Medicare Reimbursement for CPT 11900
CPT 11900 is a physician procedure code billed under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both nationally and adjustable by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $56.78 | $24.05 |
| ALASKA* (AK) | $67.02 | $32.16 |
| ALABAMA (AL) | $51.30 | $22.66 |
| ARKANSAS (AR) | $50.60 | $22.49 |
| ARIZONA (AZ) | $55.36 | $23.64 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $73.05 | $26.90 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $74.48 | $27.28 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $63.56 | $24.87 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $63.89 | $25.16 |
| NAPA (CA) | $69.14 | $26.00 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $73.11 | $26.95 |
| VALLEJO (CA) | $69.06 | $25.92 |
| BAKERSFIELD (CA) | $60.11 | $24.23 |
| CHICO (CA) | $59.95 | $24.08 |
| FRESNO (CA) | $59.95 | $24.08 |
| HANFORD-CORCORAN (CA) | $59.95 | $24.08 |
| MADERA (CA) | $59.95 | $24.08 |
| MERCED (CA) | $59.95 | $24.08 |
| MODESTO (CA) | $59.95 | $24.08 |
| REDDING (CA) | $59.95 | $24.08 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $60.50 | $24.62 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $62.83 | $24.76 |
| SALINAS (CA) | $62.59 | $24.65 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $74.71 | $27.51 |
| SANTA CRUZ-WATSONVILLE (CA) | $64.55 | $24.78 |
| SANTA ROSA-PETALUMA (CA) | $65.20 | $25.00 |
| STOCKTON (CA) | $59.95 | $24.08 |
| VISALIA (CA) | $59.95 | $24.08 |
| YUBA CITY (CA) | $59.95 | $24.08 |
| EL CENTRO (CA) | $59.96 | $24.08 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $63.99 | $24.84 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $61.59 | $24.31 |
| SANTA MARIA-SANTA BARBARA (CA) | $62.80 | $24.64 |
| REST OF CALIFORNIA (CA) | $59.95 | $24.08 |
| COLORADO (CO) | $59.06 | $24.23 |
| CONNECTICUT (CT) | $60.40 | $25.15 |
| DC + MD/VA SUBURBS (DC) | $64.67 | $26.11 |
| DELAWARE (DE) | $56.24 | $23.90 |
| FORT LAUDERDALE (FL) | $58.63 | $25.47 |
| MIAMI (FL) | $60.90 | $26.82 |
| REST OF FLORIDA (FL) | $55.95 | $24.65 |
| ATLANTA (GA) | $57.78 | $24.52 |
| REST OF GEORGIA (GA) | $52.99 | $23.79 |
| HAWAII, GUAM (HI) | $61.29 | $24.08 |
| IOWA (IA) | $52.54 | $22.59 |
| IDAHO (ID) | $52.86 | $22.74 |
| EAST ST. LOUIS (IL) | $55.43 | $25.31 |
| SUBURBAN CHICAGO (IL) | $59.22 | $25.60 |
| CHICAGO (IL) | $59.25 | $26.36 |
| REST OF ILLINOIS (IL) | $54.41 | $24.52 |
| INDIANA (IN) | $53.14 | $22.80 |
| KANSAS (KS) | $52.30 | $22.71 |
| KENTUCKY (KY) | $52.41 | $23.31 |
| NEW ORLEANS (LA) | $54.76 | $23.96 |
| REST OF LOUISIANA (LA) | $52.33 | $23.36 |
| METROPOLITAN BOSTON (MA) | $64.68 | $25.60 |
| REST OF MASSACHUSETTS (MA) | $58.73 | $24.27 |
| BALTIMORE/SURR. CNTYS (MD) | $60.23 | $25.11 |
| REST OF MARYLAND (MD) | $57.27 | $24.15 |
| SOUTHERN MAINE (ME) | $55.82 | $23.38 |
| REST OF MAINE (ME) | $53.10 | $22.99 |
| DETROIT (MI) | $56.59 | $25.01 |
| REST OF MICHIGAN (MI) | $53.68 | $23.80 |
| MINNESOTA (MN) | $56.71 | $23.03 |
| METROPOLITAN ST. LOUIS (MO) | $54.96 | $23.80 |
| METROPOLITAN KANSAS CITY (MO) | $54.42 | $23.68 |
| REST OF MISSOURI (MO) | $51.48 | $23.27 |
| MISSISSIPPI (MS) | $51.05 | $22.87 |
| MONTANA** (MT) | $56.78 | $24.05 |
| NORTH CAROLINA (NC) | $53.63 | $23.09 |
| NORTH DAKOTA** (ND) | $55.79 | $23.06 |
| NEBRASKA (NE) | $52.81 | $22.60 |
| NEW HAMPSHIRE (NH) | $58.13 | $24.06 |
| NORTHERN NJ (NJ) | $64.06 | $26.09 |
| REST OF NEW JERSEY (NJ) | $61.13 | $25.38 |
| NEW MEXICO (NM) | $53.96 | $23.94 |
| NEVADA** (NV) | $56.54 | $23.78 |
