Medicare Reimbursement for CPT 11772

CPT 11772 is a procedure code defined by the American Medical Association; the descriptive text itself 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 adjusted by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$847.38	$573.49
ALASKA* (AK)	$977.45	$685.76
ALABAMA (AL)	$753.85	$514.20
ARKANSAS (AR)	$742.13	$506.87
ARIZONA (AZ)	$822.12	$556.72
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1063.44	$677.26
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1083.08	$688.13
OXNARD-THOUSAND OAKS-VENTURA (CA)	$932.98	$609.25
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$938.98	$614.97
NAPA (CA)	$1009.79	$648.80
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1065.37	$679.19
VALLEJO (CA)	$1007.00	$646.02
BAKERSFIELD (CA)	$882.64	$582.46
CHICO (CA)	$878.01	$577.83
FRESNO (CA)	$878.01	$577.83
HANFORD-CORCORAN (CA)	$878.01	$577.83
MADERA (CA)	$878.01	$577.83
MERCED (CA)	$878.01	$577.83
MODESTO (CA)	$878.01	$577.83
REDDING (CA)	$878.01	$577.83
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$896.25	$596.07
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$919.49	$600.96
SALINAS (CA)	$916.09	$598.65
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1090.97	$696.02
SANTA CRUZ-WATSONVILLE (CA)	$944.55	$611.78
SANTA ROSA-PETALUMA (CA)	$953.87	$617.54
STOCKTON (CA)	$878.01	$577.83
VISALIA (CA)	$878.01	$577.83
YUBA CITY (CA)	$878.01	$577.83
EL CENTRO (CA)	$878.30	$578.12
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$936.58	$609.01
SAN LUIS OBISPO-PASO ROBLES (CA)	$901.71	$589.75
SANTA MARIA-SANTA BARBARA (CA)	$919.22	$599.87
REST OF CALIFORNIA (CA)	$878.01	$577.83
COLORADO (CO)	$873.09	$581.67
CONNECTICUT (CT)	$906.53	$611.55
DC + MD/VA SUBURBS (DC)	$964.83	$642.19
DELAWARE (DE)	$836.23	$565.63
FORT LAUDERDALE (FL)	$900.42	$622.98
MIAMI (FL)	$956.80	$671.68
REST OF FLORIDA (FL)	$851.69	$589.86
ATLANTA (GA)	$868.33	$590.06
REST OF GEORGIA (GA)	$798.76	$554.45
HAWAII, GUAM (HI)	$898.98	$587.57
IOWA (IA)	$766.30	$515.69
IDAHO (ID)	$773.37	$521.39
EAST ST. LOUIS (IL)	$860.87	$608.89
SUBURBAN CHICAGO (IL)	$907.77	$626.49
CHICAGO (IL)	$925.34	$650.09
REST OF ILLINOIS (IL)	$831.40	$581.34
INDIANA (IN)	$777.96	$524.07
KANSAS (KS)	$766.31	$518.72
KENTUCKY (KY)	$781.38	$537.89
NEW ORLEANS (LA)	$822.59	$564.86
REST OF LOUISIANA (LA)	$781.62	$539.23
METROPOLITAN BOSTON (MA)	$957.87	$630.85
REST OF MASSACHUSETTS (MA)	$868.90	$580.49
BALTIMORE/SURR. CNTYS (MD)	$904.90	$611.02
REST OF MARYLAND (MD)	$851.73	$574.56
SOUTHERN MAINE (ME)	$821.47	$550.05
REST OF MAINE (ME)	$781.83	$529.85
DETROIT (MI)	$867.04	$602.74
REST OF MICHIGAN (MI)	$806.76	$556.70
MINNESOTA (MN)	$823.39	$541.56
METROPOLITAN ST. LOUIS (MO)	$821.04	$560.30
METROPOLITAN KANSAS CITY (MO)	$812.46	$555.28
REST OF MISSOURI (MO)	$769.85	$533.76
MISSISSIPPI (MS)	$755.96	$520.14
MONTANA** (MT)	$847.27	$573.38
NORTH CAROLINA (NC)	$789.96	$534.42
NORTH DAKOTA** (ND)	$813.65	$539.77
NEBRASKA (NE)	$769.63	$516.83
NEW HAMPSHIRE (NH)	$862.88	$577.76
NORTHERN NJ (NJ)	$954.51	$636.80
REST OF NEW JERSEY (NJ)	$913.17	$614.09
NEW MEXICO (NM)	$813.05	$561.90
NEVADA** (NV)	$838.45	$564.29
MANHATTAN (NY)	$985.26	$667.01
NYC SUBURBS/LONG ISLAND (NY)	$1015.53	$689.88
POUGHKPSIE/N NYC SUBURBS (NY)	$922.44	$622.53
QUEENS (NY)	$988.11	$664.37
REST OF NEW YORK (NY)	$802.96	$542.77
OHIO (OH)	$799.89	$549.83
OKLAHOMA (OK)	$775.75	$531.17
PORTLAND (OR)	$897.85	$593.56
REST OF OREGON (OR)	$828.31	$555.52
METROPOLITAN PHILADELPHIA (PA)	$885.25	$600.13
REST OF PENNSYLVANIA (PA)	$799.07	$547.64
PUERTO RICO (PR)	$852.59	$575.69
RHODE ISLAND (RI)	$863.99	$581.06
SOUTH CAROLINA (SC)	$796.98	$543.91
SOUTH DAKOTA** (SD)	$809.68	$535.79
TENNESSEE (TN)	$770.94	$521.98
BRAZORIA (TX)	$831.84	$560.42
DALLAS (TX)	$839.27	$566.48
GALVESTON (TX)	$835.67	$563.70
HOUSTON (TX)	$866.79	$594.82
BEAUMONT (TX)	$793.75	$544.51
FORT WORTH (TX)	$834.50	$564.44
AUSTIN (TX)	$873.35	$583.58
REST OF TEXAS (TX)	$813.77	$553.85
UTAH (UT)	$808.52	$551.07
VIRGINIA (VA)	$821.32	$552.09
VIRGIN ISLANDS (VI)	$852.59	$575.69
VERMONT (VT)	$813.82	$542.67
SEATTLE (KING CNTY) (WA)	$974.07	$638.01
REST OF WASHINGTON (WA)	$866.13	$577.73
WISCONSIN (WI)	$784.94	$522.56
WEST VIRGINIA (WV)	$799.66	$561.65
WYOMING** (WY)	$832.62	$558.73

