Medicare Reimbursement for CPT 11303

CPT 11303 is a procedure code used for billing under Medicare Part B; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and by locality, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$147.30	$57.78
ALASKA* (AK)	$172.37	$77.03
ALABAMA (AL)	$132.64	$54.31
ARKANSAS (AR)	$130.78	$53.89
ARIZONA (AZ)	$143.50	$56.76
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$190.58	$64.36
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$194.34	$65.26
OXNARD-THOUSAND OAKS-VENTURA (CA)	$165.40	$59.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$166.21	$60.32
NAPA (CA)	$180.23	$62.25
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$190.72	$64.51
VALLEJO (CA)	$180.02	$62.04
BAKERSFIELD (CA)	$156.19	$58.08
CHICO (CA)	$155.79	$57.68
FRESNO (CA)	$155.79	$57.68
HANFORD-CORCORAN (CA)	$155.79	$57.68
MADERA (CA)	$155.79	$57.68
MERCED (CA)	$155.79	$57.68
MODESTO (CA)	$155.79	$57.68
REDDING (CA)	$155.79	$57.68
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$157.21	$59.10
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$163.41	$59.30
SALINAS (CA)	$162.80	$59.05
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$194.94	$65.86
SANTA CRUZ-WATSONVILLE (CA)	$168.11	$59.35
SANTA ROSA-PETALUMA (CA)	$169.81	$59.89
STOCKTON (CA)	$155.79	$57.68
VISALIA (CA)	$155.79	$57.68
YUBA CITY (CA)	$155.79	$57.68
EL CENTRO (CA)	$155.81	$57.70
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$166.56	$59.51
SAN LUIS OBISPO-PASO ROBLES (CA)	$160.18	$58.23
SANTA MARIA-SANTA BARBARA (CA)	$163.39	$59.02
REST OF CALIFORNIA (CA)	$155.79	$57.68
COLORADO (CO)	$153.38	$58.13
CONNECTICUT (CT)	$156.89	$60.49
DC + MD/VA SUBURBS (DC)	$168.18	$62.73
DELAWARE (DE)	$145.84	$57.40
FORT LAUDERDALE (FL)	$152.14	$61.46
MIAMI (FL)	$158.13	$64.94
REST OF FLORIDA (FL)	$144.98	$59.41
ATLANTA (GA)	$149.93	$58.98
REST OF GEORGIA (GA)	$137.09	$57.25
HAWAII, GUAM (HI)	$159.47	$57.69
IOWA (IA)	$135.99	$54.09
IDAHO (ID)	$136.83	$54.48
EAST ST. LOUIS (IL)	$143.52	$61.17
SUBURBAN CHICAGO (IL)	$153.69	$61.76
CHICAGO (IL)	$153.72	$63.76
REST OF ILLINOIS (IL)	$140.85	$59.12
INDIANA (IN)	$137.61	$54.63
KANSAS (KS)	$135.33	$54.41
KENTUCKY (KY)	$135.58	$56.01
NEW ORLEANS (LA)	$141.86	$57.63
REST OF LOUISIANA (LA)	$135.36	$56.14
METROPOLITAN BOSTON (MA)	$168.32	$61.44
REST OF MASSACHUSETTS (MA)	$152.49	$58.23
BALTIMORE/SURR. CNTYS (MD)	$156.44	$60.39
REST OF MARYLAND (MD)	$148.58	$57.99
SOUTHERN MAINE (ME)	$144.78	$56.07
REST OF MAINE (ME)	$137.48	$55.13
DETROIT (MI)	$146.70	$60.32
REST OF MICHIGAN (MI)	$138.97	$57.24
MINNESOTA (MN)	$147.21	$55.09
METROPOLITAN ST. LOUIS (MO)	$142.40	$57.18
METROPOLITAN KANSAS CITY (MO)	$140.96	$56.91
REST OF MISSOURI (MO)	$133.08	$55.92
MISSISSIPPI (MS)	$131.96	$54.89
MONTANA** (MT)	$147.29	$57.77
NORTH CAROLINA (NC)	$138.88	$55.37
NORTH DAKOTA** (ND)	$144.72	$55.20
NEBRASKA (NE)	$136.73	$54.11
NEW HAMPSHIRE (NH)	$150.95	$57.76
NORTHERN NJ (NJ)	$166.51	$62.68
REST OF NEW JERSEY (NJ)	$158.75	$61.00
NEW MEXICO (NM)	$139.69	$57.60
NEVADA** (NV)	$146.68	$57.07
MANHATTAN (NY)	$169.01	$64.99
NYC SUBURBS/LONG ISLAND (NY)	$172.94	$66.51
POUGHKPSIE/N NYC SUBURBS (NY)	$159.75	$61.73
QUEENS (NY)	$170.43	$64.62
REST OF NEW YORK (NY)	$140.90	$55.86
OHIO (OH)	$138.44	$56.71
OKLAHOMA (OK)	$135.39	$55.46
PORTLAND (OR)	$158.18	$58.73
REST OF OREGON (OR)	$145.60	$56.44
METROPOLITAN PHILADELPHIA (PA)	$153.06	$59.88
REST OF PENNSYLVANIA (PA)	$138.68	$56.50
PUERTO RICO (PR)	$148.36	$57.86
RHODE ISLAND (RI)	$150.98	$58.51
SOUTH CAROLINA (SC)	$138.88	$56.17
SOUTH DAKOTA** (SD)	$144.41	$54.90
TENNESSEE (TN)	$135.99	$54.62
BRAZORIA (TX)	$145.75	$57.04
DALLAS (TX)	$146.64	$57.48
GALVESTON (TX)	$146.16	$57.27
HOUSTON (TX)	$148.54	$59.65
BEAUMONT (TX)	$137.79	$56.33
FORT WORTH (TX)	$145.67	$57.41
AUSTIN (TX)	$152.81	$58.11
REST OF TEXAS (TX)	$141.66	$56.72
UTAH (UT)	$140.72	$56.58
VIRGINIA (VA)	$144.28	$56.29
VIRGIN ISLANDS (VI)	$148.36	$57.86
VERMONT (VT)	$144.13	$55.51
SEATTLE (KING CNTY) (WA)	$171.74	$61.91
REST OF WASHINGTON (WA)	$152.21	$57.95
WISCONSIN (WI)	$140.00	$54.25
WEST VIRGINIA (WV)	$135.78	$57.99
WYOMING** (WY)	$146.17	$56.65

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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's fee for a procedure code 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 national conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because practice-expense RVUs are lower when the service is performed in a facility (like a hospital), since the facility itself bears more of the overhead cost. The conversion factor and RVUs are updated annually and can shift due to legislative or budget-neutrality adjustments.

RVUs — work 1.22, practice expense 3.06 (non-facility) / 0.38 (facility), malpractice 0.13 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount 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, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The facility rate reflects lower practice-expense RVUs because Medicare assumes the facility (e.g., hospital) is absorbing the overhead costs, whereas non-facility rates assume the billing provider bears those costs directly.

Why does the fee for this code differ by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs), which adjust the work, practice expense, and malpractice RVUs to reflect regional cost-of-living and labor market differences before the conversion factor is applied.

Does this figure represent what Medicare will actually pay?

No. This is the Medicare Physician Fee Schedule allowed amount before adjustments such as deductible, coinsurance, modifiers, sequestration, or claim-specific edits are applied.

Where can I find the official descriptor for CPT 11303?

CPT code descriptors are copyrighted by the American Medical Association (AMA) and are not reproduced here; consult your CPT codebook or AMA-licensed coding resource.

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.