CPT 93797
Global 000 ActivePhys/qhp op car rhab wo ecg
CPT 93797 Billing & Documentation Guide
CPT code 93797 (Phys/qhp op car rhab wo ecg) is classified under Cardiovascular with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.18, a non-facility practice expense RVU of 0.34, and a malpractice RVU of 0.01, a total non-facility RVU of 0.53 and facility RVU of 0.23. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $18.27, though rates vary from $15.94 to $23.23 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 93797, 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 93797 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 93797 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 93797
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.18 | 0.18 |
| Practice Expense RVU | 0.34 | 0.04 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.53 | 0.23 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 93797
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 | $19.85 | $7.99 | $18.74 - $23.23 | 29 |
| Florida | $18.06 | $8 | $17.37 - $18.68 | 3 |
| Georgia | $17.26 | $7.7 | $16.54 - $17.97 | 2 |
| Illinois | $17.64 | $7.96 | $16.9 - $18.31 | 4 |
| Michigan | $17.15 | $7.74 | $16.76 - $17.53 | 2 |
| North Carolina | $16.82 | $7.47 | $16.82 - $16.82 | 1 |
| New York | $19.42 | $8.24 | $17.04 - $20.52 | 5 |
| Ohio | $16.72 | $7.57 | $16.72 - $16.72 | 1 |
| Pennsylvania | $17.55 | $7.73 | $16.75 - $18.34 | 2 |
| Texas | $17.54 | $7.67 | $16.66 - $18.34 | 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 93797
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 93797 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 |
| 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 |
| 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 |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12001 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 12002 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 93797
What does CPT code 93797 mean? +
CPT code 93797 represents: Phys/qhp op car rhab wo ecg. It's in the Cardiovascular category with a global period of 000.
What is the Medicare reimbursement for CPT 93797? +
The 2026 Medicare national average non-facility payment for CPT 93797 is $18.27. Rates range from $15.94 to $23.23 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 93797? +
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 93797? +
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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