Medicare Reimbursement for CPT 11471

CPT 11471 is a procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount at the national level and how it can vary by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$585.52	$331.67
ALASKA* (AK)	$677.09	$406.74
ALABAMA (AL)	$522.75	$300.63
ARKANSAS (AR)	$514.85	$296.80
ARIZONA (AZ)	$568.83	$322.86
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$745.13	$387.20
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$759.31	$393.26
OXNARD-THOUSAND OAKS-VENTURA (CA)	$650.37	$350.32
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$654.10	$353.79
NAPA (CA)	$706.19	$371.62
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$746.17	$388.25
VALLEJO (CA)	$704.69	$370.12
BAKERSFIELD (CA)	$614.49	$336.28
CHICO (CA)	$611.93	$333.72
FRESNO (CA)	$611.93	$333.72
HANFORD-CORCORAN (CA)	$611.93	$333.72
MADERA (CA)	$611.93	$333.72
MERCED (CA)	$611.93	$333.72
MODESTO (CA)	$611.93	$333.72
REDDING (CA)	$611.93	$333.72
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$621.83	$343.62
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$641.46	$346.23
SALINAS (CA)	$639.08	$344.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$763.58	$397.53
SANTA CRUZ-WATSONVILLE (CA)	$659.63	$351.21
SANTA ROSA-PETALUMA (CA)	$666.21	$354.48
STOCKTON (CA)	$611.93	$333.72
VISALIA (CA)	$611.93	$333.72
YUBA CITY (CA)	$611.93	$333.72
EL CENTRO (CA)	$612.09	$333.87
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$653.74	$350.13
SAN LUIS OBISPO-PASO ROBLES (CA)	$628.94	$339.81
SANTA MARIA-SANTA BARBARA (CA)	$641.37	$345.38
REST OF CALIFORNIA (CA)	$611.93	$333.72
COLORADO (CO)	$606.01	$335.92
CONNECTICUT (CT)	$625.61	$352.22
DC + MD/VA SUBURBS (DC)	$667.99	$368.96
DELAWARE (DE)	$578.47	$327.66
FORT LAUDERDALE (FL)	$615.49	$358.34
MIAMI (FL)	$648.72	$384.46
REST OF FLORIDA (FL)	$583.57	$340.90
ATLANTA (GA)	$598.50	$340.59
REST OF GEORGIA (GA)	$548.71	$322.28
HAWAII, GUAM (HI)	$626.76	$338.14
IOWA (IA)	$533.37	$301.10
IDAHO (ID)	$537.69	$304.15
EAST ST. LOUIS (IL)	$585.04	$351.50
SUBURBAN CHICAGO (IL)	$621.03	$360.33
CHICAGO (IL)	$628.40	$373.29
REST OF ILLINOIS (IL)	$568.41	$336.65
INDIANA (IN)	$540.85	$305.54
KANSAS (KS)	$532.31	$302.83
KENTUCKY (KY)	$539.01	$313.34
NEW ORLEANS (LA)	$566.36	$327.49
REST OF LOUISIANA (LA)	$538.75	$314.09
METROPOLITAN BOSTON (MA)	$665.39	$362.30
REST OF MASSACHUSETTS (MA)	$602.79	$335.49
BALTIMORE/SURR. CNTYS (MD)	$624.22	$351.84
REST OF MARYLAND (MD)	$589.34	$332.44
SOUTHERN MAINE (ME)	$570.62	$319.06
REST OF MAINE (ME)	$542.26	$308.73
DETROIT (MI)	$592.76	$347.79
REST OF MICHIGAN (MI)	$555.08	$323.31
MINNESOTA (MN)	$575.35	$314.14
METROPOLITAN ST. LOUIS (MO)	$566.60	$324.93
METROPOLITAN KANSAS CITY (MO)	$560.69	$322.33
REST OF MISSOURI (MO)	$530.14	$311.33
MISSISSIPPI (MS)	$522.53	$303.97
MONTANA** (MT)	$585.46	$331.61
NORTH CAROLINA (NC)	$547.93	$311.09
NORTH DAKOTA** (ND)	$567.26	$313.42
NEBRASKA (NE)	$535.95	$301.65
NEW HAMPSHIRE (NH)	$597.89	$333.64
NORTHERN NJ (NJ)	$660.92	$366.46
REST OF NEW JERSEY (NJ)	$631.25	$354.05
NEW MEXICO (NM)	$558.87	$326.09
NEVADA** (NV)	$580.78	$326.68
MANHATTAN (NY)	$677.79	$382.82
NYC SUBURBS/LONG ISLAND (NY)	$696.79	$394.97
POUGHKPSIE/N NYC SUBURBS (NY)	$636.71	$358.75
QUEENS (NY)	$681.27	$381.22
REST OF NEW YORK (NY)	$556.62	$315.46
OHIO (OH)	$551.36	$319.60
OKLAHOMA (OK)	$536.35	$309.67
PORTLAND (OR)	$624.10	$342.07
REST OF OREGON (OR)	$574.81	$321.98
METROPOLITAN PHILADELPHIA (PA)	$610.53	$346.28
REST OF PENNSYLVANIA (PA)	$551.40	$318.37
PUERTO RICO (PR)	$589.41	$332.77
RHODE ISLAND (RI)	$598.28	$336.05
SOUTH CAROLINA (SC)	$550.85	$316.30
SOUTH DAKOTA** (SD)	$565.11	$311.27
TENNESSEE (TN)	$535.30	$304.56
BRAZORIA (TX)	$576.47	$324.91
DALLAS (TX)	$581.01	$328.17
GALVESTON (TX)	$578.74	$326.67
HOUSTON (TX)	$595.58	$343.51
BEAUMONT (TX)	$547.74	$316.74
FORT WORTH (TX)	$577.45	$327.16
AUSTIN (TX)	$605.27	$336.70
REST OF TEXAS (TX)	$562.37	$321.47
UTAH (UT)	$558.66	$320.04
VIRGINIA (VA)	$569.76	$320.23
VIRGIN ISLANDS (VI)	$589.41	$332.77
VERMONT (VT)	$566.38	$315.07
SEATTLE (KING CNTY) (WA)	$677.63	$366.16
REST OF WASHINGTON (WA)	$601.20	$333.90
WISCONSIN (WI)	$547.64	$304.46
WEST VIRGINIA (WV)	$546.96	$326.36
WYOMING** (WY)	$577.53	$323.68

