Medicare Reimbursement for CPT 11105

This page covers a CPT procedure code (the official AMA descriptor is not reproduced here due to licensing) as valued under the Medicare Physician Fee Schedule. It shows the estimated Medicare-allowed amount nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$60.46	$21.38
ALASKA* (AK)	$69.58	$27.96
ALABAMA (AL)	$54.01	$19.82
ARKANSAS (AR)	$53.20	$19.63
ARIZONA (AZ)	$58.77	$20.91
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$78.31	$23.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$79.85	$23.50
OXNARD-THOUSAND OAKS-VENTURA (CA)	$67.89	$21.70
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$68.22	$21.99
NAPA (CA)	$74.04	$22.53
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$78.39	$23.29
VALLEJO (CA)	$73.92	$22.42
BAKERSFIELD (CA)	$63.99	$21.16
CHICO (CA)	$63.79	$20.96
FRESNO (CA)	$63.79	$20.96
HANFORD-CORCORAN (CA)	$63.79	$20.96
MADERA (CA)	$63.79	$20.96
MERCED (CA)	$63.79	$20.96
MODESTO (CA)	$63.79	$20.96
REDDING (CA)	$63.79	$20.96
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$64.54	$21.71
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$66.98	$21.53
SALINAS (CA)	$66.73	$21.44
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$80.18	$23.83
SANTA CRUZ-WATSONVILLE (CA)	$69.01	$21.53
SANTA ROSA-PETALUMA (CA)	$69.71	$21.72
STOCKTON (CA)	$63.79	$20.96
VISALIA (CA)	$63.79	$20.96
YUBA CITY (CA)	$63.79	$20.96
EL CENTRO (CA)	$63.80	$20.97
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$68.34	$21.60
SAN LUIS OBISPO-PASO ROBLES (CA)	$65.66	$21.15
SANTA MARIA-SANTA BARBARA (CA)	$66.99	$21.42
REST OF CALIFORNIA (CA)	$63.79	$20.96
COLORADO (CO)	$62.90	$21.32
CONNECTICUT (CT)	$64.58	$22.50
DC + MD/VA SUBURBS (DC)	$69.24	$23.21
DELAWARE (DE)	$59.77	$21.16
FORT LAUDERDALE (FL)	$62.91	$23.32
MIAMI (FL)	$65.81	$25.13
REST OF FLORIDA (FL)	$59.72	$22.36
ATLANTA (GA)	$61.66	$21.96
REST OF GEORGIA (GA)	$56.22	$21.36
HAWAII, GUAM (HI)	$65.42	$20.99
IOWA (IA)	$55.35	$19.60
IDAHO (ID)	$55.75	$19.80
EAST ST. LOUIS (IL)	$59.35	$23.40
SUBURBAN CHICAGO (IL)	$63.54	$23.40
CHICAGO (IL)	$63.80	$24.53
REST OF ILLINOIS (IL)	$57.99	$22.32
INDIANA (IN)	$56.08	$19.86
KANSAS (KS)	$55.13	$19.80
KENTUCKY (KY)	$55.44	$20.70
NEW ORLEANS (LA)	$58.21	$21.44
REST OF LOUISIANA (LA)	$55.36	$20.78
METROPOLITAN BOSTON (MA)	$69.22	$22.56
REST OF MASSACHUSETTS (MA)	$62.52	$21.37
BALTIMORE/SURR. CNTYS (MD)	$64.41	$22.48
REST OF MARYLAND (MD)	$60.93	$21.38
SOUTHERN MAINE (ME)	$59.20	$20.47
REST OF MAINE (ME)	$56.10	$20.15
DETROIT (MI)	$60.54	$22.83
REST OF MICHIGAN (MI)	$56.98	$21.30
MINNESOTA (MN)	$60.07	$19.86
METROPOLITAN ST. LOUIS (MO)	$58.38	$21.17
METROPOLITAN KANSAS CITY (MO)	$57.75	$21.06
REST OF MISSOURI (MO)	$54.40	$20.72
MISSISSIPPI (MS)	$53.81	$20.16
MONTANA** (MT)	$60.45	$21.37
NORTH CAROLINA (NC)	$56.70	$20.24
NORTH DAKOTA** (ND)	$59.07	$19.99
NEBRASKA (NE)	$55.66	$19.59
NEW HAMPSHIRE (NH)	$61.94	$21.26
NORTHERN NJ (NJ)	$68.49	$23.16
REST OF NEW JERSEY (NJ)	$65.27	$22.59
NEW MEXICO (NM)	$57.32	$21.49
NEVADA** (NV)	$60.11	$20.99
MANHATTAN (NY)	$69.80	$24.39
NYC SUBURBS/LONG ISLAND (NY)	$71.61	$25.14
POUGHKPSIE/N NYC SUBURBS (NY)	$65.73	$22.94
QUEENS (NY)	$70.33	$24.14
REST OF NEW YORK (NY)	$57.59	$20.47
OHIO (OH)	$56.70	$21.02
OKLAHOMA (OK)	$55.29	$20.39
PORTLAND (OR)	$64.91	$21.50
REST OF OREGON (OR)	$59.59	$20.66
METROPOLITAN PHILADELPHIA (PA)	$62.95	$22.27
REST OF PENNSYLVANIA (PA)	$56.77	$20.89
PUERTO RICO (PR)	$60.90	$21.39
RHODE ISLAND (RI)	$61.92	$21.55
SOUTH CAROLINA (SC)	$56.80	$20.70
SOUTH DAKOTA** (SD)	$58.90	$19.82
TENNESSEE (TN)	$55.42	$19.90
BRAZORIA (TX)	$59.67	$20.94
DALLAS (TX)	$60.08	$21.16
GALVESTON (TX)	$59.87	$21.06
HOUSTON (TX)	$61.15	$22.34
BEAUMONT (TX)	$56.38	$20.82
FORT WORTH (TX)	$59.68	$21.15
AUSTIN (TX)	$62.74	$21.39
REST OF TEXAS (TX)	$58.01	$20.93
UTAH (UT)	$57.61	$20.88
VIRGINIA (VA)	$59.03	$20.62
VIRGIN ISLANDS (VI)	$60.90	$21.39
VERMONT (VT)	$58.87	$20.18
SEATTLE (KING CNTY) (WA)	$70.62	$22.67
REST OF WASHINGTON (WA)	$62.39	$21.24
WISCONSIN (WI)	$57.01	$19.58
WEST VIRGINIA (WV)	$55.78	$21.82
WYOMING** (WY)	$59.85	$20.77

