CPT 12031
Global 010 ActiveIntmd rpr s/a/t/ext 2.5 cm/<
CPT 12031 Billing & Documentation Guide
CPT code 12031 (Intmd rpr s/a/t/ext 2.5 cm/<) is classified under Anesthesia with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.95, a non-facility practice expense RVU of 5.6, and a malpractice RVU of 0.23, a total non-facility RVU of 7.78 and facility RVU of 3.99. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $268.25, though rates vary from $229.76 to $346.13 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 12031, 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 12031 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 1 units of 12031 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 12031
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.95 | 1.95 |
| Practice Expense RVU | 5.6 | 1.81 |
| Malpractice RVU | 0.23 | 0.23 |
| Total RVU | 7.78 | 3.99 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 12031
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 | $292.96 | $143.17 | $275.36 - $346.13 | 29 |
| Florida | $267.75 | $140.74 | $255.49 - $279.27 | 3 |
| Georgia | $252.86 | $132.1 | $241.13 - $264.59 | 2 |
| Illinois | $260.78 | $138.46 | $247.91 - $271.3 | 4 |
| Michigan | $251.58 | $132.71 | $244.58 - $258.58 | 2 |
| North Carolina | $244.55 | $126.45 | $244.55 - $244.55 | 1 |
| New York | $287.33 | $146.11 | $248.23 - $305.96 | 5 |
| Ohio | $243.65 | $128.07 | $243.65 - $243.65 | 1 |
| Pennsylvania | $257.14 | $133.15 | $244.1 - $270.18 | 2 |
| Texas | $256.77 | $132.14 | $242.48 - $269.96 | 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 12031
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 12031 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 |
| 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 |
Frequently Asked Questions, CPT 12031
What does CPT code 12031 mean? +
CPT code 12031 represents: Intmd rpr s/a/t/ext 2.5 cm/<. It's in the Anesthesia category with a global period of 010.
What is the Medicare reimbursement for CPT 12031? +
The 2026 Medicare national average non-facility payment for CPT 12031 is $268.25. Rates range from $229.76 to $346.13 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 12031? +
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 12031? +
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