Medicare Reimbursement for CPT Code 11954
This page covers a Medicare Physician Fee Schedule (PFS) procedure code identified by CPT 11954. Because CPT descriptors are AMA-licensed, we refer to it generically as 'this procedure code' rather than reproducing the official description. The figures shown are estimated Medicare-allowed amounts nationally and by locality, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $173.35 | $96.19 |
| ALASKA* (AK) | $204.76 | $122.59 |
| ALABAMA (AL) | $155.58 | $88.07 |
| ARKANSAS (AR) | $153.36 | $87.09 |
| ARIZONA (AZ) | $168.52 | $93.76 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $213.97 | $105.18 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $217.79 | $106.54 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $189.11 | $97.91 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $190.47 | $99.19 |
| NAPA (CA) | $203.68 | $101.98 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $214.37 | $105.58 |
| VALLEJO (CA) | $203.10 | $101.41 |
| BAKERSFIELD (CA) | $179.67 | $95.11 |
| CHICO (CA) | $178.70 | $94.13 |
| FRESNO (CA) | $178.70 | $94.13 |
| HANFORD-CORCORAN (CA) | $178.70 | $94.13 |
| MADERA (CA) | $178.70 | $94.13 |
| MERCED (CA) | $178.70 | $94.13 |
| MODESTO (CA) | $178.70 | $94.13 |
| REDDING (CA) | $178.70 | $94.13 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $182.46 | $97.90 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $186.64 | $96.91 |
| SALINAS (CA) | $185.93 | $96.51 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $219.42 | $108.16 |
| SANTA CRUZ-WATSONVILLE (CA) | $191.02 | $97.28 |
| SANTA ROSA-PETALUMA (CA) | $192.88 | $98.13 |
| STOCKTON (CA) | $178.70 | $94.13 |
| VISALIA (CA) | $178.70 | $94.13 |
| YUBA CITY (CA) | $178.70 | $94.13 |
| EL CENTRO (CA) | $178.75 | $94.19 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $189.70 | $97.42 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $183.06 | $95.18 |
| SANTA MARIA-SANTA BARBARA (CA) | $186.47 | $96.50 |
| REST OF CALIFORNIA (CA) | $178.70 | $94.13 |
| COLORADO (CO) | $178.01 | $95.92 |
| CONNECTICUT (CT) | $184.83 | $101.73 |
| DC + MD/VA SUBURBS (DC) | $195.99 | $105.10 |
| DELAWARE (DE) | $171.25 | $95.02 |
| FORT LAUDERDALE (FL) | $184.12 | $105.96 |
| MIAMI (FL) | $195.39 | $115.07 |
| REST OF FLORIDA (FL) | $174.76 | $101.00 |
| ATLANTA (GA) | $177.51 | $99.11 |
| REST OF GEORGIA (GA) | $164.63 | $95.81 |
| HAWAII, GUAM (HI) | $182.34 | $94.61 |
| IOWA (IA) | $157.67 | $87.07 |
| IDAHO (ID) | $159.07 | $88.08 |
| EAST ST. LOUIS (IL) | $177.08 | $106.10 |
| SUBURBAN CHICAGO (IL) | $185.54 | $106.30 |
| CHICAGO (IL) | $189.42 | $111.88 |
| REST OF ILLINOIS (IL) | $171.10 | $100.65 |
| INDIANA (IN) | $159.93 | $88.41 |
| KANSAS (KS) | $157.80 | $88.06 |
| KENTUCKY (KY) | $161.09 | $92.49 |
| NEW ORLEANS (LA) | $168.95 | $96.35 |
| REST OF LOUISIANA (LA) | $161.18 | $92.90 |
| METROPOLITAN BOSTON (MA) | $194.23 | $102.10 |
| REST OF MASSACHUSETTS (MA) | $177.32 | $96.08 |
| BALTIMORE/SURR. CNTYS (MD) | $184.50 | $101.71 |
| REST OF MARYLAND (MD) | $174.21 | $96.13 |
| SOUTHERN MAINE (ME) | $168.12 | $91.66 |
| REST OF MAINE (ME) | $160.81 | $89.83 |
| DETROIT (MI) | $177.82 | $103.36 |
| REST OF MICHIGAN (MI) | $166.02 | $95.58 |
| MINNESOTA (MN) | $168.07 | $88.67 |
| METROPOLITAN ST. LOUIS (MO) | $168.50 | $95.05 |
| METROPOLITAN KANSAS CITY (MO) | $166.89 | $94.44 |
| REST OF MISSOURI (MO) | $159.03 | $92.53 |
| MISSISSIPPI (MS) | $156.19 | $89.75 |
| MONTANA** (MT) | $173.33 | $96.17 |
| NORTH CAROLINA (NC) | $162.33 | $90.34 |
| NORTH DAKOTA** (ND) | $166.41 | $89.25 |
| NEBRASKA (NE) | $158.26 | $87.05 |
