Medicare Reimbursement for CPT 11765

CPT 11765 is a procedure code defined by the American Medical Association; the exact clinical description is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$163.00	$89.18
ALASKA* (AK)	$189.34	$110.72
ALABAMA (AL)	$146.66	$82.07
ARKANSAS (AR)	$144.58	$81.18
ARIZONA (AZ)	$158.84	$87.31
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$214.34	$110.26
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$218.70	$112.26
OXNARD-THOUSAND OAKS-VENTURA (CA)	$184.86	$97.61
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$185.62	$98.30
NAPA (CA)	$202.26	$104.97
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$214.45	$110.37
VALLEJO (CA)	$202.11	$104.82
BAKERSFIELD (CA)	$174.12	$93.22
CHICO (CA)	$173.82	$92.92
FRESNO (CA)	$173.82	$92.92
HANFORD-CORCORAN (CA)	$173.82	$92.92
MADERA (CA)	$173.82	$92.92
MERCED (CA)	$173.82	$92.92
MODESTO (CA)	$173.82	$92.92
REDDING (CA)	$173.82	$92.92
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$174.81	$93.91
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$182.63	$96.78
SALINAS (CA)	$181.95	$96.40
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$219.12	$112.68
SANTA CRUZ-WATSONVILLE (CA)	$188.29	$98.60
SANTA ROSA-PETALUMA (CA)	$190.21	$99.56
STOCKTON (CA)	$173.82	$92.92
VISALIA (CA)	$173.82	$92.92
YUBA CITY (CA)	$173.82	$92.92
EL CENTRO (CA)	$173.84	$92.93
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$186.38	$98.10
SAN LUIS OBISPO-PASO ROBLES (CA)	$178.99	$94.91
SANTA MARIA-SANTA BARBARA (CA)	$182.67	$96.61
REST OF CALIFORNIA (CA)	$173.82	$92.92
COLORADO (CO)	$170.51	$91.97
CONNECTICUT (CT)	$173.68	$94.18
DC + MD/VA SUBURBS (DC)	$186.89	$99.93
DELAWARE (DE)	$161.45	$88.52
FORT LAUDERDALE (FL)	$166.99	$92.21
MIAMI (FL)	$172.52	$95.68
REST OF FLORIDA (FL)	$159.22	$88.65
ATLANTA (GA)	$165.64	$90.65
REST OF GEORGIA (GA)	$150.59	$84.74
HAWAII, GUAM (HI)	$178.20	$94.28
IOWA (IA)	$150.96	$83.42
IDAHO (ID)	$151.79	$83.88
EAST ST. LOUIS (IL)	$156.43	$88.51
SUBURBAN CHICAGO (IL)	$168.84	$93.03
CHICAGO (IL)	$167.77	$93.58
REST OF ILLINOIS (IL)	$154.23	$86.83
INDIANA (IN)	$152.67	$84.25
KANSAS (KS)	$149.96	$83.23
KENTUCKY (KY)	$149.39	$83.77
NEW ORLEANS (LA)	$156.31	$86.85
REST OF LOUISIANA (LA)	$149.04	$83.72
METROPOLITAN BOSTON (MA)	$187.62	$99.49
REST OF MASSACHUSETTS (MA)	$169.40	$91.67
BALTIMORE/SURR. CNTYS (MD)	$173.12	$93.92
REST OF MARYLAND (MD)	$164.59	$89.89
SOUTHERN MAINE (ME)	$160.80	$87.65
REST OF MAINE (ME)	$152.24	$84.33
DETROIT (MI)	$160.85	$89.62
REST OF MICHIGAN (MI)	$152.92	$85.53
MINNESOTA (MN)	$164.37	$88.41
METROPOLITAN ST. LOUIS (MO)	$157.23	$86.96
METROPOLITAN KANSAS CITY (MO)	$155.59	$86.28
REST OF MISSOURI (MO)	$146.32	$82.70
MISSISSIPPI (MS)	$145.50	$81.94
MONTANA** (MT)	$162.99	$89.17
NORTH CAROLINA (NC)	$153.85	$84.98
NORTH DAKOTA** (ND)	$161.21	$87.39
NEBRASKA (NE)	$151.87	$83.74
NEW HAMPSHIRE (NH)	$167.55	$90.71
NORTHERN NJ (NJ)	$184.94	$99.32
REST OF NEW JERSEY (NJ)	$175.94	$95.33
NEW MEXICO (NM)	$153.62	$85.93
NEVADA** (NV)	$162.61	$88.72
MANHATTAN (NY)	$186.78	$101.01
NYC SUBURBS/LONG ISLAND (NY)	$190.84	$103.08
POUGHKPSIE/N NYC SUBURBS (NY)	$176.84	$96.01
QUEENS (NY)	$188.75	$101.50
REST OF NEW YORK (NY)	$156.09	$85.97
OHIO (OH)	$152.56	$85.17
OKLAHOMA (OK)	$149.46	$83.54
PORTLAND (OR)	$176.21	$94.20
REST OF OREGON (OR)	$161.62	$88.10
METROPOLITAN PHILADELPHIA (PA)	$169.22	$92.38
REST OF PENNSYLVANIA (PA)	$152.97	$85.21
PUERTO RICO (PR)	$164.27	$89.65
RHODE ISLAND (RI)	$167.39	$91.14
SOUTH CAROLINA (SC)	$153.41	$85.20
SOUTH DAKOTA** (SD)	$161.00	$87.18
TENNESSEE (TN)	$150.66	$83.56
BRAZORIA (TX)	$161.57	$88.42
DALLAS (TX)	$162.45	$88.93
GALVESTON (TX)	$161.96	$88.66
HOUSTON (TX)	$163.60	$90.30
BEAUMONT (TX)	$151.96	$84.79
FORT WORTH (TX)	$161.28	$88.50
AUSTIN (TX)	$169.71	$91.61
REST OF TEXAS (TX)	$156.57	$86.52
UTAH (UT)	$155.48	$86.09
VIRGINIA (VA)	$160.07	$87.51
VIRGIN ISLANDS (VI)	$164.27	$89.65
VERMONT (VT)	$160.31	$87.23
SEATTLE (KING CNTY) (WA)	$191.73	$101.16
REST OF WASHINGTON (WA)	$169.17	$91.44
WISCONSIN (WI)	$155.87	$85.15
WEST VIRGINIA (WV)	$148.54	$84.39
WYOMING** (WY)	$162.21	$88.40

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 4 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) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility settings use different practice-expense RVUs, since overhead costs differ depending on whether the service is performed in an office versus a hospital or facility-based setting.

RVUs — work 1.19, practice expense 3.6 (non-facility) / 1.39 (facility), malpractice 0.09 — × 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 due to modifiers, place of service, sequestration, 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 amount lower than the non-facility amount for CPT 11765?

Facility rates use a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is absorbing some of the overhead costs, whereas non-facility (office) rates include higher practice-expense RVUs to cover those costs directly.

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

No. This figure is the Medicare-allowed amount before the 80/20 coinsurance split and before any locality-specific or claim-specific adjustments, such as modifiers or sequestration, are applied.

Why do allowed amounts differ by locality?

Geographic Practice Cost Indices (GPCIs) adjust the RVUs to reflect regional differences in wages, rents, and malpractice costs, so the same code can have different allowed amounts in different areas.

Where can I find the official descriptor for CPT 11765?

CPT code descriptors are copyrighted by the American Medical Association (AMA); consult your CPT codebook or AMA-licensed coding software for the official language.

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.