Medicare Reimbursement for CPT 11971

This page covers a CPT-coded procedure (descriptor not shown due to AMA licensing) and displays its Medicare Physician Fee Schedule (PFS) allowed amount for 2026. Figures are shown at the national level and can vary by locality, and both non-facility and facility rates are provided where they differ.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$515.71	$515.71
ALASKA* (AK)	$626.64	$626.64
ALABAMA (AL)	$466.59	$466.59
ARKANSAS (AR)	$460.50	$460.50
ARIZONA (AZ)	$501.97	$501.97
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$613.07	$613.07
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$623.13	$623.13
OXNARD-THOUSAND OAKS-VENTURA (CA)	$550.49	$550.49
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$555.45	$555.45
NAPA (CA)	$586.82	$586.82
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$614.53	$614.53
VALLEJO (CA)	$584.72	$584.72
BAKERSFIELD (CA)	$526.81	$526.81
CHICO (CA)	$523.23	$523.23
FRESNO (CA)	$523.23	$523.23
HANFORD-CORCORAN (CA)	$523.23	$523.23
MADERA (CA)	$523.23	$523.23
MERCED (CA)	$523.23	$523.23
MODESTO (CA)	$523.23	$523.23
REDDING (CA)	$523.23	$523.23
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$537.01	$537.01
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$543.95	$543.95
SALINAS (CA)	$541.83	$541.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$629.07	$629.07
SANTA CRUZ-WATSONVILLE (CA)	$553.24	$553.24
SANTA ROSA-PETALUMA (CA)	$558.47	$558.47
STOCKTON (CA)	$523.23	$523.23
VISALIA (CA)	$523.23	$523.23
YUBA CITY (CA)	$523.23	$523.23
EL CENTRO (CA)	$523.44	$523.44
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$550.90	$550.90
SAN LUIS OBISPO-PASO ROBLES (CA)	$533.74	$533.74
SANTA MARIA-SANTA BARBARA (CA)	$542.86	$542.86
REST OF CALIFORNIA (CA)	$523.23	$523.23
COLORADO (CO)	$524.74	$524.74
CONNECTICUT (CT)	$548.08	$548.08
DC + MD/VA SUBURBS (DC)	$576.40	$576.40
DELAWARE (DE)	$509.60	$509.60
FORT LAUDERDALE (FL)	$553.43	$553.43
MIAMI (FL)	$591.10	$591.10
REST OF FLORIDA (FL)	$526.46	$526.46
ATLANTA (GA)	$528.90	$528.90
REST OF GEORGIA (GA)	$497.51	$497.51
HAWAII, GUAM (HI)	$531.21	$531.21
IOWA (IA)	$469.15	$469.15
IDAHO (ID)	$473.62	$473.62
EAST ST. LOUIS (IL)	$539.50	$539.50
SUBURBAN CHICAGO (IL)	$556.92	$556.92
CHICAGO (IL)	$573.90	$573.90
REST OF ILLINOIS (IL)	$518.51	$518.51
INDIANA (IN)	$475.89	$475.89
KANSAS (KS)	$471.03	$471.03
KENTUCKY (KY)	$484.94	$484.94
NEW ORLEANS (LA)	$507.10	$507.10
REST OF LOUISIANA (LA)	$485.80	$485.80
METROPOLITAN BOSTON (MA)	$567.81	$567.81
REST OF MASSACHUSETTS (MA)	$523.64	$523.64
BALTIMORE/SURR. CNTYS (MD)	$547.35	$547.35
REST OF MARYLAND (MD)	$517.42	$517.42
SOUTHERN MAINE (ME)	$497.73	$497.73
REST OF MAINE (ME)	$479.99	$479.99
DETROIT (MI)	$536.48	$536.48
REST OF MICHIGAN (MI)	$499.95	$499.95
MINNESOTA (MN)	$492.70	$492.70
METROPOLITAN ST. LOUIS (MO)	$504.06	$504.06
METROPOLITAN KANSAS CITY (MO)	$499.81	$499.81
REST OF MISSOURI (MO)	$480.86	$480.86
MISSISSIPPI (MS)	$470.57	$470.57
MONTANA** (MT)	$515.62	$515.62
NORTH CAROLINA (NC)	$483.89	$483.89
NORTH DAKOTA** (ND)	$490.31	$490.31
NEBRASKA (NE)	$470.29	$470.29
NEW HAMPSHIRE (NH)	$520.39	$520.39
