Medicare Reimbursement for CPT Code 11951

This page covers a CPT-coded procedure (the specific descriptor is not shown here due to AMA licensing restrictions). It displays the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for your locality, and separately for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$117.24	$62.13
ALASKA* (AK)	$138.11	$79.41
ALABAMA (AL)	$105.26	$57.04
ARKANSAS (AR)	$103.76	$56.42
ARIZONA (AZ)	$114.01	$60.61
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$146.19	$68.48
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$148.86	$69.39
OXNARD-THOUSAND OAKS-VENTURA (CA)	$128.69	$63.54
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$129.55	$64.35
NAPA (CA)	$138.96	$66.32
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$146.43	$68.72
VALLEJO (CA)	$138.61	$65.98
BAKERSFIELD (CA)	$122.09	$61.69
CHICO (CA)	$121.50	$61.10
FRESNO (CA)	$121.50	$61.10
HANFORD-CORCORAN (CA)	$121.50	$61.10
MADERA (CA)	$121.50	$61.10
MERCED (CA)	$121.50	$61.10
MODESTO (CA)	$121.50	$61.10
REDDING (CA)	$121.50	$61.10
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$123.77	$63.36
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$127.03	$62.93
SALINAS (CA)	$126.55	$62.67
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$149.84	$70.37
SANTA CRUZ-WATSONVILLE (CA)	$130.16	$63.20
SANTA ROSA-PETALUMA (CA)	$131.44	$63.76
STOCKTON (CA)	$121.50	$61.10
VISALIA (CA)	$121.50	$61.10
YUBA CITY (CA)	$121.50	$61.10
EL CENTRO (CA)	$121.54	$61.14
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$129.20	$63.28
SAN LUIS OBISPO-PASO ROBLES (CA)	$124.58	$61.80
SANTA MARIA-SANTA BARBARA (CA)	$126.93	$62.67
REST OF CALIFORNIA (CA)	$121.50	$61.10
COLORADO (CO)	$120.74	$62.10
CONNECTICUT (CT)	$124.99	$65.63
DC + MD/VA SUBURBS (DC)	$132.85	$67.92
DELAWARE (DE)	$115.86	$61.41
FORT LAUDERDALE (FL)	$123.83	$68.01
MIAMI (FL)	$130.89	$73.52
REST OF FLORIDA (FL)	$117.62	$64.93
ATLANTA (GA)	$119.91	$63.91
REST OF GEORGIA (GA)	$110.86	$61.70
HAWAII, GUAM (HI)	$124.08	$61.41
IOWA (IA)	$106.93	$56.50
IDAHO (ID)	$107.82	$57.12
EAST ST. LOUIS (IL)	$118.63	$67.93
SUBURBAN CHICAGO (IL)	$124.85	$68.25
CHICAGO (IL)	$126.95	$71.56
REST OF ILLINOIS (IL)	$114.97	$64.65
INDIANA (IN)	$108.41	$57.33
KANSAS (KS)	$106.90	$57.08
KENTUCKY (KY)	$108.71	$59.71
NEW ORLEANS (LA)	$113.97	$62.11
REST OF LOUISIANA (LA)	$108.72	$59.95
METROPOLITAN BOSTON (MA)	$131.92	$66.12
REST OF MASSACHUSETTS (MA)	$120.22	$62.19
BALTIMORE/SURR. CNTYS (MD)	$124.74	$65.60
REST OF MARYLAND (MD)	$117.91	$62.13
SOUTHERN MAINE (ME)	$114.01	$59.39
REST OF MAINE (ME)	$108.87	$58.16
DETROIT (MI)	$119.55	$66.36
REST OF MICHIGAN (MI)	$111.92	$61.61
MINNESOTA (MN)	$114.37	$57.66
METROPOLITAN ST. LOUIS (MO)	$113.82	$61.35
METROPOLITAN KANSAS CITY (MO)	$112.72	$60.97
REST OF MISSOURI (MO)	$107.19	$59.68
MISSISSIPPI (MS)	$105.47	$58.02
MONTANA** (MT)	$117.22	$62.11
NORTH CAROLINA (NC)	$109.92	$58.50
NORTH DAKOTA** (ND)	$113.07	$57.96
NEBRASKA (NE)	$107.37	$56.50
