CPT 21048
Global 090 ActiveRemove maxilla cyst complex
CPT 21048 Billing & Documentation Guide
CPT code 21048 (Remove maxilla cyst complex) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 14.34, a non-facility practice expense RVU of 11.05, and a malpractice RVU of 1.76, a total non-facility RVU of 27.15 and facility RVU of 27.15. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $924.26, though rates vary from $826.28 to $1143.91 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 21048, 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 21048 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 21048 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 21048
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 14.34 | 14.34 |
| Practice Expense RVU | 11.05 | 11.05 |
| Malpractice RVU | 1.76 | 1.76 |
| Total RVU | 27.15 | 27.15 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 21048
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 | $964.73 | $964.73 | $923.13 - $1095.38 | 29 |
| Florida | $963.71 | $963.71 | $920.16 - $1011.85 | 3 |
| Georgia | $902.13 | $902.13 | $878.26 - $925.99 | 2 |
| Illinois | $949.61 | $949.61 | $907.82 - $988.16 | 4 |
| Michigan | $908.28 | $908.28 | $882.31 - $934.24 | 2 |
| North Carolina | $860.88 | $860.88 | $860.88 - $860.88 | 1 |
| New York | $993.34 | $993.34 | $870.92 - $1057.62 | 5 |
| Ohio | $875.19 | $875.19 | $875.19 - $875.19 | 1 |
| Pennsylvania | $907.64 | $907.64 | $873.34 - $941.93 | 2 |
| Texas | $899.57 | $899.57 | $869.44 - $930.19 | 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 21048
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 21048 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 |
| 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 |
| 11000 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 21048
What does CPT code 21048 mean? +
CPT code 21048 represents: Remove maxilla cyst complex. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 21048? +
The 2026 Medicare national average non-facility payment for CPT 21048 is $924.26. Rates range from $826.28 to $1143.91 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 21048? +
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 21048? +
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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