Medicare Reimbursement for CPT 11755

CPT 11755 is a procedure code defined by the American Medical Association; its official descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjustable by locality, and separately for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$119.58	$54.44
ALASKA* (AK)	$143.18	$73.82
ALABAMA (AL)	$108.59	$51.60
ARKANSAS (AR)	$107.20	$51.25
ARIZONA (AZ)	$116.72	$53.60
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$152.15	$60.31
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$155.06	$61.14
OXNARD-THOUSAND OAKS-VENTURA (CA)	$133.01	$56.02
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$133.76	$56.71
NAPA (CA)	$144.23	$58.39
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$152.27	$60.44
VALLEJO (CA)	$144.05	$58.21
BAKERSFIELD (CA)	$126.13	$54.74
CHICO (CA)	$125.78	$54.39
FRESNO (CA)	$125.78	$54.39
HANFORD-CORCORAN (CA)	$125.78	$54.39
MADERA (CA)	$125.78	$54.39
MERCED (CA)	$125.78	$54.39
MODESTO (CA)	$125.78	$54.39
REDDING (CA)	$125.78	$54.39
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$126.98	$55.60
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$131.59	$55.84
SALINAS (CA)	$131.08	$55.60
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$155.57	$61.65
SANTA CRUZ-WATSONVILLE (CA)	$134.88	$55.75
SANTA ROSA-PETALUMA (CA)	$136.23	$56.25
STOCKTON (CA)	$125.78	$54.39
VISALIA (CA)	$125.78	$54.39
YUBA CITY (CA)	$125.78	$54.39
EL CENTRO (CA)	$125.80	$54.41
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$133.84	$55.95
SAN LUIS OBISPO-PASO ROBLES (CA)	$129.01	$54.82
SANTA MARIA-SANTA BARBARA (CA)	$131.49	$55.54
REST OF CALIFORNIA (CA)	$125.78	$54.39
COLORADO (CO)	$124.07	$54.77
CONNECTICUT (CT)	$126.95	$56.80
DC + MD/VA SUBURBS (DC)	$135.57	$58.84
DELAWARE (DE)	$118.51	$54.16
FORT LAUDERDALE (FL)	$123.52	$57.54
MIAMI (FL)	$128.27	$60.47
REST OF FLORIDA (FL)	$118.12	$55.85
ATLANTA (GA)	$121.64	$55.46
REST OF GEORGIA (GA)	$112.16	$54.07
HAWAII, GUAM (HI)	$128.32	$54.27
IOWA (IA)	$110.97	$51.38
IDAHO (ID)	$111.63	$51.71
EAST ST. LOUIS (IL)	$117.29	$57.37
SUBURBAN CHICAGO (IL)	$124.73	$57.84
CHICAGO (IL)	$124.99	$59.54
REST OF ILLINOIS (IL)	$115.11	$55.64
INDIANA (IN)	$112.20	$51.82
KANSAS (KS)	$110.54	$51.66
KENTUCKY (KY)	$110.92	$53.02
NEW ORLEANS (LA)	$115.64	$54.35
REST OF LOUISIANA (LA)	$110.78	$53.14
METROPOLITAN BOSTON (MA)	$135.42	$57.65
REST OF MASSACHUSETTS (MA)	$123.46	$54.88
BALTIMORE/SURR. CNTYS (MD)	$126.58	$56.70
REST OF MARYLAND (MD)	$120.58	$54.67
SOUTHERN MAINE (ME)	$117.54	$53.00
REST OF MAINE (ME)	$112.17	$52.25
DETROIT (MI)	$119.47	$56.61
REST OF MICHIGAN (MI)	$113.51	$54.05
MINNESOTA (MN)	$119.17	$52.15
METROPOLITAN ST. LOUIS (MO)	$115.98	$53.97
METROPOLITAN KANSAS CITY (MO)	$114.91	$53.75
REST OF MISSOURI (MO)	$109.11	$52.97
MISSISSIPPI (MS)	$108.17	$52.09
MONTANA** (MT)	$119.57	$54.44
NORTH CAROLINA (NC)	$113.21	$52.45
NORTH DAKOTA** (ND)	$117.39	$52.26
NEBRASKA (NE)	$111.50	$51.39
NEW HAMPSHIRE (NH)	$122.20	$54.40
NORTHERN NJ (NJ)	$134.42	$58.86
REST OF NEW JERSEY (NJ)	$128.48	$57.35
NEW MEXICO (NM)	$114.08	$54.35
NEVADA** (NV)	$119.04	$53.84
MANHATTAN (NY)	$136.51	$60.83
NYC SUBURBS/LONG ISLAND (NY)	$139.54	$62.09
POUGHKPSIE/N NYC SUBURBS (NY)	$129.32	$58.00
QUEENS (NY)	$137.48	$60.50
REST OF NEW YORK (NY)	$114.73	$52.85
OHIO (OH)	$113.07	$53.60
OKLAHOMA (OK)	$110.71	$52.55
PORTLAND (OR)	$127.63	$55.27
REST OF OREGON (OR)	$118.18	$53.31
METROPOLITAN PHILADELPHIA (PA)	$124.10	$56.30
REST OF PENNSYLVANIA (PA)	$113.21	$53.42
PUERTO RICO (PR)	$120.35	$54.50
RHODE ISLAND (RI)	$122.43	$55.15
SOUTH CAROLINA (SC)	$113.31	$53.13
SOUTH DAKOTA** (SD)	$117.14	$52.00
TENNESSEE (TN)	$111.04	$51.83
BRAZORIA (TX)	$118.42	$53.87
DALLAS (TX)	$119.12	$54.25
GALVESTON (TX)	$118.74	$54.07
HOUSTON (TX)	$120.76	$56.08
BEAUMONT (TX)	$112.55	$53.28
FORT WORTH (TX)	$118.42	$54.20
AUSTIN (TX)	$123.60	$54.69
REST OF TEXAS (TX)	$115.39	$53.58
UTAH (UT)	$114.69	$53.47
VIRGINIA (VA)	$117.22	$53.19
VIRGIN ISLANDS (VI)	$120.35	$54.50
VERMONT (VT)	$117.01	$52.53
SEATTLE (KING CNTY) (WA)	$138.00	$58.08
REST OF WASHINGTON (WA)	$123.21	$54.63
WISCONSIN (WI)	$113.88	$51.48
WEST VIRGINIA (WV)	$111.31	$54.71
WYOMING** (WY)	$118.62	$53.49

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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 the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility and facility amounts differ mainly because the practice-expense RVU is higher when the physician's office bears more of the overhead, and lower when the service is performed in a facility that bills its own costs separately.

RVUs — work 1.22, practice expense 2.25 (non-facility) / 0.3 (facility), malpractice 0.11 — × 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 patient's deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality-specific GPCI values, 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 is the facility amount lower than the non-facility amount?

In the facility setting, the facility itself bills separately for overhead and supplies, so the practice-expense RVU used for the physician payment is reduced compared to when the physician's own office bears those costs.

Does this amount vary by state or region?

Yes. The national amount is adjusted by locality-specific GPCI values for work, practice expense, and malpractice, so the actual allowed amount can differ from one Medicare locality to another.

Will Medicare pay this full amount to the provider?

No. Medicare generally pays 80% of the allowed amount after the deductible; the remaining portion is the patient's or secondary payer's responsibility, and modifiers or other adjustments may further change the final payment.

Why might the amount change from year to year?

The RVUs, GPCIs, and the conversion factor are all updated annually (and sometimes adjusted mid-year), and budget-neutrality requirements can shift relative payments across codes.

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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.