CPT 61026
Global 000 ActiveInjection into brain canal
CPT 61026 Billing & Documentation Guide
CPT code 61026 (Injection into brain canal) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.65, a non-facility practice expense RVU of 1.01, and a malpractice RVU of 0.48, a total non-facility RVU of 3.14 and facility RVU of 3.14. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $105.17, though rates vary from $92.31 to $130.78 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 61026, 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 61026 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 61026 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 61026
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.65 | 1.65 |
| Practice Expense RVU | 1.01 | 1.01 |
| Malpractice RVU | 0.48 | 0.48 |
| Total RVU | 3.14 | 3.14 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 61026
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 | $105.7 | $105.7 | $101.62 - $118.41 | 29 |
| Florida | $120.17 | $120.17 | $111.46 - $130.78 | 3 |
| Georgia | $106.56 | $106.56 | $104.31 - $108.81 | 2 |
| Illinois | $118.54 | $118.54 | $110.97 - $126.2 | 4 |
| Michigan | $109.36 | $109.36 | $104.01 - $114.7 | 2 |
| North Carolina | $96.83 | $96.83 | $96.83 - $96.83 | 1 |
| New York | $117.16 | $117.16 | $98.43 - $128.52 | 5 |
| Ohio | $102.07 | $102.07 | $102.07 - $102.07 | 1 |
| Pennsylvania | $105.79 | $105.79 | $101.23 - $110.35 | 2 |
| Texas | $103.52 | $103.52 | $100.7 - $111.11 | 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 61026
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 61026 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 |
| 0333T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0464T | 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 |
Frequently Asked Questions, CPT 61026
What does CPT code 61026 mean? +
CPT code 61026 represents: Injection into brain canal. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 61026? +
The 2026 Medicare national average non-facility payment for CPT 61026 is $105.17. Rates range from $92.31 to $130.78 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 61026? +
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 61026? +
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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