CPT 93286
Global XXX ActivePeri-px eval pm/ldls pm ip
CPT 93286 Billing & Documentation Guide
CPT code 93286 (Peri-px eval pm/ldls pm ip) is classified under Cardiovascular with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.29, a non-facility practice expense RVU of 1.02, and a malpractice RVU of 0.02, a total non-facility RVU of 1.33 and facility RVU of 1.33. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $46.01, though rates vary from $39.3 to $60.24 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 93286, 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 93286 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 93286 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 93286
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.29 | 0.29 |
| Practice Expense RVU | 1.02 | 1.02 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.33 | 1.33 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 93286
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 | $50.71 | $50.71 | $47.55 - $60.24 | 29 |
| Florida | $45.17 | $45.17 | $43.26 - $46.84 | 3 |
| Georgia | $43 | $43 | $40.87 - $45.13 | 2 |
| Illinois | $43.92 | $43.92 | $41.84 - $45.93 | 4 |
| Michigan | $42.62 | $42.62 | $41.55 - $43.69 | 2 |
| North Carolina | $41.9 | $41.9 | $41.9 - $41.9 | 1 |
| New York | $49.06 | $49.06 | $42.52 - $52.05 | 5 |
| Ohio | $41.46 | $41.46 | $41.46 - $41.46 | 1 |
| Pennsylvania | $43.86 | $43.86 | $41.59 - $46.12 | 2 |
| Texas | $43.9 | $43.9 | $41.31 - $46.34 | 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 93286
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 93286 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0178T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0179T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0180T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0295T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0296T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0297T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0298T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0390T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0497T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0498T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 93286
What does CPT code 93286 mean? +
CPT code 93286 represents: Peri-px eval pm/ldls pm ip. It's in the Cardiovascular category with a global period of XXX.
What is the Medicare reimbursement for CPT 93286? +
The 2026 Medicare national average non-facility payment for CPT 93286 is $46.01. Rates range from $39.3 to $60.24 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 93286? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 93286? +
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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