Medicare Reimbursement for CPT 11442
This page covers CPT code 11442, a procedure code billed under Medicare Part B. It shows the Medicare Physician Fee Schedule (PFS) allowed amount at the national level and adjusted for 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) | $194.06 | $131.93 |
| ALASKA* (AK) | $228.03 | $161.87 |
| ALABAMA (AL) | $174.75 | $120.39 |
| ARKANSAS (AR) | $172.32 | $118.95 |
| ARIZONA (AZ) | $189.00 | $128.80 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $248.18 | $160.59 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $252.97 | $163.39 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $216.37 | $142.94 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $217.55 | $144.06 |
| NAPA (CA) | $235.08 | $153.20 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $248.43 | $160.84 |
| VALLEJO (CA) | $234.72 | $152.84 |
| BAKERSFIELD (CA) | $204.66 | $136.57 |
| CHICO (CA) | $204.01 | $135.92 |
| FRESNO (CA) | $204.01 | $135.92 |
| HANFORD-CORCORAN (CA) | $204.01 | $135.92 |
| MADERA (CA) | $204.01 | $135.92 |
| MERCED (CA) | $204.01 | $135.92 |
| MODESTO (CA) | $204.01 | $135.92 |
| REDDING (CA) | $204.01 | $135.92 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $206.40 | $138.31 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $213.75 | $141.49 |
| SALINAS (CA) | $212.94 | $140.94 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $253.99 | $164.41 |
| SANTA CRUZ-WATSONVILLE (CA) | $219.58 | $144.10 |
| SANTA ROSA-PETALUMA (CA) | $221.78 | $145.49 |
| STOCKTON (CA) | $204.01 | $135.92 |
| VISALIA (CA) | $204.01 | $135.92 |
| YUBA CITY (CA) | $204.01 | $135.92 |
| EL CENTRO (CA) | $204.05 | $135.96 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $217.70 | $143.39 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $209.55 | $138.79 |
| SANTA MARIA-SANTA BARBARA (CA) | $213.67 | $141.23 |
| REST OF CALIFORNIA (CA) | $204.01 | $135.92 |
| COLORADO (CO) | $201.39 | $135.29 |
| CONNECTICUT (CT) | $206.69 | $139.78 |
| DC + MD/VA SUBURBS (DC) | $220.96 | $147.77 |
| DELAWARE (DE) | $192.06 | $130.68 |
| FORT LAUDERDALE (FL) | $201.67 | $138.74 |
| MIAMI (FL) | $210.58 | $145.91 |
| REST OF FLORIDA (FL) | $192.08 | $132.69 |
| ATLANTA (GA) | $197.77 | $134.65 |
| REST OF GEORGIA (GA) | $181.55 | $126.13 |
| HAWAII, GUAM (HI) | $208.63 | $137.99 |
| IOWA (IA) | $178.67 | $121.82 |
| IDAHO (ID) | $179.87 | $122.72 |
| EAST ST. LOUIS (IL) | $191.20 | $134.04 |
| SUBURBAN CHICAGO (IL) | $203.62 | $139.81 |
| CHICAGO (IL) | $204.62 | $142.19 |
| REST OF ILLINOIS (IL) | $186.98 | $130.26 |
| INDIANA (IN) | $180.87 | $123.28 |
| KANSAS (KS) | $178.04 | $121.88 |
| KENTUCKY (KY) | $179.12 | $123.89 |
| NEW ORLEANS (LA) | $187.45 | $128.99 |
| REST OF LOUISIANA (LA) | $178.92 | $123.94 |
| METROPOLITAN BOSTON (MA) | $220.63 | $146.45 |
| REST OF MASSACHUSETTS (MA) | $200.33 | $134.91 |
| BALTIMORE/SURR. CNTYS (MD) | $206.14 | $139.48 |
| REST OF MARYLAND (MD) | $195.58 | $132.71 |
| SOUTHERN MAINE (ME) | $190.19 | $128.62 |
| REST OF MAINE (ME) | $180.97 | $123.81 |
| DETROIT (MI) | $194.59 | $134.64 |
| REST OF MICHIGAN (MI) | $183.79 | $127.07 |
| MINNESOTA (MN) | $192.62 | $128.70 |
| METROPOLITAN ST. LOUIS (MO) | $187.89 | $128.74 |
| METROPOLITAN KANSAS CITY (MO) | $186.03 | $127.69 |
| REST OF MISSOURI (MO) | $176.08 | $122.52 |
| MISSISSIPPI (MS) | $174.22 | $120.73 |
| MONTANA** (MT) | $194.04 | $131.92 |
| NORTH CAROLINA (NC) | $182.77 | $124.81 |
| NORTH DAKOTA** (ND) | $189.69 | $127.57 |
| NEBRASKA (NE) | $179.56 | $122.22 |
| NEW HAMPSHIRE (NH) | $198.43 | $133.75 |
| NORTHERN NJ (NJ) | $218.83 | $146.76 |