NORTHERN NJ (NJ)	$572.13	$572.13
REST OF NEW JERSEY (NJ)	$551.49	$551.49
NEW MEXICO (NM)	$504.01	$504.01
NEVADA** (NV)	$508.81	$508.81
MANHATTAN (NY)	$594.99	$594.99
NYC SUBURBS/LONG ISLAND (NY)	$613.18	$613.18
POUGHKPSIE/N NYC SUBURBS (NY)	$558.20	$558.20
QUEENS (NY)	$593.73	$593.73
REST OF NEW YORK (NY)	$490.79	$490.79
OHIO (OH)	$494.78	$494.78
OKLAHOMA (OK)	$480.02	$480.02
PORTLAND (OR)	$535.56	$535.56
REST OF OREGON (OR)	$502.03	$502.03
METROPOLITAN PHILADELPHIA (PA)	$538.10	$538.10
REST OF PENNSYLVANIA (PA)	$493.31	$493.31
PUERTO RICO (PR)	$517.76	$517.76
RHODE ISLAND (RI)	$523.50	$523.50
SOUTH CAROLINA (SC)	$490.72	$490.72
SOUTH DAKOTA** (SD)	$487.32	$487.32
TENNESSEE (TN)	$473.67	$473.67
BRAZORIA (TX)	$505.93	$505.93
DALLAS (TX)	$510.72	$510.72
GALVESTON (TX)	$508.47	$508.47
HOUSTON (TX)	$531.90	$531.90
BEAUMONT (TX)	$490.67	$490.67
FORT WORTH (TX)	$508.83	$508.83
AUSTIN (TX)	$525.47	$525.47
REST OF TEXAS (TX)	$499.09	$499.09
UTAH (UT)	$496.68	$496.68
VIRGINIA (VA)	$498.98	$498.98
VIRGIN ISLANDS (VI)	$517.76	$517.76
VERMONT (VT)	$492.14	$492.14
SEATTLE (KING CNTY) (WA)	$574.81	$574.81
REST OF WASHINGTON (WA)	$521.42	$521.42
WISCONSIN (WI)	$475.86	$475.86
WEST VIRGINIA (WV)	$502.11	$502.11
WYOMING** (WY)	$504.59	$504.59

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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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code each year. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which can create different allowed amounts for the same code depending on place of service.

RVUs — work 6.84, practice expense 7.32 (non-facility) / 7.32 (facility), malpractice 1.28 — × 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 the annual Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean the actual allowed amount can differ from the national figure shown here.
Always verify current rates and edits with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The practice-expense RVU component is typically lower in the facility setting because the facility (e.g., hospital) bears certain overhead costs separately, while non-facility settings like a physician's office include those costs in the code's RVUs.

Why might my local Medicare payment differ from the national amount shown here?

The national amount uses a national average GPCI-neutral input; actual payments are recalculated using the GPCIs for the specific locality where the service was rendered, which can raise or lower the amount.

Does this amount include the patient's deductible and coinsurance?

No. The figure shown is the total allowed amount before cost-sharing. Medicare generally pays 80% of that amount after the deductible is met, with the patient or secondary insurance covering the rest.

Can I use this figure to predict my exact reimbursement?

No. This is a general estimate based on standard RVUs and the conversion factor; actual payment depends on modifiers, locality, sequestration, and other claim-specific factors.

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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.