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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 pricing for this code starts with three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — that reflect the relative resources involved compared to other services. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital outpatient) settings, which is why the two amounts differ; work and malpractice RVUs generally stay the same across settings.

RVUs — work 7.17, practice expense 16.5 (non-facility) / 8.3 (facility), malpractice 1.7 — × 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 meets their deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, place of service, sequestration, and annual budget-neutrality adjustments.
Always verify current-year, locality-specific amounts with your Medicare Administrative Contractor (MAC) before billing or making financial decisions.

Frequently asked

Why is the facility amount lower than the non-facility amount?

In facility settings, Medicare assumes the facility (e.g., hospital) bears more of the practice expense overhead, so the practice-expense RVU component is lower, resulting in a lower physician-fee-schedule payment for the same code.

Does this amount include the patient's deductible and coinsurance?

No. The amount shown is the total allowed amount under the fee schedule. Medicare generally pays 80% of that after the annual deductible is met, with the remaining 20% owed by the patient or a secondary payer.

Why might my MAC's payment differ from this estimate?

Local Geographic Practice Cost Indices, applicable modifiers, contractor-specific pricing rules, sequestration reductions, and mid-year policy updates can all cause the actual paid amount to differ from a general fee-schedule estimate.

Can I see the actual CPT code description here?

No. CPT code descriptors are licensed by the American Medical Association and cannot be reproduced on this page; consult your CPT codebook or licensed coding software for the official descriptor.

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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.