Medicare Reimbursement for CPT 11771

This page covers CPT code 11771, a procedure code on the Medicare Physician Fee Schedule (PFS). It shows the estimated Medicare-allowed amount at the national level and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital outpatient/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$692.40	$441.89
ALASKA* (AK)	$799.16	$532.37
ALABAMA (AL)	$615.89	$396.70
ARKANSAS (AR)	$606.32	$391.13
ARIZONA (AZ)	$671.69	$428.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$866.74	$513.53
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$882.66	$521.43
OXNARD-THOUSAND OAKS-VENTURA (CA)	$761.16	$465.07
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$766.15	$469.80
NAPA (CA)	$823.30	$493.14
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$868.37	$515.15
VALLEJO (CA)	$820.96	$490.80
BAKERSFIELD (CA)	$720.33	$445.78
CHICO (CA)	$716.45	$441.89
FRESNO (CA)	$716.45	$441.89
HANFORD-CORCORAN (CA)	$716.45	$441.89
MADERA (CA)	$716.45	$441.89
MERCED (CA)	$716.45	$441.89
MODESTO (CA)	$716.45	$441.89
REDDING (CA)	$716.45	$441.89
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$731.79	$457.23
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$750.12	$458.78
SALINAS (CA)	$747.34	$457.00
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$889.30	$528.07
SANTA CRUZ-WATSONVILLE (CA)	$770.35	$465.98
SANTA ROSA-PETALUMA (CA)	$777.93	$470.31
STOCKTON (CA)	$716.45	$441.89
VISALIA (CA)	$716.45	$441.89
YUBA CITY (CA)	$716.45	$441.89
EL CENTRO (CA)	$716.69	$442.13
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$763.94	$464.33
SAN LUIS OBISPO-PASO ROBLES (CA)	$735.64	$450.31
SANTA MARIA-SANTA BARBARA (CA)	$749.87	$457.78
REST OF CALIFORNIA (CA)	$716.45	$441.89
COLORADO (CO)	$712.88	$446.34
CONNECTICUT (CT)	$740.76	$470.96
DC + MD/VA SUBURBS (DC)	$787.94	$492.84
DELAWARE (DE)	$683.21	$435.71
FORT LAUDERDALE (FL)	$736.79	$483.03
MIAMI (FL)	$783.73	$522.95
REST OF FLORIDA (FL)	$696.79	$457.31
ATLANTA (GA)	$709.74	$455.22
REST OF GEORGIA (GA)	$653.38	$429.93
HAWAII, GUAM (HI)	$733.43	$448.60
IOWA (IA)	$625.67	$396.46
IDAHO (ID)	$631.53	$401.06
EAST ST. LOUIS (IL)	$705.13	$474.67
SUBURBAN CHICAGO (IL)	$742.71	$485.44
CHICAGO (IL)	$757.87	$506.11
REST OF ILLINOIS (IL)	$680.47	$451.76
INDIANA (IN)	$635.28	$403.06
KANSAS (KS)	$625.87	$399.41
KENTUCKY (KY)	$638.81	$416.11
NEW ORLEANS (LA)	$672.57	$436.84
REST OF LOUISIANA (LA)	$639.08	$417.38
METROPOLITAN BOSTON (MA)	$781.85	$482.75
REST OF MASSACHUSETTS (MA)	$709.53	$445.75
BALTIMORE/SURR. CNTYS (MD)	$739.47	$470.68
REST OF MARYLAND (MD)	$695.82	$442.31
SOUTHERN MAINE (ME)	$670.76	$422.51
REST OF MAINE (ME)	$638.65	$408.18
DETROIT (MI)	$709.55	$467.81
REST OF MICHIGAN (MI)	$659.74	$431.03
MINNESOTA (MN)	$671.72	$413.94
METROPOLITAN ST. LOUIS (MO)	$671.08	$432.59
METROPOLITAN KANSAS CITY (MO)	$664.08	$428.86
REST OF MISSOURI (MO)	$629.58	$413.64
MISSISSIPPI (MS)	$617.91	$402.22
MONTANA** (MT)	$692.31	$441.80
NORTH CAROLINA (NC)	$645.26	$411.54
NORTH DAKOTA** (ND)	$664.03	$413.52
NEBRASKA (NE)	$628.33	$397.11
NEW HAMPSHIRE (NH)	$704.73	$443.95
NORTHERN NJ (NJ)	$779.55	$488.96
REST OF NEW JERSEY (NJ)	$746.02	$472.47
NEW MEXICO (NM)	$664.96	$435.25
NEVADA** (NV)	$684.87	$434.11
MANHATTAN (NY)	$805.38	$514.29
NYC SUBURBS/LONG ISLAND (NY)	$830.37	$532.52
POUGHKPSIE/N NYC SUBURBS (NY)	$753.75	$479.45
QUEENS (NY)	$807.42	$511.33
REST OF NEW YORK (NY)	$655.90	$417.92
OHIO (OH)	$653.96	$425.25
OKLAHOMA (OK)	$634.00	$410.30
PORTLAND (OR)	$732.88	$454.57
REST OF OREGON (OR)	$676.43	$426.93
METROPOLITAN PHILADELPHIA (PA)	$723.49	$462.71
REST OF PENNSYLVANIA (PA)	$653.18	$423.22
PUERTO RICO (PR)	$696.59	$443.33
RHODE ISLAND (RI)	$705.74	$446.96
SOUTH CAROLINA (SC)	$651.32	$419.85
SOUTH DAKOTA** (SD)	$660.69	$410.18
TENNESSEE (TN)	$629.68	$401.97
BRAZORIA (TX)	$679.46	$431.21
DALLAS (TX)	$685.62	$436.11
GALVESTON (TX)	$682.65	$433.90
HOUSTON (TX)	$708.82	$460.07
BEAUMONT (TX)	$648.85	$420.89
FORT WORTH (TX)	$681.78	$434.78
AUSTIN (TX)	$713.23	$448.20
REST OF TEXAS (TX)	$665.01	$427.28
UTAH (UT)	$660.75	$425.28
VIRGINIA (VA)	$670.77	$424.52
VIRGIN ISLANDS (VI)	$696.59	$443.33
VERMONT (VT)	$664.34	$416.34
SEATTLE (KING CNTY) (WA)	$794.88	$487.50
REST OF WASHINGTON (WA)	$707.21	$443.43
WISCONSIN (WI)	$640.61	$400.62
WEST VIRGINIA (WV)	$654.53	$436.84
WYOMING** (WY)	$679.98	$429.48

