CPT 99479
Global XXX ActiveSbsq ic lbw inf 1,500-2,500
CPT 99479 Billing & Documentation Guide
CPT code 99479 (Sbsq ic lbw inf 1,500-2,500) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.5, a non-facility practice expense RVU of 0.5, and a malpractice RVU of 0.15, a total non-facility RVU of 3.15 and facility RVU of 3.15. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $106.93, though rates vary from $100.43 to $145.8 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99479, 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 99479 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 99479 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 99479
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.5 | 2.5 |
| Practice Expense RVU | 0.5 | 0.5 |
| Malpractice RVU | 0.15 | 0.15 |
| Total RVU | 3.15 | 3.15 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99479
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 | $108.97 | $108.97 | $105.91 - $119.45 | 29 |
| Florida | $110.01 | $110.01 | $107 - $113.56 | 3 |
| Georgia | $105.56 | $105.56 | $104.37 - $106.74 | 2 |
| Illinois | $109.51 | $109.51 | $106.58 - $112.37 | 4 |
| Michigan | $106.24 | $106.24 | $104.41 - $108.07 | 2 |
| North Carolina | $102.29 | $102.29 | $102.29 - $102.29 | 1 |
| New York | $112.9 | $112.9 | $102.89 - $118.01 | 5 |
| Ohio | $103.8 | $103.8 | $103.8 - $103.8 | 1 |
| Pennsylvania | $105.97 | $105.97 | $103.57 - $108.37 | 2 |
| Texas | $105.06 | $105.06 | $103.35 - $107.65 | 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 99479
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99479 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0188T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0189T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99479
What does CPT code 99479 mean? +
CPT code 99479 represents: Sbsq ic lbw inf 1,500-2,500. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99479? +
The 2026 Medicare national average non-facility payment for CPT 99479 is $106.93. Rates range from $100.43 to $145.8 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99479? +
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 99479? +
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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