Medicare Reimbursement for CPT 11952

CPT 11952 is a procedure code used in Medicare Part B billing; the specific descriptor is proprietary to the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$156.65	$87.51
ALASKA* (AK)	$185.66	$112.02
ALABAMA (AL)	$140.86	$80.36
ARKANSAS (AR)	$138.89	$79.50
ARIZONA (AZ)	$152.37	$85.37
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$193.65	$96.16
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$197.12	$97.42
OXNARD-THOUSAND OAKS-VENTURA (CA)	$171.07	$89.35
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$172.29	$90.50
NAPA (CA)	$184.30	$93.17
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$193.99	$96.50
VALLEJO (CA)	$183.80	$92.68
BAKERSFIELD (CA)	$162.57	$86.79
CHICO (CA)	$161.72	$85.95
FRESNO (CA)	$161.72	$85.95
HANFORD-CORCORAN (CA)	$161.72	$85.95
MADERA (CA)	$161.72	$85.95
MERCED (CA)	$161.72	$85.95
MODESTO (CA)	$161.72	$85.95
REDDING (CA)	$161.72	$85.95
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$164.96	$89.18
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$168.90	$88.49
SALINAS (CA)	$168.26	$88.13
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$198.51	$98.81
SANTA CRUZ-WATSONVILLE (CA)	$172.83	$88.83
SANTA ROSA-PETALUMA (CA)	$174.52	$89.62
STOCKTON (CA)	$161.72	$85.95
VISALIA (CA)	$161.72	$85.95
YUBA CITY (CA)	$161.72	$85.95
EL CENTRO (CA)	$161.77	$86.00
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$171.65	$88.96
SAN LUIS OBISPO-PASO ROBLES (CA)	$165.66	$86.91
SANTA MARIA-SANTA BARBARA (CA)	$168.74	$88.12
REST OF CALIFORNIA (CA)	$161.72	$85.95
COLORADO (CO)	$160.97	$87.41
CONNECTICUT (CT)	$166.90	$92.44
DC + MD/VA SUBURBS (DC)	$177.05	$95.60
DELAWARE (DE)	$154.82	$86.51
FORT LAUDERDALE (FL)	$165.94	$95.90
MIAMI (FL)	$175.72	$103.75
REST OF FLORIDA (FL)	$157.66	$91.57
ATLANTA (GA)	$160.29	$90.05
REST OF GEORGIA (GA)	$148.69	$87.02
HAWAII, GUAM (HI)	$164.97	$86.36
IOWA (IA)	$142.83	$79.57
IDAHO (ID)	$144.05	$80.44
EAST ST. LOUIS (IL)	$159.49	$95.88
SUBURBAN CHICAGO (IL)	$167.24	$96.24
CHICAGO (IL)	$170.47	$100.98
REST OF ILLINOIS (IL)	$154.33	$91.20
INDIANA (IN)	$144.82	$80.73
KANSAS (KS)	$142.89	$80.39
KENTUCKY (KY)	$145.64	$84.17
NEW ORLEANS (LA)	$152.61	$87.55
REST OF LOUISIANA (LA)	$145.70	$84.52
METROPOLITAN BOSTON (MA)	$175.56	$93.01
REST OF MASSACHUSETTS (MA)	$160.35	$87.54
BALTIMORE/SURR. CNTYS (MD)	$166.59	$92.40
REST OF MARYLAND (MD)	$157.48	$87.51
SOUTHERN MAINE (ME)	$152.13	$83.61
REST OF MAINE (ME)	$145.54	$81.93
DETROIT (MI)	$160.32	$93.60
REST OF MICHIGAN (MI)	$149.98	$86.86
MINNESOTA (MN)	$152.25	$81.11
METROPOLITAN ST. LOUIS (MO)	$152.28	$86.46
METROPOLITAN KANSAS CITY (MO)	$150.84	$85.91
REST OF MISSOURI (MO)	$143.76	$84.16
MISSISSIPPI (MS)	$141.31	$81.78
MONTANA** (MT)	$156.63	$87.49
NORTH CAROLINA (NC)	$146.90	$82.39
NORTH DAKOTA** (ND)	$150.70	$81.56
NEBRASKA (NE)	$143.37	$79.55
NEW HAMPSHIRE (NH)	$159.15	$87.18
NORTHERN NJ (NJ)	$175.45	$95.24
REST OF NEW JERSEY (NJ)	$168.25	$92.75
NEW MEXICO (NM)	$151.07	$87.67
NEVADA** (NV)	$155.07	$85.86
MANHATTAN (NY)	$180.88	$100.53
