$469.12
48100 describes biopsy through open exposure; 48102 is the needle-biopsy alternative.
On this page
CMS RVU26D · Effective 2026-10-01
48100 Pancreatic biopsy Medicare reimbursement rates in New Mexico
Report 48100 when a surgeon obtains pancreatic tissue for diagnosis through open operative exposure rather than needle sampling or pancreatic resection. Compare 48100 office and facility rates across CMS payment localities in New Mexico.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 48100 in New Mexico?
New Mexico has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$846.84
1 of 1 localities have a supported rate.
Payment area: New Mexico
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Surgical procedure
About 48100: Open pancreatic tissue biopsy
Report 48100 when a surgeon obtains pancreatic tissue for diagnosis through open operative exposure rather than needle sampling or pancreatic resection.
An open pancreatic biopsy obtains tissue from the pancreas after the surgeon exposes it through an operative incision. General surgeons and surgical oncologists may perform it in an operating room when tissue diagnosis is needed and a needle approach is unsuitable or an open operation provides access. The specimen is submitted for pathologic examination; this code describes the surgeon's biopsy work, not the microscopic interpretation.
Select 48100 for an open biopsy rather than a needle sample or an operation that removes or debrides pancreatic tissue. The operative report should identify the pancreatic target, open approach, biopsy purpose, and tissue obtained. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 48100
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.10 · 56%
- Practice expense (office) RVU7.61 · 30%
- Malpractice RVU3.56 · 14%
98
Medicare services in 2024 · #4899 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
48100 compared with similar codes
Office rates for New Mexico, from the same CMS release.
No office rate
Choose 48120 when a pancreatic lesion is removed. Choose 48100 when the surgeon obtains tissue for diagnosis without coding the service as lesion removal.
No office rate
48105 describes pancreatic resection or debridement. 48100 is for diagnostic tissue sampling, not removal or debridement of pancreatic tissue.
No office rate
48140 is a partial pancreatic removal procedure; 48100 is a biopsy when the operative service is tissue sampling rather than partial resection.
Compare 48100 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
New Mexico →
Office / nonfacility
Unavailable
Facility
$846.84
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 48100 in New Mexico.
PPRRVU2026_Oct_nonQPP.csv
5,733
- Code
- 48100
- Physician work
- 14.10
- Practice expense
- 7.61
- Malpractice
- 3.56
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.10 | × 1.000 | 14.1000 |
| Practice expense | 7.61 | × 0.917 | 6.9784 |
| Malpractice | 3.56 | × 1.201 | 4.2756 |
| Total RVUs | 25.3539 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, New Mexico$846.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.1 | 1 |
| Practice expense | 7.61 | 0.917 |
| Malpractice | 3.56 | 1.201 |
(14.1 × 1 + 7.61 × 0.917 + 3.56 × 1.201) × $33.4009 = $846.84
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
48100 billing questions
When should 48100 be chosen over 48102?
Use 48100 for tissue obtained through open surgical exposure. Use 48102 when the pancreatic biopsy is performed with a needle.
Is pathology interpretation included in 48100?
No. This code describes the surgeon's open tissue sampling; microscopic interpretation is a separate pathology service when performed and reported by the pathologist.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
What operative documentation supports 48100?
Document the open approach, pancreatic target, diagnostic purpose, and tissue obtained. The record should distinguish biopsy from removal or debridement of pancreatic tissue.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, while team-surgery payment is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,73048000,,Drainage of abdomen,A,,31.15,12.82,NA,12.82,,8.33,52.30,52.30,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73148001,,Placement of drain pancreas,A,,38.70,14.66,NA,14.66,,10.37,63.73,63.73,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73248020,,Removal of pancreatic stone,A,,18.61,9.78,NA,9.78,,4.96,33.35,33.35,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73348100,,Biopsy of pancreas open,A,,14.10,7.61,NA,7.61,,3.56,25.27,25.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73448102,,Needle biopsy pancreas,A,,4.58,9.68,,1.03,,0.49,14.75,6.10,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73548105,,Resect/debride pancreas,A,,48.03,18.08,NA,18.08,,10.41,76.52,76.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73648120,,Removal of pancreas lesion,A,,17.95,8.60,NA,8.60,,4.80,31.35,31.35,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068
7612402,NJ,99,REST OF NEW JERSEY,1.040,1.092,1.097
7704212,NM,05,NEW MEXICO,1.000,0.917,1.201
7813202,NY,01,MANHATTAN,1.064,1.162,1.586
7913202,NY,02,NYC SUBURBS/LONG ISLAND,1.064,1.189,1.857
8013202,NY,03,POUGHKPSIE/N NYC SUBURBS,1.045,1.095,1.210