Medicare Reimbursement for CPT 11901

This page provides estimated Medicare Physician Fee Schedule (PFS) allowed amounts for procedure code 11901, shown at the national level and adjusted by locality. Amounts are broken out for non-facility (e.g., office) and facility (e.g., hospital outpatient) settings, reflecting differences in practice expense. Because the CPT code descriptor is proprietary to the AMA, it is not reproduced here.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$68.81	$36.41
ALASKA* (AK)	$83.41	$48.90
ALABAMA (AL)	$62.74	$34.39
ARKANSAS (AR)	$61.97	$34.14
ARIZONA (AZ)	$67.22	$35.82
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$86.51	$40.82
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$88.13	$41.41
OXNARD-THOUSAND OAKS-VENTURA (CA)	$76.01	$37.71
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$76.48	$38.16
NAPA (CA)	$82.15	$39.45
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$86.59	$40.90
VALLEJO (CA)	$82.03	$39.33
BAKERSFIELD (CA)	$72.27	$36.76
CHICO (CA)	$72.04	$36.53
FRESNO (CA)	$72.04	$36.53
HANFORD-CORCORAN (CA)	$72.04	$36.53
MADERA (CA)	$72.04	$36.53
MERCED (CA)	$72.04	$36.53
MODESTO (CA)	$72.04	$36.53
REDDING (CA)	$72.04	$36.53
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$72.81	$37.30
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$75.25	$37.57
SALINAS (CA)	$74.95	$37.40
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$88.45	$41.73
SANTA CRUZ-WATSONVILLE (CA)	$76.96	$37.59
SANTA ROSA-PETALUMA (CA)	$77.72	$37.93
STOCKTON (CA)	$72.04	$36.53
VISALIA (CA)	$72.04	$36.53
YUBA CITY (CA)	$72.04	$36.53
EL CENTRO (CA)	$72.06	$36.55
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$76.44	$37.69
SAN LUIS OBISPO-PASO ROBLES (CA)	$73.78	$36.88
SANTA MARIA-SANTA BARBARA (CA)	$75.16	$37.38
REST OF CALIFORNIA (CA)	$72.04	$36.53
COLORADO (CO)	$71.19	$36.72
CONNECTICUT (CT)	$72.93	$38.04
DC + MD/VA SUBURBS (DC)	$77.67	$39.50
DELAWARE (DE)	$68.21	$36.20
FORT LAUDERDALE (FL)	$71.22	$38.40
MIAMI (FL)	$74.04	$40.31
REST OF FLORIDA (FL)	$68.20	$37.23
ATLANTA (GA)	$70.00	$37.08
REST OF GEORGIA (GA)	$64.89	$35.99
HAWAII, GUAM (HI)	$73.36	$36.52
IOWA (IA)	$63.96	$34.32
IDAHO (ID)	$64.34	$34.53
EAST ST. LOUIS (IL)	$67.94	$38.14
SUBURBAN CHICAGO (IL)	$71.88	$38.61
CHICAGO (IL)	$72.22	$39.66
REST OF ILLINOIS (IL)	$66.61	$37.03
INDIANA (IN)	$64.65	$34.62
KANSAS (KS)	$63.77	$34.48
KENTUCKY (KY)	$64.12	$35.32
NEW ORLEANS (LA)	$66.74	$36.25
REST OF LOUISIANA (LA)	$64.06	$35.39
METROPOLITAN BOSTON (MA)	$77.46	$38.77
REST OF MASSACHUSETTS (MA)	$70.89	$36.77
BALTIMORE/SURR. CNTYS (MD)	$72.73	$37.96
REST OF MARYLAND (MD)	$69.36	$36.57
SOUTHERN MAINE (ME)	$67.58	$35.47
REST OF MAINE (ME)	$64.69	$34.88
DETROIT (MI)	$69.00	$37.73
REST OF MICHIGAN (MI)	$65.59	$36.01
MINNESOTA (MN)	$68.33	$34.99
METROPOLITAN ST. LOUIS (MO)	$66.87	$36.03
METROPOLITAN KANSAS CITY (MO)	$66.29	$35.86
REST OF MISSOURI (MO)	$63.17	$35.24
MISSISSIPPI (MS)	$62.58	$34.68
MONTANA** (MT)	$68.80	$36.40
NORTH CAROLINA (NC)	$65.25	$35.03
NORTH DAKOTA** (ND)	$67.42	$35.02
