Medicare Reimbursement for CPT 11770

CPT 11770 is a procedure code used in Medicare billing; the official descriptor is not reproduced here because CPT content is licensed by the AMA. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$390.12	$181.03
ALASKA* (AK)	$442.64	$219.96
ALABAMA (AL)	$345.88	$162.92
ARKANSAS (AR)	$340.30	$160.70
ARIZONA (AZ)	$378.41	$175.80
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$502.75	$207.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$512.54	$211.04
OXNARD-THOUSAND OAKS-VENTURA (CA)	$436.41	$189.27
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$438.66	$191.30
NAPA (CA)	$475.62	$200.04
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$503.45	$208.63
VALLEJO (CA)	$474.62	$199.04
BAKERSFIELD (CA)	$410.99	$181.83
CHICO (CA)	$409.33	$180.17
FRESNO (CA)	$409.33	$180.17
HANFORD-CORCORAN (CA)	$409.33	$180.17
MADERA (CA)	$409.33	$180.17
MERCED (CA)	$409.33	$180.17
MODESTO (CA)	$409.33	$180.17
REDDING (CA)	$409.33	$180.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$415.88	$186.71
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$429.95	$186.78
SALINAS (CA)	$428.39	$186.05
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$515.38	$213.87
SANTA CRUZ-WATSONVILLE (CA)	$443.38	$189.34
SANTA ROSA-PETALUMA (CA)	$447.84	$191.08
STOCKTON (CA)	$409.33	$180.17
VISALIA (CA)	$409.33	$180.17
YUBA CITY (CA)	$409.33	$180.17
EL CENTRO (CA)	$409.43	$180.27
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$438.90	$188.83
SAN LUIS OBISPO-PASO ROBLES (CA)	$421.51	$183.36
SANTA MARIA-SANTA BARBARA (CA)	$430.11	$186.31
REST OF CALIFORNIA (CA)	$409.33	$180.17
COLORADO (CO)	$404.83	$182.35
CONNECTICUT (CT)	$417.94	$192.75
DC + MD/VA SUBURBS (DC)	$447.51	$201.21
DELAWARE (DE)	$385.10	$178.52
FORT LAUDERDALE (FL)	$410.27	$198.46
MIAMI (FL)	$432.89	$215.23
REST OF FLORIDA (FL)	$387.91	$188.02
ATLANTA (GA)	$399.01	$186.57
REST OF GEORGIA (GA)	$363.44	$176.94
HAWAII, GUAM (HI)	$420.35	$182.61
IOWA (IA)	$353.76	$162.44
IDAHO (ID)	$356.73	$164.36
EAST ST. LOUIS (IL)	$388.12	$195.76
SUBURBAN CHICAGO (IL)	$414.10	$199.37
CHICAGO (IL)	$418.53	$208.39
REST OF ILLINOIS (IL)	$376.95	$186.05
INDIANA (IN)	$358.97	$165.15
KANSAS (KS)	$352.83	$163.81
KENTUCKY (KY)	$356.95	$171.07
NEW ORLEANS (LA)	$376.18	$179.43
REST OF LOUISIANA (LA)	$356.69	$171.65
METROPOLITAN BOSTON (MA)	$446.38	$196.72
REST OF MASSACHUSETTS (MA)	$402.38	$182.21
BALTIMORE/SURR. CNTYS (MD)	$417.01	$192.66
REST OF MARYLAND (MD)	$392.72	$181.12
SOUTHERN MAINE (ME)	$380.06	$172.85
REST OF MAINE (ME)	$359.76	$167.40
DETROIT (MI)	$394.19	$192.41
REST OF MICHIGAN (MI)	$368.11	$177.21
MINNESOTA (MN)	$383.99	$168.84
METROPOLITAN ST. LOUIS (MO)	$376.57	$177.51
METROPOLITAN KANSAS CITY (MO)	$372.38	$176.04
REST OF MISSOURI (MO)	$350.51	$170.27
MISSISSIPPI (MS)	$345.43	$165.41
MONTANA** (MT)	$390.08	$180.99
NORTH CAROLINA (NC)	$363.79	$168.71
NORTH DAKOTA** (ND)	$378.02	$168.93
NEBRASKA (NE)	$355.64	$162.65
NEW HAMPSHIRE (NH)	$399.19	$181.53
NORTHERN NJ (NJ)	$442.28	$199.73
REST OF NEW JERSEY (NJ)	$421.62	$193.29
NEW MEXICO (NM)	$370.71	$178.97
