CPT 21123
Global 090 ActiveGeniop sldg augmentation
CPT 21123 Billing & Documentation Guide
CPT code 21123 (Geniop sldg augmentation) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 11.06, a non-facility practice expense RVU of 10.62, and a malpractice RVU of 1.61, a total non-facility RVU of 23.29 and facility RVU of 23.29. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $793.19, though rates vary from $701.81 to $961.53 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 21123, 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 21123 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 21123 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 21123
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 11.06 | 11.06 |
| Practice Expense RVU | 10.62 | 10.62 |
| Malpractice RVU | 1.61 | 1.61 |
| Total RVU | 23.29 | 23.29 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 21123
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 | $831.54 | $831.54 | $793.29 - $950.38 | 29 |
| Florida | $830 | $830 | $789.35 - $874.67 | 3 |
| Georgia | $772.71 | $772.71 | $749.92 - $795.5 | 2 |
| Illinois | $816.22 | $816.22 | $777.32 - $851.91 | 4 |
| Michigan | $778.18 | $778.18 | $753.98 - $802.38 | 2 |
| North Carolina | $734.73 | $734.73 | $734.73 - $734.73 | 1 |
| New York | $855.76 | $855.76 | $744.2 - $914.68 | 5 |
| Ohio | $747.48 | $747.48 | $747.48 - $747.48 | 1 |
| Pennsylvania | $777.67 | $777.67 | $745.86 - $809.48 | 2 |
| Texas | $770.62 | $770.62 | $742.16 - $798.6 | 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 21123
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 21123 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 |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | 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 |
Frequently Asked Questions, CPT 21123
What does CPT code 21123 mean? +
CPT code 21123 represents: Geniop sldg augmentation. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 21123? +
The 2026 Medicare national average non-facility payment for CPT 21123 is $793.19. Rates range from $701.81 to $961.53 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 21123? +
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 21123? +
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 June 1, 2026.
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