CPT Code 12004Complete Billing & Coding Guide (2026)Rpr s/n/ax/gen/trk7.6-12.5cm
About CPT 12004
CPT 12004 is a Current Procedural Terminology code in the Anesthesia category maintained by the American Medical Association. The CMS short descriptor reads "Rpr s/n/ax/gen/trk7.6-12.5cm". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
Documentation specificity, correct ICD-10 linkage, and modifier accuracy determine whether 12004 pays cleanly or triggers a denial. Verify CMS National Physician Fee Schedule status, applicable Medicare LCDs, and any payer-specific medical policies before submission.
12004 has 10 NCCI bundling edit pairs documented. Run your scrubber against the NCCI quarterly update before submission. When clinically warranted, use modifier 59 or the X-modifiers (XE, XS, XP, XU) to bypass an indicator-1 edit, with chart documentation supporting the distinct service.
Code Properties
RVU Breakdown
Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.
Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.
Medicare Payment by State
Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.
Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.
NCCI Bundling Edits
10 pairsThese codes trigger National Correct Coding Initiative edits when billed with 12004. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.
Billing 12004 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Bundling denials on 12004 are recoverable when the edit indicator is 1 and the chart documents a distinct, separately identifiable service. Our coders verify the indicator and pick the precise X-modifier (XE, XS, XP, XU) instead of defaulting to modifier 59.
Applicable Modifiers
Modifiers commonly paired with 12004 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.
Modifier audits catch what scrubbers miss. Our AAPC-certified team reviews every modifier choice on 12004 against the chart documentation before submission, surfacing missed and misapplied modifiers across the practice.
Find the revenue leakage in your 12004 claims.
Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Anesthesia claims. Our AAPC-certified team audits your last 90 days of 12004 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.
Losing revenue on CPT 12004? We’ll find it.
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Related CPT Codes
Codes in the same family as 12004
Specialty billing guides
CPT 12004 is among the top codes profiled in these specialty billing guides.
Everything about CPT 12004
What does CPT code 12004 cover?
CPT 12004 is a Current Procedural Terminology code in the Anesthesia category maintained by the American Medical Association. The CMS short descriptor reads "Rpr s/n/ax/gen/trk7.6-12.5cm". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
What is the Medicare payment for CPT 12004?
The national average Medicare payment for CPT 12004 is approximately $161.99 in a non-facility setting and $72.15 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 4.85 with a conversion factor of $33.4009.
What is the global period for CPT 12004?
CPT 12004 has a 0-day global period (indicator 000). Same-day E/M is bundled into the procedure, but office visits the next day or after are separately billable for unrelated care. Use modifier 24 for unrelated E/M during the global period.
What codes bundle with CPT 12004?
CPT 12004 has NCCI Procedure-to-Procedure edits with 10+ codes including 0213T, 0216T, 0543T. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.
CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.
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We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.