Medicare Reimbursement for CPT 11970

CPT 11970 is a procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code at the national level and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$517.38	$517.38
ALASKA* (AK)	$633.90	$633.90
ALABAMA (AL)	$469.25	$469.25
ARKANSAS (AR)	$463.30	$463.30
ARIZONA (AZ)	$503.80	$503.80
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$608.29	$608.29
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$617.99	$617.99
OXNARD-THOUSAND OAKS-VENTURA (CA)	$548.79	$548.79
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$554.03	$554.03
NAPA (CA)	$583.21	$583.21
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$609.82	$609.82
VALLEJO (CA)	$581.00	$581.00
BAKERSFIELD (CA)	$526.31	$526.31
CHICO (CA)	$522.54	$522.54
FRESNO (CA)	$522.54	$522.54
HANFORD-CORCORAN (CA)	$522.54	$522.54
MADERA (CA)	$522.54	$522.54
MERCED (CA)	$522.54	$522.54
MODESTO (CA)	$522.54	$522.54
REDDING (CA)	$522.54	$522.54
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$537.07	$537.07
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$542.47	$542.47
SALINAS (CA)	$540.34	$540.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$624.26	$624.26
SANTA CRUZ-WATSONVILLE (CA)	$550.70	$550.70
SANTA ROSA-PETALUMA (CA)	$555.86	$555.86
STOCKTON (CA)	$522.54	$522.54
VISALIA (CA)	$522.54	$522.54
YUBA CITY (CA)	$522.54	$522.54
EL CENTRO (CA)	$522.76	$522.76
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$548.82	$548.82
SAN LUIS OBISPO-PASO ROBLES (CA)	$532.36	$532.36
SANTA MARIA-SANTA BARBARA (CA)	$541.21	$541.21
REST OF CALIFORNIA (CA)	$522.54	$522.54
COLORADO (CO)	$525.05	$525.05
CONNECTICUT (CT)	$549.32	$549.32
DC + MD/VA SUBURBS (DC)	$576.31	$576.31
DELAWARE (DE)	$511.30	$511.30
FORT LAUDERDALE (FL)	$556.78	$556.78
MIAMI (FL)	$595.69	$595.69
REST OF FLORIDA (FL)	$530.01	$530.01
ATLANTA (GA)	$530.83	$530.83
REST OF GEORGIA (GA)	$501.36	$501.36
HAWAII, GUAM (HI)	$529.70	$529.70
IOWA (IA)	$470.77	$470.77
IDAHO (ID)	$475.34	$475.34
EAST ST. LOUIS (IL)	$544.83	$544.83
SUBURBAN CHICAGO (IL)	$560.07	$560.07
CHICAGO (IL)	$578.62	$578.62
REST OF ILLINOIS (IL)	$522.89	$522.89
INDIANA (IN)	$477.53	$477.53
KANSAS (KS)	$473.08	$473.08
KENTUCKY (KY)	$488.19	$488.19
NEW ORLEANS (LA)	$510.03	$510.03
REST OF LOUISIANA (LA)	$489.21	$489.21
METROPOLITAN BOSTON (MA)	$566.74	$566.74
REST OF MASSACHUSETTS (MA)	$524.24	$524.24
BALTIMORE/SURR. CNTYS (MD)	$548.65	$548.65
REST OF MARYLAND (MD)	$518.86	$518.86
SOUTHERN MAINE (ME)	$498.69	$498.69
REST OF MAINE (ME)	$482.06	$482.06
DETROIT (MI)	$540.32	$540.32
REST OF MICHIGAN (MI)	$503.32	$503.32
MINNESOTA (MN)	$492.26	$492.26
METROPOLITAN ST. LOUIS (MO)	$506.50	$506.50
METROPOLITAN KANSAS CITY (MO)	$502.41	$502.41
REST OF MISSOURI (MO)	$484.68	$484.68
MISSISSIPPI (MS)	$473.85	$473.85
MONTANA** (MT)	$517.29	$517.29
NORTH CAROLINA (NC)	$485.80	$485.80
NORTH DAKOTA** (ND)	$490.60	$490.60
NEBRASKA (NE)	$471.74	$471.74
NEW HAMPSHIRE (NH)	$521.11	$521.11
NORTHERN NJ (NJ)	$572.36	$572.36
REST OF NEW JERSEY (NJ)	$552.53	$552.53
NEW MEXICO (NM)	$507.48	$507.48
NEVADA** (NV)	$510.08	$510.08
MANHATTAN (NY)	$596.42	$596.42
NYC SUBURBS/LONG ISLAND (NY)	$614.81	$614.81
POUGHKPSIE/N NYC SUBURBS (NY)	$559.53	$559.53
QUEENS (NY)	$594.50	$594.50
REST OF NEW YORK (NY)	$492.56	$492.56
OHIO (OH)	$497.86	$497.86
OKLAHOMA (OK)	$482.88	$482.88
PORTLAND (OR)	$535.10	$535.10
REST OF OREGON (OR)	$503.07	$503.07
METROPOLITAN PHILADELPHIA (PA)	$539.84	$539.84
REST OF PENNSYLVANIA (PA)	$496.17	$496.17
PUERTO RICO (PR)	$519.22	$519.22
RHODE ISLAND (RI)	$524.68	$524.68
SOUTH CAROLINA (SC)	$493.25	$493.25
SOUTH DAKOTA** (SD)	$487.44	$487.44
TENNESSEE (TN)	$475.71	$475.71
BRAZORIA (TX)	$507.35	$507.35
DALLAS (TX)	$512.26	$512.26
GALVESTON (TX)	$509.98	$509.98
HOUSTON (TX)	$534.69	$534.69
BEAUMONT (TX)	$493.62	$493.62
FORT WORTH (TX)	$510.56	$510.56
AUSTIN (TX)	$525.98	$525.98
REST OF TEXAS (TX)	$501.35	$501.35
UTAH (UT)	$499.07	$499.07
VIRGINIA (VA)	$500.24	$500.24
VIRGIN ISLANDS (VI)	$519.22	$519.22
VERMONT (VT)	$492.82	$492.82
SEATTLE (KING CNTY) (WA)	$573.18	$573.18
REST OF WASHINGTON (WA)	$521.88	$521.88
WISCONSIN (WI)	$476.58	$476.58
WEST VIRGINIA (WV)	$506.89	$506.89
WYOMING** (WY)	$505.66	$505.66

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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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. 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 locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Because practice expense RVUs differ depending on where the service is furnished, non-facility and facility settings can produce different totals even though the work and malpractice components stay the same.

RVUs — work 7.3, practice expense 6.84 (non-facility) / 6.84 (facility), malpractice 1.35 — × 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 deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual updates to RVUs, GPCIs, and the conversion factor, as well as budget-neutrality adjustments, can shift amounts from year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the amount differ between non-facility and facility settings?

Practice expense RVUs account for overhead costs like staff, equipment, and supplies. These costs are typically higher when a service is performed in a non-facility setting (e.g., a physician's office) because the practice bears more of the overhead, versus a facility setting where the facility absorbs some of those costs.

Does this figure represent what the provider actually collects?

No. It represents the Medicare-allowed amount before cost-sharing. The actual payment depends on patient deductible status, coinsurance, secondary insurance, and any applicable adjustments or modifiers.

Why do amounts vary by locality?

Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect differences in labor, rent, and malpractice costs across different regions of the country.

Will this amount change next year?

Yes, potentially. The conversion factor, RVUs, and GPCIs are reviewed and updated annually by CMS, which can raise or lower the allowed amount even if the code itself doesn't change.

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.