Medicare Reimbursement for CPT 11302

This page covers CPT code 11302, a procedure code defined by the American Medical Association. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$131.60	$48.43
ALASKA* (AK)	$153.43	$64.85
ALABAMA (AL)	$118.48	$45.71
ARKANSAS (AR)	$116.81	$45.37
ARIZONA (AZ)	$128.24	$47.65
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$171.86	$54.60
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$175.31	$55.39
OXNARD-THOUSAND OAKS-VENTURA (CA)	$148.62	$50.32
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$149.28	$50.90
NAPA (CA)	$162.33	$52.71
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$171.96	$54.70
VALLEJO (CA)	$162.18	$52.56
BAKERSFIELD (CA)	$140.15	$48.99
CHICO (CA)	$139.86	$48.71
FRESNO (CA)	$139.86	$48.71
HANFORD-CORCORAN (CA)	$139.86	$48.71
MADERA (CA)	$139.86	$48.71
MERCED (CA)	$139.86	$48.71
MODESTO (CA)	$139.86	$48.71
REDDING (CA)	$139.86	$48.71
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$140.85	$49.69
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$146.84	$50.11
SALINAS (CA)	$146.29	$49.90
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$175.73	$55.80
SANTA CRUZ-WATSONVILLE (CA)	$151.24	$50.19
SANTA ROSA-PETALUMA (CA)	$152.78	$50.65
STOCKTON (CA)	$139.86	$48.71
VISALIA (CA)	$139.86	$48.71
YUBA CITY (CA)	$139.86	$48.71
EL CENTRO (CA)	$139.87	$48.72
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$149.77	$50.30
SAN LUIS OBISPO-PASO ROBLES (CA)	$143.92	$49.19
SANTA MARIA-SANTA BARBARA (CA)	$146.85	$49.88
REST OF CALIFORNIA (CA)	$139.86	$48.71
COLORADO (CO)	$137.40	$48.91
CONNECTICUT (CT)	$140.19	$50.62
DC + MD/VA SUBURBS (DC)	$150.60	$52.63
DELAWARE (DE)	$130.33	$48.16
FORT LAUDERDALE (FL)	$135.26	$51.01
MIAMI (FL)	$140.07	$53.49
REST OF FLORIDA (FL)	$128.95	$49.44
ATLANTA (GA)	$133.82	$49.32
REST OF GEORGIA (GA)	$121.97	$47.78
HAWAII, GUAM (HI)	$143.28	$48.72
IOWA (IA)	$121.75	$45.65
IDAHO (ID)	$122.45	$45.94
EAST ST. LOUIS (IL)	$127.09	$50.57
SUBURBAN CHICAGO (IL)	$136.71	$51.30
CHICAGO (IL)	$136.20	$52.62
REST OF ILLINOIS (IL)	$125.07	$49.14
INDIANA (IN)	$123.15	$46.06
KANSAS (KS)	$121.03	$45.85
KENTUCKY (KY)	$120.85	$46.92
NEW ORLEANS (LA)	$126.43	$48.17
REST OF LOUISIANA (LA)	$120.60	$47.00
METROPOLITAN BOSTON (MA)	$151.00	$51.70
REST OF MASSACHUSETTS (MA)	$136.54	$48.97
BALTIMORE/SURR. CNTYS (MD)	$139.76	$50.52
REST OF MARYLAND (MD)	$132.83	$48.66
SOUTHERN MAINE (ME)	$129.64	$47.22
REST OF MAINE (ME)	$122.90	$46.39
DETROIT (MI)	$130.35	$50.10
REST OF MICHIGAN (MI)	$123.76	$47.83
MINNESOTA (MN)	$132.22	$46.64
METROPOLITAN ST. LOUIS (MO)	$127.07	$47.89
METROPOLITAN KANSAS CITY (MO)	$125.76	$47.67
REST OF MISSOURI (MO)	$118.48	$46.79
MISSISSIPPI (MS)	$117.68	$46.07
MONTANA** (MT)	$131.59	$48.43
NORTH CAROLINA (NC)	$124.18	$46.59
NORTH DAKOTA** (ND)	$129.81	$46.65
NEBRASKA (NE)	$122.45	$45.69
NEW HAMPSHIRE (NH)	$135.10	$48.52
NORTHERN NJ (NJ)	$149.07	$52.60
REST OF NEW JERSEY (NJ)	$141.95	$51.13
NEW MEXICO (NM)	$124.36	$48.09
NEVADA** (NV)	$131.19	$47.94
MANHATTAN (NY)	$150.85	$54.21
NYC SUBURBS/LONG ISLAND (NY)	$154.22	$55.33