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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

Medicare's allowed amount for this procedure code is built from three Relative Value Units (RVUs): work, practice expense, and malpractice. Each RVU component is adjusted using the 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 amount. Non-facility and facility totals differ mainly because the practice-expense RVU is lower in facility settings, since the facility (hospital or ASC) bears more of the overhead cost. The result is an estimate of the total allowed amount before patient cost-sharing is applied.

RVUs — work 5.94, practice expense 13.36 (non-facility) / 5.86 (facility), malpractice 1.43 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
This code's official descriptor is copyrighted by the AMA and is not reproduced here.
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 11771?

In facility settings, Medicare assumes the facility (hospital or ASC) incurs the overhead costs, so the practice-expense RVU used in the calculation is lower, reducing the total allowed amount.

Does the amount shown reflect what Medicare actually pays?

It reflects the full allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible, with the patient or secondary insurance covering the rest.

Why might my locality's amount differ from the national figure?

Local wage, rent, and malpractice cost differences are captured through GPCIs, which adjust the RVUs before the conversion factor is applied, causing amounts to vary by geographic area.

Can modifiers or other billing factors change this amount?

Yes. Modifiers (e.g., bilateral, multiple procedure reductions), sequestration, and annual budget-neutrality adjustments can all affect the final payment amount for a claim.

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.