Medicare Reimbursement for CPT 11950

CPT 11950 is a procedure code used for physician billing under Medicare Part B; the AMA-owned descriptor is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjustable by locality, and separately for non-facility (e.g., office) versus facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$88.18	$44.42
ALASKA* (AK)	$103.25	$56.65
ALABAMA (AL)	$79.03	$40.75
ARKANSAS (AR)	$77.88	$40.30
ARIZONA (AZ)	$85.73	$43.33
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$110.77	$49.07
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$112.82	$49.73
OXNARD-THOUSAND OAKS-VENTURA (CA)	$97.21	$45.49
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$97.83	$46.06
NAPA (CA)	$105.18	$47.51
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$110.94	$49.24
VALLEJO (CA)	$104.93	$47.26
BAKERSFIELD (CA)	$92.09	$44.14
CHICO (CA)	$91.67	$43.72
FRESNO (CA)	$91.67	$43.72
HANFORD-CORCORAN (CA)	$91.67	$43.72
MADERA (CA)	$91.67	$43.72
MERCED (CA)	$91.67	$43.72
MODESTO (CA)	$91.67	$43.72
REDDING (CA)	$91.67	$43.72
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$93.29	$45.33
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$95.93	$45.04
SALINAS (CA)	$95.57	$44.86
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$113.52	$50.43
SANTA CRUZ-WATSONVILLE (CA)	$98.42	$45.26
SANTA ROSA-PETALUMA (CA)	$99.39	$45.66
STOCKTON (CA)	$91.67	$43.72
VISALIA (CA)	$91.67	$43.72
YUBA CITY (CA)	$91.67	$43.72
EL CENTRO (CA)	$91.70	$43.74
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$97.64	$45.31
SAN LUIS OBISPO-PASO ROBLES (CA)	$94.07	$44.24
SANTA MARIA-SANTA BARBARA (CA)	$95.88	$44.86
REST OF CALIFORNIA (CA)	$91.67	$43.72
COLORADO (CO)	$90.98	$44.42
CONNECTICUT (CT)	$94.07	$46.95
DC + MD/VA SUBURBS (DC)	$100.15	$48.61
DELAWARE (DE)	$87.14	$43.91
FORT LAUDERDALE (FL)	$92.95	$48.63
MIAMI (FL)	$98.13	$52.58
REST OF FLORIDA (FL)	$88.24	$46.41
ATLANTA (GA)	$90.16	$45.70
REST OF GEORGIA (GA)	$83.12	$44.09
HAWAII, GUAM (HI)	$93.71	$43.96
IOWA (IA)	$80.42	$40.38
IDAHO (ID)	$81.08	$40.82
EAST ST. LOUIS (IL)	$88.80	$48.54
SUBURBAN CHICAGO (IL)	$93.74	$48.81
CHICAGO (IL)	$95.14	$51.16
REST OF ILLINOIS (IL)	$86.15	$46.20
INDIANA (IN)	$81.53	$40.97
KANSAS (KS)	$80.34	$40.78
KENTUCKY (KY)	$81.56	$42.66
NEW ORLEANS (LA)	$85.57	$44.40
REST OF LOUISIANA (LA)	$81.55	$42.83
METROPOLITAN BOSTON (MA)	$99.57	$47.33
REST OF MASSACHUSETTS (MA)	$90.56	$44.48
BALTIMORE/SURR. CNTYS (MD)	$93.88	$46.93
REST OF MARYLAND (MD)	$88.71	$44.43
SOUTHERN MAINE (ME)	$85.83	$42.47
REST OF MAINE (ME)	$81.82	$41.57
DETROIT (MI)	$89.66	$47.44
REST OF MICHIGAN (MI)	$83.97	$44.02
MINNESOTA (MN)	$86.27	$41.24
METROPOLITAN ST. LOUIS (MO)	$85.51	$43.86
METROPOLITAN KANSAS CITY (MO)	$84.66	$43.57
REST OF MISSOURI (MO)	$80.35	$42.63
MISSISSIPPI (MS)	$79.12	$41.44
MONTANA** (MT)	$88.17	$44.41
NORTH CAROLINA (NC)	$82.63	$41.81
NORTH DAKOTA** (ND)	$85.20	$41.45
NEBRASKA (NE)	$80.77	$40.38
NEW HAMPSHIRE (NH)	$89.84	$44.29
NORTHERN NJ (NJ)	$99.17	$48.41
