Medicare Reimbursement for CPT Code 11960
CPT 11960 is a physician procedure code (the specific descriptor is licensed by the AMA and not reproduced here). This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $948.25 | $948.25 |
| ALASKA* (AK) | $1138.62 | $1138.62 |
| ALABAMA (AL) | $856.05 | $856.05 |
| ARKANSAS (AR) | $844.54 | $844.54 |
| ARIZONA (AZ) | $922.98 | $922.98 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1154.05 | $1154.05 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1174.07 | $1174.07 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1026.25 | $1026.25 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1034.34 | $1034.34 |
| NAPA (CA) | $1100.83 | $1100.83 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1156.30 | $1156.30 |
| VALLEJO (CA) | $1097.59 | $1097.59 |
| BAKERSFIELD (CA) | $978.27 | $978.27 |
| CHICO (CA) | $972.70 | $972.70 |
| FRESNO (CA) | $972.70 | $972.70 |
| HANFORD-CORCORAN (CA) | $972.70 | $972.70 |
| MADERA (CA) | $972.70 | $972.70 |
| MERCED (CA) | $972.70 | $972.70 |
| MODESTO (CA) | $972.70 | $972.70 |
| REDDING (CA) | $972.70 | $972.70 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $994.03 | $994.03 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1013.84 | $1013.84 |
| SALINAS (CA) | $1009.94 | $1009.94 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1183.26 | $1183.26 |
| SANTA CRUZ-WATSONVILLE (CA) | $1034.65 | $1034.65 |
| SANTA ROSA-PETALUMA (CA) | $1044.62 | $1044.62 |
| STOCKTON (CA) | $972.70 | $972.70 |
| VISALIA (CA) | $972.70 | $972.70 |
| YUBA CITY (CA) | $972.70 | $972.70 |
| EL CENTRO (CA) | $973.03 | $973.03 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1028.76 | $1028.76 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $994.54 | $994.54 |
| SANTA MARIA-SANTA BARBARA (CA) | $1012.37 | $1012.37 |
| REST OF CALIFORNIA (CA) | $972.70 | $972.70 |
| COLORADO (CO) | $970.77 | $970.77 |
| CONNECTICUT (CT) | $1008.74 | $1008.74 |
| DC + MD/VA SUBURBS (DC) | $1066.35 | $1066.35 |
| DELAWARE (DE) | $937.35 | $937.35 |
| FORT LAUDERDALE (FL) | $1008.29 | $1008.29 |
| MIAMI (FL) | $1070.20 | $1070.20 |
| REST OF FLORIDA (FL) | $959.16 | $959.16 |
| ATLANTA (GA) | $970.80 | $970.80 |
| REST OF GEORGIA (GA) | $906.08 | $906.08 |
| HAWAII, GUAM (HI) | $990.01 | $990.01 |
| IOWA (IA) | $865.19 | $865.19 |
| IDAHO (ID) | $872.76 | $872.76 |
| EAST ST. LOUIS (IL) | $974.67 | $974.67 |
| SUBURBAN CHICAGO (IL) | $1015.64 | $1015.64 |
| CHICAGO (IL) | $1039.05 | $1039.05 |
| REST OF ILLINOIS (IL) | $941.29 | $941.29 |
| INDIANA (IN) | $877.17 | $877.17 |
| KANSAS (KS) | $866.68 | $866.68 |
| KENTUCKY (KY) | $886.24 | $886.24 |
| NEW ORLEANS (LA) | $927.27 | $927.27 |
| REST OF LOUISIANA (LA) | $887.05 | $887.05 |
| METROPOLITAN BOSTON (MA) | $1054.87 | $1054.87 |
| REST OF MASSACHUSETTS (MA) | $967.74 | $967.74 |
| BALTIMORE/SURR. CNTYS (MD) | $1007.00 | $1007.00 |
| REST OF MARYLAND (MD) | $952.67 | $952.67 |
| SOUTHERN MAINE (ME) | $919.28 | $919.28 |
| REST OF MAINE (ME) | $882.61 | $882.61 |
| DETROIT (MI) | $975.84 | $975.84 |
| REST OF MICHIGAN (MI) | $912.58 | $912.58 |
| MINNESOTA (MN) | $916.43 | $916.43 |
| METROPOLITAN ST. LOUIS (MO) | $924.00 | $924.00 |
| METROPOLITAN KANSAS CITY (MO) | $915.74 | $915.74 |
| REST OF MISSOURI (MO) | $876.42 | $876.42 |
| MISSISSIPPI (MS) | $860.37 | $860.37 |
| MONTANA** (MT) | $948.12 | $948.12 |
| NORTH CAROLINA (NC) | $890.34 | $890.34 |
| NORTH DAKOTA** (ND) | $908.97 | $908.97 |
| NEBRASKA (NE) | $868.00 | $868.00 |
| NEW HAMPSHIRE (NH) | $960.81 | $960.81 |
| NORTHERN NJ (NJ) | $1057.60 | $1057.60 |
| REST OF NEW JERSEY (NJ) | $1016.37 | $1016.37 |
