CPT 17264
Global 010 ActiveDstrj mal les t/a/l 3.1-4.0
CPT 17264 Billing & Documentation Guide
CPT code 17264 (Dstrj mal les t/a/l 3.1-4.0) is classified under Anesthesia with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.94, a non-facility practice expense RVU of 3.92, and a malpractice RVU of 0.19, a total non-facility RVU of 6.05 and facility RVU of 3.27. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $208.2, though rates vary from $180.54 to $264.13 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 17264, 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 17264 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 3 units of 17264 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 17264
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.94 | 1.94 |
| Practice Expense RVU | 3.92 | 1.14 |
| Malpractice RVU | 0.19 | 0.19 |
| Total RVU | 6.05 | 3.27 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 17264
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 | $225.49 | $115.62 | $212.8 - $264.13 | 29 |
| Florida | $208.52 | $115.36 | $199.51 - $217.15 | 3 |
| Georgia | $197.39 | $108.82 | $189.15 - $205.64 | 2 |
| Illinois | $203.67 | $113.94 | $194.26 - $211.4 | 4 |
| Michigan | $196.68 | $109.49 | $191.5 - $201.85 | 2 |
| North Carolina | $191.01 | $104.38 | $191.01 - $191.01 | 1 |
| New York | $222.56 | $118.98 | $193.64 - $236.41 | 5 |
| Ohio | $190.74 | $105.96 | $190.74 - $190.74 | 1 |
| Pennsylvania | $200.41 | $109.46 | $190.99 - $209.83 | 2 |
| Texas | $199.95 | $108.54 | $189.84 - $209.08 | 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 17264
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 17264 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 |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 17264
What does CPT code 17264 mean? +
CPT code 17264 represents: Dstrj mal les t/a/l 3.1-4.0. It's in the Anesthesia category with a global period of 010.
What is the Medicare reimbursement for CPT 17264? +
The 2026 Medicare national average non-facility payment for CPT 17264 is $208.2. Rates range from $180.54 to $264.13 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 17264? +
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 17264? +
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 2, 2026.
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