CPT 49215
Global 090 ActiveExcise sacral spine tumor
CPT 49215 Billing & Documentation Guide
CPT code 49215 (Excise sacral spine tumor) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 36.86, a non-facility practice expense RVU of 15.04, and a malpractice RVU of 8.08, a total non-facility RVU of 59.98 and facility RVU of 59.98. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $2011.59, though rates vary from $1795.53 to $2530.44 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 49215, 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 49215 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 49215 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 49215
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 36.86 | 36.86 |
| Practice Expense RVU | 15.04 | 15.04 |
| Malpractice RVU | 8.08 | 8.08 |
| Total RVU | 59.98 | 59.98 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 49215
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 | $2016.05 | $2016.05 | $1947.32 - $2235.63 | 29 |
| Florida | $2260.55 | $2260.55 | $2117.03 - $2436.63 | 3 |
| Georgia | $2035.16 | $2035.16 | $2000.95 - $2069.36 | 2 |
| Illinois | $2236.6 | $2236.6 | $2111.62 - $2364.01 | 4 |
| Michigan | $2082.72 | $2082.72 | $1994.5 - $2170.94 | 2 |
| North Carolina | $1872.3 | $1872.3 | $1872.3 - $1872.3 | 1 |
| New York | $2216.86 | $2216.86 | $1898.11 - $2408.41 | 5 |
| Ohio | $1961.84 | $1961.84 | $1961.84 - $1961.84 | 1 |
| Pennsylvania | $2022.79 | $2022.79 | $1947.35 - $2098.23 | 2 |
| Texas | $1983.18 | $1983.18 | $1939.01 - $2111.19 | 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 49215
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 49215 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 49215
What does CPT code 49215 mean? +
CPT code 49215 represents: Excise sacral spine tumor. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 49215? +
The 2026 Medicare national average non-facility payment for CPT 49215 is $2011.59. Rates range from $1795.53 to $2530.44 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 49215? +
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 49215? +
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 April 17, 2026.
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