Medicare Reimbursement for CPT 11057
This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions). It shows the Medicare Physician Fee Schedule (PFS) allowed amount at the national level and how it may vary by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $88.85 | $25.38 |
| ALASKA* (AK) | $102.92 | $35.33 |
| ALABAMA (AL) | $79.85 | $24.33 |
| ARKANSAS (AR) | $78.71 | $24.20 |
| ARIZONA (AZ) | $86.56 | $25.06 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $117.00 | $27.52 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $119.39 | $27.87 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $100.84 | $25.83 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $101.25 | $26.18 |
| NAPA (CA) | $110.38 | $26.74 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $117.06 | $27.58 |
| VALLEJO (CA) | $110.30 | $26.66 |
| BAKERSFIELD (CA) | $94.94 | $25.39 |
| CHICO (CA) | $94.78 | $25.22 |
| FRESNO (CA) | $94.78 | $25.22 |
| HANFORD-CORCORAN (CA) | $94.78 | $25.22 |
| MADERA (CA) | $94.78 | $25.22 |
| MERCED (CA) | $94.78 | $25.22 |
| MODESTO (CA) | $94.78 | $25.22 |
| REDDING (CA) | $94.78 | $25.22 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $95.33 | $25.77 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $99.61 | $25.80 |
| SALINAS (CA) | $99.24 | $25.69 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $119.62 | $28.11 |
| SANTA CRUZ-WATSONVILLE (CA) | $102.73 | $25.63 |
| SANTA ROSA-PETALUMA (CA) | $103.78 | $25.85 |
| STOCKTON (CA) | $94.78 | $25.22 |
| VISALIA (CA) | $94.78 | $25.22 |
| YUBA CITY (CA) | $94.78 | $25.22 |
| EL CENTRO (CA) | $94.79 | $25.23 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $101.68 | $25.77 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $97.62 | $25.34 |
| SANTA MARIA-SANTA BARBARA (CA) | $99.64 | $25.64 |
| REST OF CALIFORNIA (CA) | $94.78 | $25.22 |
| COLORADO (CO) | $92.97 | $25.44 |
| CONNECTICUT (CT) | $94.71 | $26.36 |
| DC + MD/VA SUBURBS (DC) | $101.94 | $27.19 |
| DELAWARE (DE) | $87.99 | $25.29 |
| FORT LAUDERDALE (FL) | $91.06 | $26.77 |
| MIAMI (FL) | $94.11 | $28.05 |
| REST OF FLORIDA (FL) | $86.78 | $26.11 |
| ATLANTA (GA) | $90.30 | $25.83 |
| REST OF GEORGIA (GA) | $82.02 | $25.42 |
| HAWAII, GUAM (HI) | $97.20 | $25.05 |
| IOWA (IA) | $82.22 | $24.15 |
| IDAHO (ID) | $82.68 | $24.29 |
| EAST ST. LOUIS (IL) | $85.25 | $26.86 |
| SUBURBAN CHICAGO (IL) | $92.07 | $26.89 |
| CHICAGO (IL) | $91.49 | $27.71 |
| REST OF ILLINOIS (IL) | $84.03 | $26.09 |
| INDIANA (IN) | $83.16 | $24.33 |
| KANSAS (KS) | $81.67 | $24.30 |
| KENTUCKY (KY) | $81.36 | $24.95 |
| NEW ORLEANS (LA) | $85.17 | $25.45 |
| REST OF LOUISIANA (LA) | $81.17 | $25.01 |
| METROPOLITAN BOSTON (MA) | $102.36 | $26.58 |
| REST OF MASSACHUSETTS (MA) | $92.35 | $25.52 |
| BALTIMORE/SURR. CNTYS (MD) | $94.41 | $26.31 |
| REST OF MARYLAND (MD) | $89.71 | $25.49 |
| SOUTHERN MAINE (ME) | $87.63 | $24.74 |
| REST OF MAINE (ME) | $82.92 | $24.54 |
| DETROIT (MI) | $87.68 | $26.44 |
| REST OF MICHIGAN (MI) | $83.31 | $25.37 |
| MINNESOTA (MN) | $89.59 | $24.29 |
| METROPOLITAN ST. LOUIS (MO) | $85.68 | $25.26 |
| METROPOLITAN KANSAS CITY (MO) | $84.77 | $25.18 |
| REST OF MISSOURI (MO) | $79.68 | $24.97 |
| MISSISSIPPI (MS) | $79.22 | $24.58 |
| MONTANA** (MT) | $88.84 | $25.38 |
| NORTH CAROLINA (NC) | $83.81 | $24.60 |
| NORTH DAKOTA** (ND) | $87.85 | $24.39 |