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 units per patient per day — Date of Service Edit: Clinical. 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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (staff, supplies, equipment) are typically higher when the service is performed in a physician's office versus a hospital or ambulatory surgical center.

RVUs — work 0.44, practice expense 1.3 (non-facility) / 0.13 (facility), malpractice 0.07 — × 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 patient meets the annual Part B deductible; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary based on modifiers, multiple-procedure reductions, sequestration, and other claim-specific adjustments.
The conversion factor and RVUs are subject to annual budget-neutrality adjustments and legislative changes.
Always verify the specific locality-adjusted amount and any applicable edits with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the allowed amount differ between non-facility and facility settings?

The practice-expense RVU is lower in the facility setting because the facility (not the billing physician) absorbs certain overhead costs like equipment, supplies, and staff time.

Does this amount reflect what my specific locality will be paid?

No — the national figures are averages. The locality-specific amount is calculated by applying that area's GPCI values to the RVUs before multiplying by the conversion factor.

Will Medicare pay 100% of the listed allowed amount?

No. Medicare generally pays 80% of the allowed amount after the deductible is met; the remaining 20% is typically the patient's or secondary payer's responsibility.

Why might the amount I see on a remittance advice differ from this estimate?

Modifiers, multiple-procedure payment reductions, sequestration, and mid-year policy updates can all change the final paid amount from the base fee schedule 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.