Medicare Reimbursement for CPT 11006

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and displays its estimated Medicare Physician Fee Schedule (PFS) allowed amount. Amounts are shown at the national level and can vary by locality, and are broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$623.93	$623.93
ALASKA* (AK)	$801.61	$801.61
ALABAMA (AL)	$570.15	$570.15
ARKANSAS (AR)	$563.69	$563.69
ARIZONA (AZ)	$607.17	$607.17
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$652.61	$652.61
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$659.67	$659.67
OXNARD-THOUSAND OAKS-VENTURA (CA)	$619.15	$619.15
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$628.66	$628.66
NAPA (CA)	$637.28	$637.28
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$655.81	$655.81
VALLEJO (CA)	$632.66	$632.66
BAKERSFIELD (CA)	$605.11	$605.11
CHICO (CA)	$597.38	$597.38
FRESNO (CA)	$597.38	$597.38
HANFORD-CORCORAN (CA)	$597.38	$597.38
MADERA (CA)	$597.38	$597.38
MERCED (CA)	$597.38	$597.38
MODESTO (CA)	$597.38	$597.38
REDDING (CA)	$597.38	$597.38
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$627.67	$627.67
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$612.40	$612.40
SALINAS (CA)	$609.86	$609.86
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$672.76	$672.76
SANTA CRUZ-WATSONVILLE (CA)	$611.37	$611.37
SANTA ROSA-PETALUMA (CA)	$616.55	$616.55
STOCKTON (CA)	$597.38	$597.38
VISALIA (CA)	$597.38	$597.38
YUBA CITY (CA)	$597.38	$597.38
EL CENTRO (CA)	$597.85	$597.85
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$613.81	$613.81
SAN LUIS OBISPO-PASO ROBLES (CA)	$601.82	$601.82
SANTA MARIA-SANTA BARBARA (CA)	$609.30	$609.30
REST OF CALIFORNIA (CA)	$597.38	$597.38
COLORADO (CO)	$615.02	$615.02
CONNECTICUT (CT)	$660.19	$660.19
DC + MD/VA SUBURBS (DC)	$675.98	$675.98
DELAWARE (DE)	$615.31	$615.31
FORT LAUDERDALE (FL)	$701.38	$701.38
MIAMI (FL)	$772.18	$772.18
REST OF FLORIDA (FL)	$666.77	$666.77
ATLANTA (GA)	$645.79	$645.79
REST OF GEORGIA (GA)	$630.87	$630.87
HAWAII, GUAM (HI)	$598.41	$598.41
IOWA (IA)	$558.36	$558.36
IDAHO (ID)	$566.03	$566.03
EAST ST. LOUIS (IL)	$711.18	$711.18
SUBURBAN CHICAGO (IL)	$702.42	$702.42
CHICAGO (IL)	$749.41	$749.41
REST OF ILLINOIS (IL)	$667.98	$667.98
INDIANA (IN)	$567.98	$567.98
KANSAS (KS)	$567.30	$567.30
KENTUCKY (KY)	$604.47	$604.47
NEW ORLEANS (LA)	$630.65	$630.65
REST OF LOUISIANA (LA)	$608.10	$608.10
METROPOLITAN BOSTON (MA)	$651.08	$651.08
REST OF MASSACHUSETTS (MA)	$617.10	$617.10
BALTIMORE/SURR. CNTYS (MD)	$660.61	$660.61
REST OF MARYLAND (MD)	$621.71	$621.71
SOUTHERN MAINE (ME)	$588.24	$588.24
REST OF MAINE (ME)	$580.07	$580.07
DETROIT (MI)	$684.93	$684.93
REST OF MICHIGAN (MI)	$627.10	$627.10
MINNESOTA (MN)	$560.61	$560.61
METROPOLITAN ST. LOUIS (MO)	$619.16	$619.16
METROPOLITAN KANSAS CITY (MO)	$615.47	$615.47
REST OF MISSOURI (MO)	$607.24	$607.24
MISSISSIPPI (MS)	$585.00	$585.00
MONTANA** (MT)	$623.74	$623.74
NORTH CAROLINA (NC)	$583.01	$583.01
NORTH DAKOTA** (ND)	$567.98	$567.98
NEBRASKA (NE)	$557.40	$557.40
NEW HAMPSHIRE (NH)	$616.39	$616.39
NORTHERN NJ (NJ)	$673.72	$673.72
REST OF NEW JERSEY (NJ)	$659.62	$659.62
NEW MEXICO (NM)	$634.29	$634.29
NEVADA** (NV)	$608.30	$608.30
MANHATTAN (NY)	$723.14	$723.14
NYC SUBURBS/LONG ISLAND (NY)	$751.45	$751.45
POUGHKPSIE/N NYC SUBURBS (NY)	$672.71	$672.71
QUEENS (NY)	$711.64	$711.64
REST OF NEW YORK (NY)	$590.79	$590.79
OHIO (OH)	$615.70	$615.70
OKLAHOMA (OK)	$591.88	$591.88
PORTLAND (OR)	$618.10	$618.10
REST OF OREGON (OR)	$595.54	$595.54
METROPOLITAN PHILADELPHIA (PA)	$654.02	$654.02
REST OF PENNSYLVANIA (PA)	$610.29	$610.29
PUERTO RICO (PR)	$623.65	$623.65
RHODE ISLAND (RI)	$625.27	$625.27
SOUTH CAROLINA (SC)	$601.96	$601.96
SOUTH DAKOTA** (SD)	$561.39	$561.39
TENNESSEE (TN)	$570.93	$570.93
BRAZORIA (TX)	$605.69	$605.69
DALLAS (TX)	$613.98	$613.98
GALVESTON (TX)	$610.42	$610.42
HOUSTON (TX)	$662.03	$662.03
BEAUMONT (TX)	$607.95	$607.95
FORT WORTH (TX)	$614.17	$614.17
AUSTIN (TX)	$620.03	$620.03
REST OF TEXAS (TX)	$609.53	$609.53
UTAH (UT)	$608.13	$608.13
VIRGINIA (VA)	$594.48	$594.48
VIRGIN ISLANDS (VI)	$623.65	$623.65
VERMONT (VT)	$576.37	$576.37
SEATTLE (KING CNTY) (WA)	$651.45	$651.45
REST OF WASHINGTON (WA)	$612.43	$612.43
WISCONSIN (WI)	$554.41	$554.41
WEST VIRGINIA (WV)	$651.00	$651.00
WYOMING** (WY)	$599.44	$599.44