POUGHKPSIE/N NYC SUBURBS (NY)	$142.74	$51.67
QUEENS (NY)	$152.31	$54.01
REST OF NEW YORK (NY)	$125.98	$46.97
OHIO (OH)	$123.40	$47.47
OKLAHOMA (OK)	$120.82	$46.55
PORTLAND (OR)	$141.87	$49.47
REST OF OREGON (OR)	$130.33	$47.49
METROPOLITAN PHILADELPHIA (PA)	$136.67	$50.09
REST OF PENNSYLVANIA (PA)	$123.68	$47.33
PUERTO RICO (PR)	$132.59	$48.51
RHODE ISLAND (RI)	$135.04	$49.13
SOUTH CAROLINA (SC)	$123.96	$47.12
SOUTH DAKOTA** (SD)	$129.60	$46.44
TENNESSEE (TN)	$121.61	$46.01
BRAZORIA (TX)	$130.36	$47.94
DALLAS (TX)	$131.10	$48.27
GALVESTON (TX)	$130.69	$48.11
HOUSTON (TX)	$132.34	$49.75
BEAUMONT (TX)	$122.88	$47.20
FORT WORTH (TX)	$130.20	$48.19
AUSTIN (TX)	$136.81	$48.82
REST OF TEXAS (TX)	$126.49	$47.56
UTAH (UT)	$125.62	$47.44
VIRGINIA (VA)	$129.11	$47.35
VIRGIN ISLANDS (VI)	$132.59	$48.51
VERMONT (VT)	$129.17	$46.83
SEATTLE (KING CNTY) (WA)	$154.21	$52.16
REST OF WASHINGTON (WA)	$136.33	$48.76
WISCONSIN (WI)	$125.55	$45.87
WEST VIRGINIA (WV)	$120.51	$48.24
WYOMING** (WY)	$130.82	$47.65

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 4 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's PFS amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice risk. 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 national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility settings (e.g., a physician office) and facility settings (e.g., hospital outpatient), which is why the same code can have two different national and locality-specific amounts. These calculations are updated annually and can shift due to policy changes even if the underlying RVUs stay the same.

RVUs — work 1.02, practice expense 2.83 (non-facility) / 0.34 (facility), malpractice 0.09 — × 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 insurance is generally responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current, locality-specific rates with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why is the facility amount lower than the non-facility amount?

In the facility setting, the facility (e.g., hospital) bears more of the practice-expense costs like supplies and staff time, so the practice-expense RVU assigned to the physician's payment is lower, reducing the total allowed amount.

Does this amount reflect what my specific Medicare Administrative Contractor will pay?

Not exactly. The figures shown are calculated using national RVUs and locality GPCIs, but final payment can be affected by claim-specific modifiers, contractor edits, and other adjustments not reflected here.

Why might this number change next year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and applies budget-neutrality adjustments across the fee schedule, so the same code's allowed amount can shift from year to year even without a change in the code's definition.

Can I see the actual CPT code description here?

No. CPT code descriptors are copyrighted by the American Medical Association and are not reproduced on this page; consult your CPT codebook or licensed coding software for the official descriptor.

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.