CPT 21016
Global 090 ActiveResect face/scalp tum 2 cm/>
CPT 21016 Billing & Documentation Guide
CPT code 21016 (Resect face/scalp tum 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 14.88, a non-facility practice expense RVU of 9.36, and a malpractice RVU of 2.75, a total non-facility RVU of 26.99 and facility RVU of 26.99. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $912.06, though rates vary from $812.86 to $1129.07 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 21016, 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 21016 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 2 units of 21016 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 21016
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 14.88 | 14.88 |
| Practice Expense RVU | 9.36 | 9.36 |
| Malpractice RVU | 2.75 | 2.75 |
| Total RVU | 26.99 | 26.99 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 21016
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 | $934.56 | $934.56 | $897.33 - $1051.72 | 29 |
| Florida | $989.49 | $989.49 | $933.94 - $1054.75 | 3 |
| Georgia | $905.91 | $905.91 | $885.36 - $926.45 | 2 |
| Illinois | $976.36 | $976.36 | $926 - $1025.48 | 4 |
| Michigan | $919.85 | $919.85 | $886.14 - $953.56 | 2 |
| North Carolina | $847.39 | $847.39 | $847.39 - $847.39 | 1 |
| New York | $994.22 | $994.22 | $858.58 - $1071.1 | 5 |
| Ohio | $875.03 | $875.03 | $875.03 - $875.03 | 1 |
| Pennsylvania | $905.89 | $905.89 | $870.8 - $940.98 | 2 |
| Texas | $892.85 | $892.85 | $866.83 - $937.81 | 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 21016
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 21016 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 21016
What does CPT code 21016 mean? +
CPT code 21016 represents: Resect face/scalp tum 2 cm/>. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 21016? +
The 2026 Medicare national average non-facility payment for CPT 21016 is $912.06. Rates range from $812.86 to $1129.07 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 21016? +
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 21016? +
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