Medicare Reimbursement for CPT 11201

This page covers CPT code 11201, a physician procedure code billed under the Medicare Physician Fee Schedule (PFS). It shows the estimated national Medicare allowed amount for 2026, broken out by non-facility and facility settings, along with the underlying RVU and locality adjustment inputs used to derive them.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$18.37	$13.03
ALASKA* (AK)	$23.12	$17.43
ALABAMA (AL)	$16.93	$12.26
ARKANSAS (AR)	$16.75	$12.16
ARIZONA (AZ)	$17.98	$12.80
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$21.97	$14.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$22.34	$14.63
OXNARD-THOUSAND OAKS-VENTURA (CA)	$19.71	$13.40
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$19.88	$13.56
NAPA (CA)	$21.02	$13.97
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$22.00	$14.47
VALLEJO (CA)	$20.97	$13.92
BAKERSFIELD (CA)	$18.93	$13.07
CHICO (CA)	$18.83	$12.98
FRESNO (CA)	$18.83	$12.98
HANFORD-CORCORAN (CA)	$18.83	$12.98
MADERA (CA)	$18.83	$12.98
MERCED (CA)	$18.83	$12.98
MODESTO (CA)	$18.83	$12.98
REDDING (CA)	$18.83	$12.98
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$19.16	$13.30
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$19.55	$13.33
SALINAS (CA)	$19.47	$13.28
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$22.48	$14.77
SANTA CRUZ-WATSONVILLE (CA)	$19.83	$13.33
SANTA ROSA-PETALUMA (CA)	$20.01	$13.45
STOCKTON (CA)	$18.83	$12.98
VISALIA (CA)	$18.83	$12.98
YUBA CITY (CA)	$18.83	$12.98
EL CENTRO (CA)	$18.84	$12.98
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$19.76	$13.37
SAN LUIS OBISPO-PASO ROBLES (CA)	$19.18	$13.09
SANTA MARIA-SANTA BARBARA (CA)	$19.50	$13.27
REST OF CALIFORNIA (CA)	$18.83	$12.98
COLORADO (CO)	$18.78	$13.09
CONNECTICUT (CT)	$19.39	$13.63
DC + MD/VA SUBURBS (DC)	$20.42	$14.12
DELAWARE (DE)	$18.22	$12.94
FORT LAUDERDALE (FL)	$19.28	$13.87
MIAMI (FL)	$20.23	$14.67
REST OF FLORIDA (FL)	$18.52	$13.41
ATLANTA (GA)	$18.73	$13.30
REST OF GEORGIA (GA)	$17.70	$12.93
HAWAII, GUAM (HI)	$19.05	$12.97
IOWA (IA)	$17.08	$12.20
IDAHO (ID)	$17.20	$12.28
EAST ST. LOUIS (IL)	$18.75	$13.83
SUBURBAN CHICAGO (IL)	$19.43	$13.94
CHICAGO (IL)	$19.77	$14.40
REST OF ILLINOIS (IL)	$18.24	$13.36
INDIANA (IN)	$17.27	$12.32
KANSAS (KS)	$17.10	$12.27
KENTUCKY (KY)	$17.40	$12.64
NEW ORLEANS (LA)	$18.03	$13.00
REST OF LOUISIANA (LA)	$17.41	$12.68
METROPOLITAN BOSTON (MA)	$20.20	$13.82
REST OF MASSACHUSETTS (MA)	$18.74	$13.11
BALTIMORE/SURR. CNTYS (MD)	$19.34	$13.61
REST OF MARYLAND (MD)	$18.48	$13.07
SOUTHERN MAINE (ME)	$17.93	$12.63
REST OF MAINE (ME)	$17.35	$12.43
DETROIT (MI)	$18.78	$13.62
REST OF MICHIGAN (MI)	$17.80	$12.92
MINNESOTA (MN)	$17.90	$12.40
METROPOLITAN ST. LOUIS (MO)	$17.99	$12.90
METROPOLITAN KANSAS CITY (MO)	$17.86	$12.84
REST OF MISSOURI (MO)	$17.24	$12.63
MISSISSIPPI (MS)	$16.99	$12.39
MONTANA** (MT)	$18.37	$13.02
NORTH CAROLINA (NC)	$17.47	$12.49
NORTH DAKOTA** (ND)	$17.78	$12.43
NEBRASKA (NE)	$17.13	$12.20