| REST OF NEW JERSEY (NJ) | $208.94 | $141.10 |
| NEW MEXICO (NM) | $184.84 | $127.87 |
| NEVADA** (NV) | $192.96 | $130.77 |
| MANHATTAN (NY) | $222.95 | $150.76 |
| NYC SUBURBS/LONG ISLAND (NY) | $228.42 | $154.55 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $210.45 | $142.42 |
| QUEENS (NY) | $224.47 | $151.04 |
| REST OF NEW YORK (NY) | $185.43 | $126.41 |
| OHIO (OH) | $182.90 | $126.18 |
| OKLAHOMA (OK) | $178.63 | $123.15 |
| PORTLAND (OR) | $207.41 | $138.39 |
| REST OF OREGON (OR) | $191.36 | $129.48 |
| METROPOLITAN PHILADELPHIA (PA) | $201.80 | $137.13 |
| REST OF PENNSYLVANIA (PA) | $183.08 | $126.05 |
| PUERTO RICO (PR) | $195.37 | $132.56 |
| RHODE ISLAND (RI) | $198.62 | $134.44 |
| SOUTH CAROLINA (SC) | $183.16 | $125.75 |
| SOUTH DAKOTA** (SD) | $189.18 | $127.05 |
| TENNESSEE (TN) | $178.92 | $122.45 |
| BRAZORIA (TX) | $191.74 | $130.18 |
| DALLAS (TX) | $193.02 | $131.14 |
| GALVESTON (TX) | $192.36 | $130.66 |
| HOUSTON (TX) | $196.38 | $134.69 |
| BEAUMONT (TX) | $181.93 | $125.40 |
| FORT WORTH (TX) | $191.83 | $130.57 |
| AUSTIN (TX) | $200.81 | $135.09 |
| REST OF TEXAS (TX) | $186.77 | $127.81 |
| UTAH (UT) | $185.57 | $127.18 |
| VIRGINIA (VA) | $189.71 | $128.64 |
| VIRGIN ISLANDS (VI) | $195.37 | $132.56 |
| VERMONT (VT) | $189.14 | $127.64 |
| SEATTLE (KING CNTY) (WA) | $224.87 | $148.64 |
| REST OF WASHINGTON (WA) | $199.89 | $134.47 |
| WISCONSIN (WI) | $183.56 | $124.04 |
| WEST VIRGINIA (WV) | $180.34 | $126.35 |
| WYOMING** (WY) | $192.15 | $130.02 |
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's PFS 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 locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly in the practice-expense RVU, since non-facility rates assume the practice bears overhead costs (supplies, staff, equipment) while facility rates assume a hospital or ASC bears most of those costs. The work and malpractice RVUs generally stay the same across settings, while the PE RVU is lower for facility billing.
RVUs — work 1.73, practice expense 3.86 (non-facility) / 2 (facility), malpractice 0.22 — × 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 payer is responsible for the remainder.
- Actual payment varies by locality GPCI values, applicable modifiers, claim-specific adjustments, and sequestration reductions.
- Annual budget-neutrality adjustments and conversion factor updates can change amounts from year to year.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).
Frequently asked
Why is the facility rate lower than the non-facility rate for this code?
The facility rate uses a lower practice-expense RVU because the cost of overhead (space, equipment, supplies) is assumed to be borne by the facility rather than the billing provider's own practice.
Does this amount reflect what my locality will actually be paid?
No. The amount shown is adjusted using GPCI values, but actual payment can differ slightly due to contractor-specific factors, claim edits, and current sequestration or legislative adjustments.
Will Medicare pay the full allowed amount?
No. Under standard Part B rules, Medicare generally pays 80% of the allowed amount after the patient meets their deductible; the remaining 20% is typically the patient's or secondary payer's responsibility.
Why isn't the CPT code description shown here?
CPT code descriptors are licensed by the American Medical Association (AMA) and cannot be reproduced here. This code is referred to generically as 'this procedure code.'
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.
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