CPT 99452
Global XXX ActiveNtrprof ph1/ntrnet/ehr rfrl
CPT 99452 Billing & Documentation Guide
CPT code 99452 (Ntrprof ph1/ntrnet/ehr rfrl) 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 0.36, and a malpractice RVU of 0.05, a total non-facility RVU of 1.11 and facility RVU of 0.93. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $37.84, though rates vary from $34.57 to $48.8 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99452, 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 99452 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 99452 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 99452
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.7 | 0.7 |
| Practice Expense RVU | 0.36 | 0.18 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 1.11 | 0.93 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99452
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 | $39.35 | $32.24 | $37.85 - $44.19 | 29 |
| Florida | $38.7 | $32.66 | $37.39 - $40.12 | 3 |
| Georgia | $36.89 | $31.15 | $36.1 - $37.67 | 2 |
| Illinois | $38.27 | $32.47 | $36.97 - $39.46 | 4 |
| Michigan | $37.02 | $31.38 | $36.24 - $37.8 | 2 |
| North Carolina | $35.67 | $30.06 | $35.67 - $35.67 | 1 |
| New York | $40.18 | $33.47 | $35.98 - $42.28 | 5 |
| Ohio | $36.04 | $30.55 | $36.04 - $36.04 | 1 |
| Pennsylvania | $37.16 | $31.27 | $36 - $38.31 | 2 |
| Texas | $36.9 | $30.98 | $35.87 - $37.81 | 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 99452
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99452 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 |
| 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 |
| 94004 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 99452
What does CPT code 99452 mean? +
CPT code 99452 represents: Ntrprof ph1/ntrnet/ehr rfrl. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99452? +
The 2026 Medicare national average non-facility payment for CPT 99452 is $37.84. Rates range from $34.57 to $48.8 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99452? +
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 99452? +
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 May 31, 2026.
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