CPT 21030
Global 090 ActiveExcise max/zygoma b9 tumor
CPT 21030 Billing & Documentation Guide
CPT code 21030 (Excise max/zygoma b9 tumor) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 4.79, a non-facility practice expense RVU of 8.87, and a malpractice RVU of 0.59, a total non-facility RVU of 14.25 and facility RVU of 10.08. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $489.32, though rates vary from $424.63 to $615.37 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 21030, 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 21030 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 1 units of 21030 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 21030
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 4.79 | 4.79 |
| Practice Expense RVU | 8.87 | 4.7 |
| Malpractice RVU | 0.59 | 0.59 |
| Total RVU | 14.25 | 10.08 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 21030
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 | $526.97 | $362.17 | $497.98 - $615.37 | 29 |
| Florida | $495.61 | $355.86 | $472.84 - $518.24 | 3 |
| Georgia | $466.45 | $333.57 | $447.75 - $485.14 | 2 |
| Illinois | $484.47 | $349.9 | $461.28 - $504.08 | 4 |
| Michigan | $465.92 | $335.14 | $452.73 - $479.11 | 2 |
| North Carolina | $449 | $319.05 | $449 - $449 | 1 |
| New York | $524.88 | $369.5 | $455.3 - $559.08 | 5 |
| Ohio | $450.35 | $323.18 | $450.35 - $450.35 | 1 |
| Pennsylvania | $472.69 | $336.26 | $450.59 - $494.79 | 2 |
| Texas | $470.85 | $333.72 | $447.9 - $491.22 | 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 21030
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 21030 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 | 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 |
| 0707T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0869T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 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 |
Frequently Asked Questions, CPT 21030
What does CPT code 21030 mean? +
CPT code 21030 represents: Excise max/zygoma b9 tumor. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 21030? +
The 2026 Medicare national average non-facility payment for CPT 21030 is $489.32. Rates range from $424.63 to $615.37 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 21030? +
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 21030? +
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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