CPT 99451
Global XXX ActiveNtrprof ph1/ntrnet/ehr 5/>
CPT 99451 Billing & Documentation Guide
CPT code 99451 (Ntrprof ph1/ntrnet/ehr 5/>) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.7, a non-facility practice expense RVU of 0.31, and a malpractice RVU of 0.05, a total non-facility RVU of 1.06 and facility RVU of 0.9. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $36.09, though rates vary from $33.14 to $47.02 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99451, 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 99451 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 1 units of 99451 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 99451
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.7 | 0.7 |
| Practice Expense RVU | 0.31 | 0.15 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 1.06 | 0.9 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99451
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 | $37.38 | $31.05 | $36.02 - $41.78 | 29 |
| Florida | $37.02 | $31.66 | $35.79 - $38.38 | 3 |
| Georgia | $35.3 | $30.2 | $34.61 - $35.98 | 2 |
| Illinois | $36.66 | $31.49 | $35.44 - $37.78 | 4 |
| Michigan | $35.46 | $30.44 | $34.72 - $36.19 | 2 |
| North Carolina | $34.11 | $29.12 | $34.11 - $34.11 | 1 |
| New York | $38.31 | $32.35 | $34.39 - $40.29 | 5 |
| Ohio | $34.52 | $29.64 | $34.52 - $34.52 | 1 |
| Pennsylvania | $35.52 | $30.29 | $34.46 - $36.57 | 2 |
| Texas | $35.25 | $29.99 | $34.35 - $36.15 | 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 99451
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99451 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0373T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0469T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 76140 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93792 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 93793 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94002 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94003 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 99451
What does CPT code 99451 mean? +
CPT code 99451 represents: Ntrprof ph1/ntrnet/ehr 5/>. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99451? +
The 2026 Medicare national average non-facility payment for CPT 99451 is $36.09. Rates range from $33.14 to $47.02 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99451? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99451? +
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 1, 2026.
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