Medicare Reimbursement for CPT 11604

CPT 11604 is a procedure code billed under the Medicare Physician Fee Schedule (PFS); the specific clinical descriptor is not shown here because CPT descriptors are licensed by the AMA. This page shows the estimated Medicare-allowed amount 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)	$310.96	$181.03
ALASKA* (AK)	$369.20	$230.83
ALABAMA (AL)	$280.86	$167.18
ARKANSAS (AR)	$277.07	$165.46
ARIZONA (AZ)	$303.01	$177.11
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$392.79	$209.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$400.18	$212.82
OXNARD-THOUSAND OAKS-VENTURA (CA)	$344.19	$190.62
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$346.28	$192.57
NAPA (CA)	$372.71	$201.46
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$393.24	$210.04
VALLEJO (CA)	$372.05	$200.81
BAKERSFIELD (CA)	$326.36	$183.96
CHICO (CA)	$325.18	$182.78
FRESNO (CA)	$325.18	$182.78
HANFORD-CORCORAN (CA)	$325.18	$182.78
MADERA (CA)	$325.18	$182.78
MERCED (CA)	$325.18	$182.78
MODESTO (CA)	$325.18	$182.78
REDDING (CA)	$325.18	$182.78
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$329.52	$187.12
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$340.16	$189.06
SALINAS (CA)	$338.87	$188.28
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$402.04	$214.68
SANTA CRUZ-WATSONVILLE (CA)	$348.73	$190.86
SANTA ROSA-PETALUMA (CA)	$352.18	$192.63
STOCKTON (CA)	$325.18	$182.78
VISALIA (CA)	$325.18	$182.78
YUBA CITY (CA)	$325.18	$182.78
EL CENTRO (CA)	$325.25	$182.84
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$346.04	$190.64
SAN LUIS OBISPO-PASO ROBLES (CA)	$333.54	$185.55
SANTA MARIA-SANTA BARBARA (CA)	$339.92	$188.42
REST OF CALIFORNIA (CA)	$325.18	$182.78
COLORADO (CO)	$321.72	$183.47
CONNECTICUT (CT)	$330.80	$190.87
DC + MD/VA SUBURBS (DC)	$352.65	$199.59
DELAWARE (DE)	$307.80	$179.43
FORT LAUDERDALE (FL)	$324.28	$192.67
MIAMI (FL)	$339.36	$204.10
REST OF FLORIDA (FL)	$309.13	$184.92
ATLANTA (GA)	$317.07	$185.06
REST OF GEORGIA (GA)	$292.53	$176.64
HAWAII, GUAM (HI)	$331.97	$184.24
IOWA (IA)	$286.38	$167.50
IDAHO (ID)	$288.37	$168.83
EAST ST. LOUIS (IL)	$308.96	$189.42
SUBURBAN CHICAGO (IL)	$327.25	$193.81
CHICAGO (IL)	$329.96	$199.38
REST OF ILLINOIS (IL)	$301.57	$182.95
INDIANA (IN)	$289.90	$169.46
KANSAS (KS)	$285.67	$168.22
KENTUCKY (KY)	$288.25	$172.74
NEW ORLEANS (LA)	$301.31	$179.05
REST OF LOUISIANA (LA)	$288.05	$173.06
METROPOLITAN BOSTON (MA)	$351.44	$196.30
REST OF MASSACHUSETTS (MA)	$320.20	$183.39
BALTIMORE/SURR. CNTYS (MD)	$329.97	$190.56
REST OF MARYLAND (MD)	$313.23	$181.74
SOUTHERN MAINE (ME)	$304.28	$175.52
REST OF MAINE (ME)	$290.36	$170.83
DETROIT (MI)	$313.32	$187.94
REST OF MICHIGAN (MI)	$295.77	$177.15
MINNESOTA (MN)	$307.19	$173.50
METROPOLITAN ST. LOUIS (MO)	$301.66	$177.97
METROPOLITAN KANSAS CITY (MO)	$298.80	$176.79
REST OF MISSOURI (MO)	$283.79	$171.79
MISSISSIPPI (MS)	$280.45	$168.59
MONTANA** (MT)	$310.94	$181.01
NORTH CAROLINA (NC)	$293.11	$171.89
NORTH DAKOTA** (ND)	$303.03	$173.10
NEBRASKA (NE)	$287.68	$167.76
NEW HAMPSHIRE (NH)	$317.26	$182.01
NORTHERN NJ (NJ)	$349.48	$198.76
REST OF NEW JERSEY (NJ)	$334.27	$192.39
NEW MEXICO (NM)	$297.51	$178.37
NEVADA** (NV)	$308.93	$178.87
MANHATTAN (NY)	$356.89	$205.91
NYC SUBURBS/LONG ISLAND (NY)	$365.76	$211.27
POUGHKPSIE/N NYC SUBURBS (NY)	$336.88	$194.61
QUEENS (NY)	$358.85	$205.28
REST OF NEW YORK (NY)	$297.27	$173.84
OHIO (OH)	$294.16	$175.53
OKLAHOMA (OK)	$287.18	$171.16
PORTLAND (OR)	$330.77	$186.42
REST OF OREGON (OR)	$306.22	$176.81
METROPOLITAN PHILADELPHIA (PA)	$323.37	$188.11
REST OF PENNSYLVANIA (PA)	$294.29	$175.01
PUERTO RICO (PR)	$312.90	$181.54
RHODE ISLAND (RI)	$317.90	$183.68
SOUTH CAROLINA (SC)	$294.18	$174.13
SOUTH DAKOTA** (SD)	$302.09	$172.16
TENNESSEE (TN)	$287.09	$168.98
BRAZORIA (TX)	$307.10	$178.34
DALLAS (TX)	$309.22	$179.81
GALVESTON (TX)	$308.13	$179.11
HOUSTON (TX)	$315.45	$186.43
BEAUMONT (TX)	$292.52	$174.28
FORT WORTH (TX)	$307.45	$179.34
AUSTIN (TX)	$320.92	$183.46
REST OF TEXAS (TX)	$299.75	$176.45
UTAH (UT)	$297.94	$175.80
VIRGINIA (VA)	$303.73	$176.01
VIRGIN ISLANDS (VI)	$312.90	$181.54
VERMONT (VT)	$302.42	$173.79
SEATTLE (KING CNTY) (WA)	$357.81	$198.38
REST OF WASHINGTON (WA)	$319.41	$182.60
WISCONSIN (WI)	$293.55	$169.08
WEST VIRGINIA (WV)	$291.26	$178.35
WYOMING** (WY)	$307.49	$177.56

