CPT 16036
Global ZZZ ActiveEscharotomy ea addl incision
CPT 16036 Billing & Documentation Guide
CPT code 16036 (Escharotomy ea addl incision) is classified under Anesthesia with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.46, a non-facility practice expense RVU of 0.38, and a malpractice RVU of 0.36, a total non-facility RVU of 2.2 and facility RVU of 2.2. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $73.3, though rates vary from $64.63 to $93.29 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 16036, 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 16036 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 8 units of 16036 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 16036
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.46 | 1.46 |
| Practice Expense RVU | 0.38 | 0.38 |
| Malpractice RVU | 0.36 | 0.36 |
| Total RVU | 2.2 | 2.2 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 16036
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 | $72.05 | $72.05 | $69.95 - $78.88 | 29 |
| Florida | $84.91 | $84.91 | $78.97 - $92.39 | 3 |
| Georgia | $75.34 | $75.34 | $74.42 - $76.25 | 2 |
| Illinois | $84.18 | $84.18 | $79.15 - $89.46 | 4 |
| Michigan | $77.61 | $77.61 | $73.93 - $81.29 | 2 |
| North Carolina | $68.29 | $68.29 | $68.29 - $68.29 | 1 |
| New York | $81.59 | $81.59 | $69.28 - $89.31 | 5 |
| Ohio | $72.47 | $72.47 | $72.47 - $72.47 | 1 |
| Pennsylvania | $74.49 | $74.49 | $71.78 - $77.2 | 2 |
| Texas | $72.7 | $72.7 | $71.11 - $78.3 | 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 16036
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 16036 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 11000 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11004 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11005 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11006 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11042 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11043 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11044 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11045 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11046 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 16036
What does CPT code 16036 mean? +
CPT code 16036 represents: Escharotomy ea addl incision. It's in the Anesthesia category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 16036? +
The 2026 Medicare national average non-facility payment for CPT 16036 is $73.3. Rates range from $64.63 to $93.29 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 16036? +
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 16036? +
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 June 1, 2026.
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