| NEW HAMPSHIRE (NH) | $176.05 | $95.73 |
| NORTHERN NJ (NJ) | $194.18 | $104.68 |
| REST OF NEW JERSEY (NJ) | $186.23 | $101.98 |
| NEW MEXICO (NM) | $167.27 | $96.52 |
| NEVADA** (NV) | $171.50 | $94.27 |
| MANHATTAN (NY) | $200.50 | $110.84 |
| NYC SUBURBS/LONG ISLAND (NY) | $206.41 | $114.67 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $188.16 | $103.67 |
| QUEENS (NY) | $200.85 | $109.65 |
| REST OF NEW YORK (NY) | $164.80 | $91.50 |
| OHIO (OH) | $164.61 | $94.17 |
| OKLAHOMA (OK) | $159.88 | $90.98 |
| PORTLAND (OR) | $182.59 | $96.87 |
| REST OF OREGON (OR) | $169.47 | $92.63 |
| METROPOLITAN PHILADELPHIA (PA) | $180.85 | $100.53 |
| REST OF PENNSYLVANIA (PA) | $164.38 | $93.55 |
| PUERTO RICO (PR) | $174.29 | $96.29 |
| RHODE ISLAND (RI) | $176.58 | $96.88 |
| SOUTH CAROLINA (SC) | $163.88 | $92.59 |
| SOUTH DAKOTA** (SD) | $165.59 | $88.43 |
| TENNESSEE (TN) | $158.70 | $88.56 |
| BRAZORIA (TX) | $170.35 | $93.88 |
| DALLAS (TX) | $171.83 | $94.98 |
| GALVESTON (TX) | $171.11 | $94.49 |
| HOUSTON (TX) | $177.52 | $100.90 |
| BEAUMONT (TX) | $163.38 | $93.17 |
| FORT WORTH (TX) | $170.96 | $94.89 |
| AUSTIN (TX) | $178.03 | $96.40 |
| REST OF TEXAS (TX) | $167.04 | $93.82 |
| UTAH (UT) | $166.07 | $93.54 |
| VIRGINIA (VA) | $168.19 | $92.34 |
| VIRGIN ISLANDS (VI) | $174.29 | $96.29 |
| VERMONT (VT) | $166.56 | $90.18 |
| SEATTLE (KING CNTY) (WA) | $197.27 | $102.60 |
| REST OF WASHINGTON (WA) | $176.72 | $95.47 |
| WISCONSIN (WI) | $161.00 | $87.08 |
| WEST VIRGINIA (WV) | $165.09 | $98.04 |
| WYOMING** (WY) | $170.31 | $93.16 |
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: Clinical. 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 starts with three Relative Value Units (RVUs) assigned to the code: work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the provider's locality to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility settings typically differ because the practice-expense RVU is higher when the practice bears overhead costs (non-facility) versus when those costs are borne by a facility (facility setting).
RVUs — work 1.8, practice expense 3.04 (non-facility) / 0.73 (facility), malpractice 0.35 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- All amounts shown are estimates only, not a guarantee of payment.
- Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
- Actual payment can vary by locality-specific GPCIs, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments to RVUs or the conversion factor.
- Always verify current amounts and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The practice-expense RVU is lower in the facility setting because the facility, not the billing practice, absorbs overhead costs like equipment, space, and staff for the procedure.
Why might my locality's payment differ from the national amount?
Each locality has its own GPCI values for work, practice expense, and malpractice, which adjust the RVUs to reflect local costs of practicing medicine before the conversion factor is applied.
Does this amount reflect what Medicare will actually pay?
No — it's an estimated allowed amount. Medicare generally reimburses 80% of the allowed amount after the deductible is met, and modifiers or claim-specific factors can change the final payment.
Why can the conversion factor change year to year?
CMS updates the conversion factor annually based on statutory formulas and budget-neutrality adjustments, which can raise or lower payments across all PFS codes.
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.
Bill accurately, get paid faster
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free