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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 pricing starts with three Relative Value Units (RVUs) assigned to the code: 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. Practice-expense RVUs differ depending on whether the service is furnished in a non-facility (e.g., physician office) or facility (e.g., hospital outpatient) setting, which is why the two allowed amounts differ. Work and malpractice RVUs generally stay the same across settings, while practice-expense RVUs are typically higher in non-facility settings to reflect the additional overhead a practice bears.

RVUs — work 4.77, practice expense 11.84 (non-facility) / 4.24 (facility), malpractice 0.92 — × 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 varies by locality GPCIs, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify the current allowed amount and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 11471?

The two amounts reflect different practice-expense RVUs. Non-facility settings (like a physician office) include overhead costs the practice absorbs directly, so practice-expense RVUs are usually higher, resulting in a larger allowed amount than the facility setting, where the facility itself bears more of the overhead.

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

No. The figures shown include a national reference amount, but actual payment depends on the GPCIs of the specific locality where the service was rendered, which can raise or lower the final allowed amount.

Will Medicare pay the full allowed amount?

No. Under Medicare Part B, the program generally pays 80% of the allowed amount once the annual deductible has been met, with the remaining 20% owed as coinsurance unless covered by supplemental insurance.

Can modifiers change the reimbursement for this code?

Yes. Modifiers (such as those indicating bilateral procedures, reduced services, or multiple procedures) can increase or decrease the calculated allowed amount, so the base figures shown here may not reflect the final paid amount.

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.