CPT 65860
Global 090 ActiveSevering ads ant sgm laser
CPT 65860 Billing & Documentation Guide
CPT code 65860 (Severing ads ant sgm laser) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.5, a non-facility practice expense RVU of 5.51, and a malpractice RVU of 0.27, a total non-facility RVU of 9.28 and facility RVU of 6.26. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $319.08, though rates vary from $279.64 to $399.98 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 65860, 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 65860 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 65860 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 65860
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.5 | 3.5 |
| Practice Expense RVU | 5.51 | 2.49 |
| Malpractice RVU | 0.27 | 0.27 |
| Total RVU | 9.28 | 6.26 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 65860
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 | $343.75 | $224.39 | $325.43 - $399.98 | 29 |
| Florida | $319.11 | $217.91 | $306.4 - $331.29 | 3 |
| Georgia | $303.45 | $207.21 | $291.82 - $315.07 | 2 |
| Illinois | $312.38 | $214.91 | $299.03 - $323.38 | 4 |
| Michigan | $302.41 | $207.7 | $295.11 - $309.71 | 2 |
| North Carolina | $294.37 | $200.26 | $294.37 - $294.37 | 1 |
| New York | $340.02 | $227.49 | $298.08 - $359.95 | 5 |
| Ohio | $294.02 | $201.93 | $294.02 - $294.02 | 1 |
| Pennsylvania | $307.86 | $209.06 | $294.37 - $321.35 | 2 |
| Texas | $307.11 | $207.8 | $292.76 - $319.84 | 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 65860
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 65860 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 |
| 0621T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0622T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 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 65860
What does CPT code 65860 mean? +
CPT code 65860 represents: Severing ads ant sgm laser. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 090.
What is the Medicare reimbursement for CPT 65860? +
The 2026 Medicare national average non-facility payment for CPT 65860 is $319.08. Rates range from $279.64 to $399.98 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 65860? +
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 65860? +
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 2, 2026.
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