NYC SUBURBS/LONG ISLAND (NY)	$186.06	$103.85
POUGHKPSIE/N NYC SUBURBS (NY)	$169.93	$94.22
QUEENS (NY)	$181.26	$99.54
REST OF NEW YORK (NY)	$149.10	$83.42
OHIO (OH)	$148.77	$85.64
OKLAHOMA (OK)	$144.62	$82.88
PORTLAND (OR)	$165.13	$88.31
REST OF OREGON (OR)	$153.31	$84.44
METROPOLITAN PHILADELPHIA (PA)	$163.33	$91.35
REST OF PENNSYLVANIA (PA)	$148.59	$85.12
PUERTO RICO (PR)	$157.51	$87.61
RHODE ISLAND (RI)	$159.64	$88.21
SOUTH CAROLINA (SC)	$148.19	$84.31
SOUTH DAKOTA** (SD)	$150.00	$80.86
TENNESSEE (TN)	$143.68	$80.83
BRAZORIA (TX)	$154.06	$85.55
DALLAS (TX)	$155.36	$86.49
GALVESTON (TX)	$154.73	$86.07
HOUSTON (TX)	$160.22	$91.56
BEAUMONT (TX)	$147.70	$84.78
FORT WORTH (TX)	$154.57	$86.40
AUSTIN (TX)	$160.93	$87.78
REST OF TEXAS (TX)	$151.01	$85.40
UTAH (UT)	$150.14	$85.15
VIRGINIA (VA)	$152.15	$84.18
VIRGIN ISLANDS (VI)	$157.51	$87.61
VERMONT (VT)	$150.79	$82.34
SEATTLE (KING CNTY) (WA)	$178.35	$93.51
REST OF WASHINGTON (WA)	$159.82	$87.02
WISCONSIN (WI)	$145.87	$79.64
WEST VIRGINIA (WV)	$148.98	$88.90
WYOMING** (WY)	$154.04	$84.91

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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

The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for a given locality to reflect local cost differences. These locality-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher when the physician's office bears the overhead, and lower when the service is performed in a hospital or facility setting that bills its own overhead separately. Every year, CMS updates RVUs, GPCIs, and the conversion factor, which can change the allowed amount even if the code itself doesn't change.

RVUs — work 1.65, practice expense 2.74 (non-facility) / 0.67 (facility), malpractice 0.3 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates based on the Medicare Physician Fee Schedule and may not reflect the exact payment on any specific claim.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final payment.
Locality-specific amounts depend on current GPCI values, which are updated periodically by CMS.
Always confirm the applicable rate with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

The facility rate uses a lower practice-expense RVU because the facility (e.g., hospital) — not the billing physician — incurs most of the overhead costs for the procedure.

Will I be paid the exact national amount shown here?

No. The national figure is a baseline; your actual payment depends on your specific locality's GPCIs, any applicable modifiers, and other claim-specific adjustments.

Does this amount include patient cost-sharing?

No. The listed amount is the total allowed amount before Medicare's standard 80/20 cost-sharing split and before the Part B deductible is applied.

Why might this amount differ from what I was paid last year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can shift allowed amounts even without a change in the code's definition.

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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.