NEW HAMPSHIRE (NH)	$119.29	$61.92
NORTHERN NJ (NJ)	$131.59	$67.66
REST OF NEW JERSEY (NJ)	$126.04	$65.86
NEW MEXICO (NM)	$112.71	$62.18
NEVADA** (NV)	$116.14	$60.97
MANHATTAN (NY)	$135.41	$71.37
NYC SUBURBS/LONG ISLAND (NY)	$139.24	$73.71
POUGHKPSIE/N NYC SUBURBS (NY)	$127.24	$66.90
QUEENS (NY)	$135.83	$70.68
REST OF NEW YORK (NY)	$111.58	$59.22
OHIO (OH)	$111.07	$60.76
OKLAHOMA (OK)	$108.02	$58.81
PORTLAND (OR)	$124.00	$62.77
REST OF OREGON (OR)	$114.87	$59.98
METROPOLITAN PHILADELPHIA (PA)	$122.22	$64.85
REST OF PENNSYLVANIA (PA)	$110.99	$60.40
PUERTO RICO (PR)	$117.92	$62.20
RHODE ISLAND (RI)	$119.57	$62.64
SOUTH CAROLINA (SC)	$110.75	$59.83
SOUTH DAKOTA** (SD)	$112.58	$57.47
TENNESSEE (TN)	$107.49	$57.39
BRAZORIA (TX)	$115.36	$60.75
DALLAS (TX)	$116.30	$61.41
GALVESTON (TX)	$115.84	$61.11
HOUSTON (TX)	$119.68	$64.96
BEAUMONT (TX)	$110.31	$60.15
FORT WORTH (TX)	$115.68	$61.34
AUSTIN (TX)	$120.66	$62.35
REST OF TEXAS (TX)	$112.91	$60.61
UTAH (UT)	$112.23	$60.43
VIRGINIA (VA)	$113.96	$59.79
VIRGIN ISLANDS (VI)	$117.92	$62.20
VERMONT (VT)	$113.06	$58.50
SEATTLE (KING CNTY) (WA)	$134.12	$66.49
REST OF WASHINGTON (WA)	$119.85	$61.82
WISCONSIN (WI)	$109.38	$56.58
WEST VIRGINIA (WV)	$110.90	$63.00
WYOMING** (WY)	$115.41	$60.30

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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 is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher in non-facility settings (where the practicing clinician bears overhead costs like staff, supplies, and equipment) and lower in facility settings (where the facility itself is paid separately for those overhead costs).

RVUs — work 1.16, practice expense 2.14 (non-facility) / 0.49 (facility), malpractice 0.21 — × 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 annual Part B deductible is met; the beneficiary or secondary insurance is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
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?

In facility settings, the facility (e.g., hospital) is separately reimbursed for overhead costs like equipment and staff, so the practice-expense RVU assigned to the professional service is lower than when the same service is performed in a non-facility setting like a physician's office.

Does this amount reflect what Medicare will actually pay?

No. It reflects the PFS allowed amount before the standard 80/20 cost-sharing split, deductible application, and any locality-specific or claim-specific adjustments are applied.

Why does the amount change every year?

The conversion factor, RVUs, and GPCIs are updated annually by CMS, and budget-neutrality adjustments required by law can shift payment amounts even when RVUs stay the same.

Can I use this figure to predict my exact reimbursement?

Use it only as a general estimate. Your MAC's locality-specific fee schedule, any applicable modifiers, and your contract terms (if applicable) will determine the exact payment.

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.