CPT 20526
Global 000 ActiveTher injection carp tunnel
CPT 20526 Billing & Documentation Guide
CPT code 20526 (Ther injection carp tunnel) is classified under Surgery (Musculoskeletal) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.92, a non-facility practice expense RVU of 1.55, and a malpractice RVU of 0.17, a total non-facility RVU of 2.64 and facility RVU of 1.48. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $90.25, though rates vary from $78.12 to $111.81 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 20526, 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 20526 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 20526 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 20526
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.92 | 0.92 |
| Practice Expense RVU | 1.55 | 0.39 |
| Malpractice RVU | 0.17 | 0.17 |
| Total RVU | 2.64 | 1.48 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 20526
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 | $96.17 | $50.32 | $91.04 - $111.81 | 29 |
| Florida | $93.73 | $54.85 | $88.76 - $98.98 | 3 |
| Georgia | $86.96 | $50 | $83.68 - $90.24 | 2 |
| Illinois | $91.71 | $54.28 | $86.87 - $96.01 | 4 |
| Michigan | $87.34 | $50.95 | $84.41 - $90.26 | 2 |
| North Carolina | $82.66 | $46.51 | $82.66 - $82.66 | 1 |
| New York | $97.66 | $54.44 | $83.9 - $104.8 | 5 |
| Ohio | $83.72 | $48.35 | $83.72 - $83.72 | 1 |
| Pennsylvania | $87.79 | $49.83 | $83.62 - $91.95 | 2 |
| Texas | $87.14 | $49 | $83.12 - $90.6 | 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 20526
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 20526 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | Yes | 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 |
| 10030 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 20526
What does CPT code 20526 mean? +
CPT code 20526 represents: Ther injection carp tunnel. It's in the Surgery (Musculoskeletal) category with a global period of 000.
What is the Medicare reimbursement for CPT 20526? +
The 2026 Medicare national average non-facility payment for CPT 20526 is $90.25. Rates range from $78.12 to $111.81 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 20526? +
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 20526? +
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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