NEW HAMPSHIRE (NH)	$18.57	$13.01
NORTHERN NJ (NJ)	$20.31	$14.11
REST OF NEW JERSEY (NJ)	$19.58	$13.74
NEW MEXICO (NM)	$17.91	$13.01
NEVADA** (NV)	$18.21	$12.86
MANHATTAN (NY)	$20.85	$14.64
NYC SUBURBS/LONG ISLAND (NY)	$21.34	$14.99
POUGHKPSIE/N NYC SUBURBS (NY)	$19.76	$13.91
QUEENS (NY)	$20.87	$14.55
REST OF NEW YORK (NY)	$17.67	$12.60
OHIO (OH)	$17.68	$12.80
OKLAHOMA (OK)	$17.29	$12.52
PORTLAND (OR)	$19.15	$13.22
REST OF OREGON (OR)	$18.04	$12.72
METROPOLITAN PHILADELPHIA (PA)	$19.06	$13.50
REST OF PENNSYLVANIA (PA)	$17.66	$12.75
PUERTO RICO (PR)	$18.44	$13.04
RHODE ISLAND (RI)	$18.70	$13.18
SOUTH CAROLINA (SC)	$17.61	$12.67
SOUTH DAKOTA** (SD)	$17.71	$12.36
TENNESSEE (TN)	$17.18	$12.32
BRAZORIA (TX)	$18.15	$12.86
DALLAS (TX)	$18.28	$12.96
GALVESTON (TX)	$18.22	$12.91
HOUSTON (TX)	$18.77	$13.46
BEAUMONT (TX)	$17.58	$12.71
FORT WORTH (TX)	$18.21	$12.94
AUSTIN (TX)	$18.74	$13.09
REST OF TEXAS (TX)	$17.86	$12.79
UTAH (UT)	$17.79	$12.76
VIRGINIA (VA)	$17.94	$12.69
VIRGIN ISLANDS (VI)	$18.44	$13.04
VERMONT (VT)	$17.80	$12.50
SEATTLE (KING CNTY) (WA)	$20.47	$13.92
REST OF WASHINGTON (WA)	$18.68	$13.05
WISCONSIN (WI)	$17.34	$12.22
WEST VIRGINIA (WV)	$17.75	$13.11
WYOMING** (WY)	$18.11	$12.77

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: 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's allowed amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility rates (e.g., office settings) generally use a higher PE RVU than facility rates (e.g., hospital settings), since the physician does not bear as many overhead costs when a facility furnishes the setting and equipment.

RVUs — work 0.28, practice expense 0.24 (non-facility) / 0.08 (facility), malpractice 0.03 — × 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, claim-specific adjustments, and annual budget-neutrality adjustments.
Sequestration and other federal payment adjustments may reduce the amount actually disbursed.
Always verify final rates and coverage rules with your local Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

The facility rate uses a lower practice expense RVU because the facility (e.g., hospital) — not the physician's office — absorbs certain overhead and equipment costs when the service is performed there.

Does this amount reflect what my practice will actually be paid?

No. It's a national estimate based on standard RVUs and the conversion factor. Your actual payment depends on your specific locality's GPCIs, any modifiers on the claim, and other adjustments applied by your MAC.

Why can't you show the CPT code's official description?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page references the code generically rather than reproducing the descriptor.

How often do these amounts change?

The conversion factor, RVUs, and GPCIs are updated annually (and sometimes mid-year) by CMS, so estimates shown here are specific to the stated fee schedule year.

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.