Medicare Reimbursement for CPT Code 11200

This page covers a specific CPT procedure code used in physician billing (the descriptor itself is not shown here due to AMA licensing restrictions). It presents the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level, along with how the amount can vary by locality and by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$92.19	$69.14
ALASKA* (AK)	$108.43	$83.88
ALABAMA (AL)	$83.18	$63.01
ARKANSAS (AR)	$82.04	$62.24
ARIZONA (AZ)	$89.86	$67.52
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$118.93	$86.44
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$121.27	$88.04
OXNARD-THOUSAND OAKS-VENTURA (CA)	$103.36	$76.11
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$103.88	$76.61
NAPA (CA)	$112.52	$82.15
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$119.02	$86.53
VALLEJO (CA)	$112.39	$82.02
BAKERSFIELD (CA)	$97.68	$72.42
CHICO (CA)	$97.43	$72.17
FRESNO (CA)	$97.43	$72.17
HANFORD-CORCORAN (CA)	$97.43	$72.17
MADERA (CA)	$97.43	$72.17
MERCED (CA)	$97.43	$72.17
MODESTO (CA)	$97.43	$72.17
REDDING (CA)	$97.43	$72.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$98.30	$73.04
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$102.14	$75.34
SALINAS (CA)	$101.76	$75.05
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$121.64	$88.41
SANTA CRUZ-WATSONVILLE (CA)	$105.01	$77.01
SANTA ROSA-PETALUMA (CA)	$106.07	$77.76
STOCKTON (CA)	$97.43	$72.17
VISALIA (CA)	$97.43	$72.17
YUBA CITY (CA)	$97.43	$72.17
EL CENTRO (CA)	$97.44	$72.18
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$104.07	$76.51
SAN LUIS OBISPO-PASO ROBLES (CA)	$100.13	$73.88
SANTA MARIA-SANTA BARBARA (CA)	$102.12	$75.25
REST OF CALIFORNIA (CA)	$97.43	$72.17
COLORADO (CO)	$95.94	$71.42
CONNECTICUT (CT)	$98.12	$73.30
DC + MD/VA SUBURBS (DC)	$105.11	$77.96
DELAWARE (DE)	$91.30	$68.53
FORT LAUDERDALE (FL)	$95.16	$71.82
MIAMI (FL)	$98.85	$74.86
REST OF FLORIDA (FL)	$90.77	$68.74
ATLANTA (GA)	$93.81	$70.39
REST OF GEORGIA (GA)	$85.92	$65.36
HAWAII, GUAM (HI)	$99.66	$73.46
IOWA (IA)	$85.24	$64.15
IDAHO (ID)	$85.75	$64.55
EAST ST. LOUIS (IL)	$89.87	$68.67
SUBURBAN CHICAGO (IL)	$96.13	$72.46
CHICAGO (IL)	$96.15	$72.99
REST OF ILLINOIS (IL)	$88.23	$67.19
INDIANA (IN)	$86.23	$64.86
KANSAS (KS)	$84.83	$64.00
KENTUCKY (KY)	$84.99	$64.50
NEW ORLEANS (LA)	$88.85	$67.16
REST OF LOUISIANA (LA)	$84.85	$64.46
METROPOLITAN BOSTON (MA)	$105.17	$77.65
REST OF MASSACHUSETTS (MA)	$95.40	$71.13
BALTIMORE/SURR. CNTYS (MD)	$97.83	$73.10
REST OF MARYLAND (MD)	$92.99	$69.66
SOUTHERN MAINE (ME)	$90.64	$67.80
REST OF MAINE (ME)	$86.15	$64.95
DETROIT (MI)	$91.82	$69.58
REST OF MICHIGAN (MI)	$87.07	$66.03
MINNESOTA (MN)	$92.13	$68.41
METROPOLITAN ST. LOUIS (MO)	$89.18	$67.24
METROPOLITAN KANSAS CITY (MO)	$88.29	$66.65
REST OF MISSOURI (MO)	$83.45	$63.59
MISSISSIPPI (MS)	$82.76	$62.92
MONTANA** (MT)	$92.18	$69.13
NORTH CAROLINA (NC)	$87.01	$65.51
NORTH DAKOTA** (ND)	$90.60	$67.55
NEBRASKA (NE)	$85.69	$64.42
NEW HAMPSHIRE (NH)	$94.43	$70.44
NORTHERN NJ (NJ)	$104.10	$77.36
REST OF NEW JERSEY (NJ)	$99.29	$74.12
NEW MEXICO (NM)	$87.51	$66.38
NEVADA** (NV)	$91.80	$68.73
MANHATTAN (NY)	$105.64	$78.85
NYC SUBURBS/LONG ISLAND (NY)	$108.05	$80.65
POUGHKPSIE/N NYC SUBURBS (NY)	$99.92	$74.68
QUEENS (NY)	$106.51	$79.27
REST OF NEW YORK (NY)	$88.25	$66.36
OHIO (OH)	$86.74	$65.70
OKLAHOMA (OK)	$84.87	$64.29
PORTLAND (OR)	$98.90	$73.30
REST OF OREGON (OR)	$91.14	$68.19
METROPOLITAN PHILADELPHIA (PA)	$95.76	$71.77
REST OF PENNSYLVANIA (PA)	$86.89	$65.73
PUERTO RICO (PR)	$92.84	$69.54
RHODE ISLAND (RI)	$94.48	$70.67
SOUTH CAROLINA (SC)	$87.01	$65.72
SOUTH DAKOTA** (SD)	$90.41	$67.37
TENNESSEE (TN)	$85.24	$64.29
BRAZORIA (TX)	$91.25	$68.41
DALLAS (TX)	$91.80	$68.84
GALVESTON (TX)	$91.50	$68.62
HOUSTON (TX)	$92.97	$70.08
BEAUMONT (TX)	$86.35	$65.37
FORT WORTH (TX)	$91.20	$68.48
AUSTIN (TX)	$95.58	$71.19
REST OF TEXAS (TX)	$88.72	$66.85
UTAH (UT)	$88.15	$66.48
VIRGINIA (VA)	$90.33	$67.68
VIRGIN ISLANDS (VI)	$92.84	$69.54
VERMONT (VT)	$90.24	$67.42
SEATTLE (KING CNTY) (WA)	$107.29	$79.01
REST OF WASHINGTON (WA)	$95.22	$70.96
WISCONSIN (WI)	$87.70	$65.62
WEST VIRGINIA (WV)	$85.11	$65.08
WYOMING** (WY)	$91.49	$68.45

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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) — work, practice expense, and malpractice — assigned to this procedure code. Each RVU component is adjusted using Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the allowed amount differs between the two.

RVUs — work 0.8, practice expense 1.88 (non-facility) / 1.19 (facility), malpractice 0.08 — × 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 remainder.
Actual payment can vary by locality, provider type, modifiers, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the facility amount differ from the non-facility amount?

Facility rates use lower practice-expense RVUs because the facility (e.g., hospital) bears some of the overhead costs, whereas non-facility rates assume the billing provider covers all practice expenses.

Does this amount reflect what a patient will pay?

No. This is the Medicare-allowed amount before cost-sharing. Patients are generally responsible for 20% coinsurance after meeting their deductible, unless supplemental coverage applies.

Will this rate be the same in every state?

No. The GPCI adjustments mean the same code can have different allowed amounts depending on the locality where the service is billed.

Can modifiers change this amount?

Yes. Certain modifiers can increase, decrease, or otherwise adjust the base allowed amount, so the figures shown here represent an unmodified baseline estimate.

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.