CPT 21011
Global 090 ActiveExc face les sc <2 cm
CPT 21011 Billing & Documentation Guide
CPT code 21011 (Exc face les sc <2 cm) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.92, a non-facility practice expense RVU of 8.38, and a malpractice RVU of 0.53, a total non-facility RVU of 11.83 and facility RVU of 7.49. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $406.79, though rates vary from $347.08 to $521.36 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 21011, 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 21011 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 4 units of 21011 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 21011
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.92 | 2.92 |
| Practice Expense RVU | 8.38 | 4.04 |
| Malpractice RVU | 0.53 | 0.53 |
| Total RVU | 11.83 | 7.49 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 21011
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 | $441.83 | $270.3 | $415.45 - $521.36 | 29 |
| Florida | $412.82 | $267.38 | $391.72 - $433.68 | 3 |
| Georgia | $385.88 | $247.59 | $368.3 - $403.46 | 2 |
| Illinois | $402.16 | $262.09 | $380.75 - $420.14 | 4 |
| Michigan | $385.28 | $249.15 | $373.07 - $397.48 | 2 |
| North Carolina | $369.99 | $234.74 | $369.99 - $369.99 | 1 |
| New York | $438.48 | $276.76 | $375.88 - $469.45 | 5 |
| Ohio | $370.92 | $238.57 | $370.92 - $370.92 | 1 |
| Pennsylvania | $391.5 | $249.51 | $371.21 - $411.78 | 2 |
| Texas | $390.07 | $247.36 | $368.68 - $409.54 | 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 21011
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 21011 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 | No | Standards of medical/surgical practice |
| 0216T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 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 |
| 10005 | Column 1 (primary), can be billed with modifier | Yes | Sequential procedure |
Frequently Asked Questions, CPT 21011
What does CPT code 21011 mean? +
CPT code 21011 represents: Exc face les sc <2 cm. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 21011? +
The 2026 Medicare national average non-facility payment for CPT 21011 is $406.79. Rates range from $347.08 to $521.36 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 21011? +
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 21011? +
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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