NEVADA** (NV)	$387.00	$177.70
MANHATTAN (NY)	$453.48	$210.52
NYC SUBURBS/LONG ISLAND (NY)	$466.65	$218.04
POUGHKPSIE/N NYC SUBURBS (NY)	$425.20	$196.25
QUEENS (NY)	$456.21	$209.07
REST OF NEW YORK (NY)	$369.91	$171.27
OHIO (OH)	$365.64	$174.74
OKLAHOMA (OK)	$355.27	$168.56
PORTLAND (OR)	$417.73	$185.43
REST OF OREGON (OR)	$382.94	$174.69
METROPOLITAN PHILADELPHIA (PA)	$407.22	$189.56
REST OF PENNSYLVANIA (PA)	$365.78	$173.83
PUERTO RICO (PR)	$392.93	$181.54
RHODE ISLAND (RI)	$398.91	$182.92
SOUTH CAROLINA (SC)	$365.54	$172.34
SOUTH DAKOTA** (SD)	$376.59	$167.50
TENNESSEE (TN)	$354.91	$164.85
BRAZORIA (TX)	$383.78	$176.58
DALLAS (TX)	$386.87	$178.62
GALVESTON (TX)	$385.33	$177.70
HOUSTON (TX)	$396.49	$188.87
BEAUMONT (TX)	$363.18	$172.91
FORT WORTH (TX)	$384.31	$178.15
AUSTIN (TX)	$404.40	$183.18
REST OF TEXAS (TX)	$373.70	$175.27
UTAH (UT)	$371.05	$174.51
VIRGINIA (VA)	$379.32	$173.78
VIRGIN ISLANDS (VI)	$392.93	$181.54
VERMONT (VT)	$377.23	$170.23
SEATTLE (KING CNTY) (WA)	$455.01	$198.46
REST OF WASHINGTON (WA)	$401.39	$181.22
WISCONSIN (WI)	$364.13	$163.82
WEST VIRGINIA (WV)	$361.80	$180.10
WYOMING** (WY)	$384.83	$175.74

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit 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

The Medicare PFS amount is derived from 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) for the specific locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the allowed amount differs between the two.

RVUs — work 2.59, practice expense 8.48 (non-facility) / 2.22 (facility), malpractice 0.61 — × 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 beneficiary or secondary insurer is responsible for the remainder.
Modifiers, add-on codes, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Rates vary by locality due to GPCI adjustments; the amount shown may not match your specific Medicare Administrative Contractor (MAC) locality.
Always verify current rates and coverage policy with your local MAC before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 11770?

The two amounts use different practice-expense RVUs because the cost of resources (staff, supplies, equipment) is assumed to be lower when a service is performed in a facility setting, since the facility itself bears many of those costs.

Does this figure represent what Medicare will actually pay?

No. The figure shown is the Medicare allowed amount before the standard 80/20 split, deductible application, and any modifier or sequestration adjustments, so actual payment may be lower.

Why might my locality's rate differ from the national rate shown here?

The national rate uses standardized GPCI values, while your locality's actual rate reflects the specific wage, rent, and malpractice cost indices for that geographic area.

Where can I find the exact CPT code description?

Because CPT codes are copyrighted by the American Medical Association, the official descriptor must be obtained from the AMA's CPT codebook or a licensed coding reference, not reproduced here.

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.