| NEBRASKA (NE) | $82.72 | $24.14 |
| NEW HAMPSHIRE (NH) | $91.35 | $25.29 |
| NORTHERN NJ (NJ) | $100.87 | $27.25 |
| REST OF NEW JERSEY (NJ) | $95.93 | $26.63 |
| NEW MEXICO (NM) | $83.69 | $25.50 |
| NEVADA** (NV) | $88.63 | $25.11 |
| MANHATTAN (NY) | $101.89 | $28.14 |
| NYC SUBURBS/LONG ISLAND (NY) | $104.12 | $28.67 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $96.43 | $26.94 |
| QUEENS (NY) | $102.97 | $27.96 |
| REST OF NEW YORK (NY) | $85.04 | $24.76 |
| OHIO (OH) | $83.11 | $25.17 |
| OKLAHOMA (OK) | $81.40 | $24.73 |
| PORTLAND (OR) | $96.10 | $25.59 |
| REST OF OREGON (OR) | $88.09 | $24.88 |
| METROPOLITAN PHILADELPHIA (PA) | $92.26 | $26.20 |
| REST OF PENNSYLVANIA (PA) | $83.33 | $25.07 |
| PUERTO RICO (PR) | $89.55 | $25.39 |
| RHODE ISLAND (RI) | $91.25 | $25.69 |
| SOUTH CAROLINA (SC) | $83.57 | $24.93 |
| SOUTH DAKOTA** (SD) | $87.74 | $24.28 |
| TENNESSEE (TN) | $82.05 | $24.37 |
| BRAZORIA (TX) | $88.05 | $25.16 |
| DALLAS (TX) | $88.53 | $25.33 |
| GALVESTON (TX) | $88.26 | $25.25 |
| HOUSTON (TX) | $89.18 | $26.16 |
| BEAUMONT (TX) | $82.78 | $25.03 |
| FORT WORTH (TX) | $87.89 | $25.32 |
| AUSTIN (TX) | $92.53 | $25.39 |
| REST OF TEXAS (TX) | $85.31 | $25.09 |
| UTAH (UT) | $84.71 | $25.05 |
| VIRGINIA (VA) | $87.23 | $24.85 |
| VIRGIN ISLANDS (VI) | $89.55 | $25.39 |
| VERMONT (VT) | $87.36 | $24.53 |
| SEATTLE (KING CNTY) (WA) | $104.61 | $26.74 |
| REST OF WASHINGTON (WA) | $92.23 | $25.40 |
| WISCONSIN (WI) | $84.91 | $24.12 |
| WEST VIRGINIA (WV) | $80.90 | $25.75 |
| WYOMING** (WY) | $88.41 | $24.95 |
Look up another code or locality →
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 payment is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility rates (e.g., office settings) generally include higher practice-expense RVUs than facility rates (e.g., hospitals or ASCs), since the facility itself absorbs certain overhead costs in the latter setting. This is why the same code can show two different national or locality-based allowed amounts depending on place of service.
RVUs — work 0.63, practice expense 1.98 (non-facility) / 0.08 (facility), malpractice 0.05 — × 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 insurer is responsible for the rest.
- Actual payment varies by locality GPCIs, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
- Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The facility rate uses a lower practice-expense RVU because the facility (e.g., hospital) bears certain overhead costs itself, whereas the non-facility rate assumes the billing provider covers those costs directly.
Does this amount reflect what my locality will actually pay?
No. The figures shown include a national reference amount; actual payment is recalculated using your specific locality's GPCIs, which can raise or lower the total compared to the national average.
Why can't you show the CPT code description?
CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so this page refers to the code generically rather than reproducing the official descriptor.
Will this be the exact amount Medicare pays my practice?
Not necessarily. Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final payment from the base PFS calculation.
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.
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