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. Units above the MUE are denied; some MUEs can be exceeded only with appropriate documentation and modifiers where policy allows.

How the amount is calculated

Medicare's PFS amount is built from three Relative Value Units (RVUs): physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility and facility rates differ primarily in the practice-expense RVU, since facility settings (like hospitals) assume the facility bears some overhead costs that a physician's office would otherwise absorb. For this code, the non-facility and facility PE RVUs are the same, so the resulting national amounts are equal in both settings — though locality-adjusted amounts may still vary based on GPCI factors alone.

RVUs — work 12.77, practice expense 3.09 (non-facility) / 3.09 (facility), malpractice 2.82 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does this code show the same amount for non-facility and facility settings?

The practice-expense RVU — the component that typically differs between settings — is identical here, so both calculations produce the same national amount. Locality-adjusted amounts could still differ slightly due to GPCI weighting.

Why can't you show the CPT descriptor for this code?

CPT code descriptions are copyrighted and licensed by the American Medical Association. This page refers to the code generically and does not reproduce the official descriptor.

Will my locality's payment amount be different from the national figure shown?

Likely yes. The national amount uses a GPCI value of 1.00 for illustration; actual payments in your locality apply that area's specific GPCI adjustments to the RVUs before applying the conversion factor.

Does this amount reflect what Medicare will actually pay?

No — it reflects the estimated Medicare-allowed amount before beneficiary cost-sharing. Medicare generally reimburses 80% of this amount after the deductible, with adjustments for sequestration or other factors.

More free billing tools: all Medicare fees · fee calculator · denial code decoder

Estimated Medicare Physician Fee Schedule amount. Medicare generally pays 80% after the deductible; actual amounts vary by locality, modifiers, sequestration, and annual updates. Verify with your MAC.