12011 mean? +
CPT code 12011 represents: Rpr f/e/e/n/l/m 2.5 cm/<. It's in the Anesthesia category with a global period of 000.
What is the Medicare reimbursement for CPT 12011? +
The 2026 Medicare national average non-facility payment for CPT 12011 is $143.46. Rates range from $122.19 to $182.83 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 12011? +
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 12011? +
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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