NEBRASKA (NE)	$64.24	$34.34
NEW HAMPSHIRE (NH)	$70.17	$36.44
NORTHERN NJ (NJ)	$77.07	$39.49
REST OF NEW JERSEY (NJ)	$73.79	$38.41
NEW MEXICO (NM)	$65.92	$36.21
NEVADA** (NV)	$68.46	$36.02
MANHATTAN (NY)	$78.39	$40.74
NYC SUBURBS/LONG ISLAND (NY)	$80.12	$41.59
POUGHKPSIE/N NYC SUBURBS (NY)	$74.31	$38.83
QUEENS (NY)	$78.86	$40.57
REST OF NEW YORK (NY)	$66.09	$35.31
OHIO (OH)	$65.31	$35.73
OKLAHOMA (OK)	$63.96	$35.03
PORTLAND (OR)	$73.11	$37.12
REST OF OREGON (OR)	$67.95	$35.68
METROPOLITAN PHILADELPHIA (PA)	$71.38	$37.66
REST OF PENNSYLVANIA (PA)	$65.36	$35.62
PUERTO RICO (PR)	$69.22	$36.46
RHODE ISLAND (RI)	$70.38	$36.91
SOUTH CAROLINA (SC)	$65.38	$35.45
SOUTH DAKOTA** (SD)	$67.25	$34.85
TENNESSEE (TN)	$64.05	$34.59
BRAZORIA (TX)	$68.14	$36.03
DALLAS (TX)	$68.55	$36.28
GALVESTON (TX)	$68.33	$36.16
HOUSTON (TX)	$69.61	$37.44
BEAUMONT (TX)	$65.00	$35.52
FORT WORTH (TX)	$68.17	$36.23
AUSTIN (TX)	$70.94	$36.66
REST OF TEXAS (TX)	$66.52	$35.77
UTAH (UT)	$66.14	$35.69
VIRGINIA (VA)	$67.43	$35.58
VIRGIN ISLANDS (VI)	$69.22	$36.46
VERMONT (VT)	$67.25	$35.17
SEATTLE (KING CNTY) (WA)	$78.85	$39.10
REST OF WASHINGTON (WA)	$70.73	$36.61
WISCONSIN (WI)	$65.49	$34.45
WEST VIRGINIA (WV)	$64.52	$36.36
WYOMING** (WY)	$68.20	$35.80

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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: 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 for a code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility and facility amounts differ mainly because practice-expense RVUs are lower in facility settings, where the facility itself absorbs certain overhead costs.

RVUs — work 0.78, practice expense 1.21 (non-facility) / 0.24 (facility), malpractice 0.07 — × 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 Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean actual amounts vary by geographic area and may differ from the national figures shown.
Always confirm current rates and edits with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

Facility rates use lower practice-expense RVUs because the facility (e.g., hospital) bills separately for overhead, equipment, and supplies, whereas non-facility rates assume the physician's practice bears those costs.

Will my locality's payment match the national amount shown?

Not necessarily. The national amount is calculated using national GPCI values; your actual payment depends on the GPCIs assigned to your specific Medicare locality.

Does this figure reflect what the patient or secondary insurer will owe?

No. The amount shown is the total Medicare-allowed amount. Medicare generally pays 80% of it after the deductible, with the remaining balance owed by the patient or a secondary payer.

Can modifiers change this estimate?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple-procedure discounting can increase or decrease the final allowed amount from the base figure shown here.

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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.