| MANHATTAN (NY) | $65.02 | $26.98 |
| NYC SUBURBS/LONG ISLAND (NY) | $66.50 | $27.58 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $61.52 | $25.67 |
| QUEENS (NY) | $65.54 | $26.85 |
| REST OF NEW YORK (NY) | $54.38 | $23.29 |
| OHIO (OH) | $53.48 | $23.60 |
| OKLAHOMA (OK) | $52.33 | $23.10 |
| PORTLAND (OR) | $60.85 | $24.49 |
| REST OF OREGON (OR) | $56.13 | $23.53 |
| METROPOLITAN PHILADELPHIA (PA) | $58.97 | $24.90 |
| REST OF PENNSYLVANIA (PA) | $53.57 | $23.52 |
| PUERTO RICO (PR) | $57.18 | $24.08 |
| RHODE ISLAND (RI) | $58.18 | $24.37 |
| SOUTH CAROLINA (SC) | $53.64 | $23.39 |
| SOUTH DAKOTA** (SD) | $55.67 | $22.94 |
| TENNESSEE (TN) | $52.54 | $22.79 |
| BRAZORIA (TX) | $56.21 | $23.77 |
| DALLAS (TX) | $56.55 | $23.94 |
| GALVESTON (TX) | $56.36 | $23.86 |
| HOUSTON (TX) | $57.28 | $24.78 |
| BEAUMONT (TX) | $53.24 | $23.45 |
| FORT WORTH (TX) | $56.19 | $23.91 |
| AUSTIN (TX) | $58.83 | $24.20 |
| REST OF TEXAS (TX) | $54.68 | $23.61 |
| UTAH (UT) | $54.33 | $23.56 |
| VIRGINIA (VA) | $55.64 | $23.47 |
| VIRGIN ISLANDS (VI) | $57.18 | $24.08 |
| VERMONT (VT) | $55.58 | $23.17 |
| SEATTLE (KING CNTY) (WA) | $65.97 | $25.81 |
| REST OF WASHINGTON (WA) | $58.62 | $24.15 |
| WISCONSIN (WI) | $54.03 | $22.67 |
| WEST VIRGINIA (WV) | $52.51 | $24.07 |
| WYOMING** (WY) | $56.35 | $23.61 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. 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. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why two separate national amounts are shown. Locality-specific GPCIs mean the same code can price differently across the country even though the RVUs and conversion factor stay the same.
RVUs — work 0.51, practice expense 1.14 (non-facility) / 0.16 (facility), malpractice 0.05 — × 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 Part B deductible is met; the beneficiary or secondary payer may owe the remainder.
- Modifiers, place of service, and specific payer policies can change the final allowed amount.
- Annual budget-neutrality adjustments and sequestration can alter the conversion factor or final payment.
- Always confirm current rates and locality-specific amounts with your Medicare Administrative Contractor (MAC).
Frequently asked
Why does the amount differ between non-facility and facility settings?
Practice-expense RVUs are lower in facility settings because the facility (e.g., hospital) is separately reimbursed for overhead costs like equipment and staff, while non-facility rates assume the physician's practice bears those costs.
Why might my locality's payment differ from the national amount shown?
The PFS formula applies Geographic Practice Cost Indices (GPCIs) specific to each locality to account for regional differences in wages, rent, and malpractice costs, so the same code can price differently across the country.
Does this page reflect what Medicare will actually pay me?
No. It reflects the allowed amount under the national PFS formula for 2026. Actual payment depends on the beneficiary's deductible status, applicable modifiers, sequestration, and the specific locality, and should be verified with your MAC.
What do the RVU components represent?
Work RVU reflects physician time and effort, practice-expense RVU reflects overhead costs (which vary by setting), and malpractice RVU reflects liability insurance costs — all three are combined and adjusted before applying the conversion factor.
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.
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