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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 payment for this procedure code is based on 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, and the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility settings (like an office, where the practice bears more overhead) and facility settings (like a hospital, where the facility separately bills overhead), which is why the two allowed amounts differ. The conversion factor and RVU values are updated annually by CMS and can shift the final amount year to year.

RVUs — work 3.09, practice expense 5.82 (non-facility) / 1.93 (facility), malpractice 0.4 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment depends on the specific locality, claim modifiers, and payer processing.
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.
Amounts are subject to sequestration reductions and annual budget-neutrality adjustments set by CMS.
Always verify current-year rates and locality-specific figures with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

In a facility setting, the facility (e.g., hospital) bills separately for overhead costs, so the physician practice-expense RVU is lower than when the same service is performed in a non-facility setting like an office.

Does this amount apply in every state?

No. The national amount is adjusted by locality-specific GPCIs, so the actual allowed amount can be higher or lower depending on where the service is furnished.

Is this the amount Medicare will actually pay?

No. This is the Medicare-allowed amount used as a basis for payment. Medicare generally pays 80% of this figure after the deductible, and modifiers, sequestration, or other adjustments may change the final reimbursement.

Why might this figure differ from what I see on my remittance advice?

Remittance amounts reflect the specific claim's locality, modifiers, sequestration, and any secondary payer adjustments, which are not reflected in this general reference figure.

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.