REST OF NEW JERSEY (NJ)	$94.89	$47.11
NEW MEXICO (NM)	$84.56	$44.43
NEVADA** (NV)	$87.40	$43.60
MANHATTAN (NY)	$101.90	$51.06
NYC SUBURBS/LONG ISLAND (NY)	$104.77	$52.74
POUGHKPSIE/N NYC SUBURBS (NY)	$95.76	$47.85
QUEENS (NY)	$102.30	$50.58
REST OF NEW YORK (NY)	$83.90	$42.33
OHIO (OH)	$83.37	$43.42
OKLAHOMA (OK)	$81.09	$42.02
PORTLAND (OR)	$93.53	$44.91
REST OF OREGON (OR)	$86.47	$42.89
METROPOLITAN PHILADELPHIA (PA)	$91.93	$46.38
REST OF PENNSYLVANIA (PA)	$83.33	$43.16
PUERTO RICO (PR)	$88.72	$44.48
RHODE ISLAND (RI)	$90.00	$44.80
SOUTH CAROLINA (SC)	$83.19	$42.76
SOUTH DAKOTA** (SD)	$84.85	$41.10
TENNESSEE (TN)	$80.78	$41.01
BRAZORIA (TX)	$86.79	$43.43
DALLAS (TX)	$87.49	$43.91
GALVESTON (TX)	$87.15	$43.70
HOUSTON (TX)	$89.89	$46.44
BEAUMONT (TX)	$82.80	$42.99
FORT WORTH (TX)	$87.00	$43.86
AUSTIN (TX)	$90.90	$44.60
REST OF TEXAS (TX)	$84.85	$43.32
UTAH (UT)	$84.32	$43.19
VIRGINIA (VA)	$85.76	$42.75
VIRGIN ISLANDS (VI)	$88.72	$44.48
VERMONT (VT)	$85.15	$41.83
SEATTLE (KING CNTY) (WA)	$101.29	$47.61
REST OF WASHINGTON (WA)	$90.29	$44.22
WISCONSIN (WI)	$82.37	$40.45
WEST VIRGINIA (WV)	$83.03	$45.01
WYOMING** (WY)	$86.88	$43.12

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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 payment is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by 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 allowed amount. Practice-expense RVUs differ between non-facility (office) and facility (hospital/ASC) settings because overhead costs differ, which is why two separate allowed amounts are shown.

RVUs — work 0.82, practice expense 1.67 (non-facility) / 0.36 (facility), malpractice 0.15 — × 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 is responsible for the remainder.
Actual payment varies by locality-specific GPCI values, applicable modifiers, place of service, and claims-processing rules.
Amounts may be affected by sequestration, annual budget-neutrality adjustments, and mid-year rule changes.
Always verify the specific allowed amount and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is bearing certain overhead costs separately, whereas the non-facility rate reflects the full practice-expense burden carried by the billing office.

Why does the allowed amount change by locality?

Each RVU component is multiplied by a locality-specific GPCI that reflects relative differences in local cost of labor, rent, and malpractice insurance, so the same code can have different allowed amounts in different areas.

Does this figure represent what Medicare actually pays?

It represents the Medicare-allowed amount before the standard 80/20 cost-sharing split and before any modifier, deductible, or sequestration adjustments are applied to a specific claim.

Why isn't the CPT code description shown?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page cannot reproduce the official language and instead refers to the code generically.

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.