| NEW MEXICO (NM) | $919.38 | $919.38 |
| NEVADA** (NV) | $937.72 | $937.72 |
| MANHATTAN (NY) | $1093.25 | $1093.25 |
| NYC SUBURBS/LONG ISLAND (NY) | $1124.89 | $1124.89 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1027.24 | $1027.24 |
| QUEENS (NY) | $1093.89 | $1093.89 |
| REST OF NEW YORK (NY) | $903.21 | $903.21 |
| OHIO (OH) | $904.58 | $904.58 |
| OKLAHOMA (OK) | $879.14 | $879.14 |
| PORTLAND (OR) | $993.70 | $993.70 |
| REST OF OREGON (OR) | $926.58 | $926.58 |
| METROPOLITAN PHILADELPHIA (PA) | $988.58 | $988.58 |
| REST OF PENNSYLVANIA (PA) | $902.96 | $902.96 |
| PUERTO RICO (PR) | $952.85 | $952.85 |
| RHODE ISLAND (RI) | $964.98 | $964.98 |
| SOUTH CAROLINA (SC) | $899.72 | $899.72 |
| SOUTH DAKOTA** (SD) | $904.34 | $904.34 |
| TENNESSEE (TN) | $871.40 | $871.40 |
| BRAZORIA (TX) | $932.12 | $932.12 |
| DALLAS (TX) | $940.20 | $940.20 |
| GALVESTON (TX) | $936.31 | $936.31 |
| HOUSTON (TX) | $972.55 | $972.55 |
| BEAUMONT (TX) | $897.83 | $897.83 |
| FORT WORTH (TX) | $935.97 | $935.97 |
| AUSTIN (TX) | $970.93 | $970.93 |
| REST OF TEXAS (TX) | $915.93 | $915.93 |
| UTAH (UT) | $911.02 | $911.02 |
| VIRGINIA (VA) | $920.17 | $920.17 |
| VIRGIN ISLANDS (VI) | $952.85 | $952.85 |
| VERMONT (VT) | $910.50 | $910.50 |
| SEATTLE (KING CNTY) (WA) | $1070.18 | $1070.18 |
| REST OF WASHINGTON (WA) | $964.23 | $964.23 |
| WISCONSIN (WI) | $881.15 | $881.15 |
| WEST VIRGINIA (WV) | $910.20 | $910.20 |
| WYOMING** (WY) | $931.06 | $931.06 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 2 units 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 is built from three Relative Value Units (RVUs) assigned to a 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 the allowed amount. Non-facility and facility settings often use different practice-expense RVUs because overhead costs differ when a service is performed in a physician office versus a hospital or ambulatory surgical center; for this code those two values happen to align in the national calculation shown here.
RVUs — work 11.2, practice expense 15.21 (non-facility) / 15.21 (facility), malpractice 1.98 — × 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 annual deductible; the patient or secondary payer is responsible for the remainder.
- Actual payment can vary by locality, applicable modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality adjustments to the conversion factor.
- Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why does the amount differ between non-facility and facility settings?
Practice-expense RVUs can differ because overhead costs (staff, supplies, equipment) are usually higher when the physician's office bears them directly, compared to a facility setting where the facility itself absorbs some of those costs.
Why might the amount for my locality differ from the national figure?
Locality-specific GPCIs adjust the work, practice expense, and malpractice RVUs to reflect regional differences in wages, rents, and liability costs, so the final allowed amount can be higher or lower than the national average.
Does this amount reflect what Medicare will actually pay?
No. This figure represents the estimated allowed amount before beneficiary cost-sharing, sequestration, or claim-specific modifiers are applied. Actual payment may differ.
Where can I verify the descriptor for CPT 11960?
CPT code descriptors are copyrighted by the American Medical Association (AMA); consult your CPT codebook or AMA-licensed coding resource for the official descriptor.
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.
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