Medicare Reimbursement for CPT Code 11976

CPT 11976 is a procedure code used for physician billing under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for the code, both at the national level and adjusted by locality, and separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$146.63	$80.16
ALASKA* (AK)	$176.29	$105.50
ALABAMA (AL)	$132.47	$74.31
ARKANSAS (AR)	$130.70	$73.61
ARIZONA (AZ)	$142.75	$78.35
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$178.57	$84.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$181.67	$85.83
OXNARD-THOUSAND OAKS-VENTURA (CA)	$158.77	$80.20
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$160.01	$81.38
NAPA (CA)	$170.32	$82.72
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$178.91	$85.19
VALLEJO (CA)	$169.83	$82.23
BAKERSFIELD (CA)	$151.35	$78.50
CHICO (CA)	$150.50	$77.66
FRESNO (CA)	$150.50	$77.66
HANFORD-CORCORAN (CA)	$150.50	$77.66
MADERA (CA)	$150.50	$77.66
MERCED (CA)	$150.50	$77.66
MODESTO (CA)	$150.50	$77.66
REDDING (CA)	$150.50	$77.66
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$153.74	$80.89
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$156.87	$79.56
SALINAS (CA)	$156.26	$79.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$183.07	$87.22
SANTA CRUZ-WATSONVILLE (CA)	$160.08	$79.32
SANTA ROSA-PETALUMA (CA)	$161.62	$80.00
STOCKTON (CA)	$150.50	$77.66
VISALIA (CA)	$150.50	$77.66
YUBA CITY (CA)	$150.50	$77.66
EL CENTRO (CA)	$150.55	$77.71
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$159.17	$79.67
SAN LUIS OBISPO-PASO ROBLES (CA)	$153.88	$78.17
SANTA MARIA-SANTA BARBARA (CA)	$156.64	$79.14
REST OF CALIFORNIA (CA)	$150.50	$77.66
COLORADO (CO)	$150.16	$79.43
CONNECTICUT (CT)	$155.94	$84.35
DC + MD/VA SUBURBS (DC)	$164.87	$86.57
DELAWARE (DE)	$144.97	$79.30
FORT LAUDERDALE (FL)	$155.75	$88.41
MIAMI (FL)	$165.17	$95.98
REST OF FLORIDA (FL)	$148.22	$84.67
ATLANTA (GA)	$150.07	$82.54
REST OF GEORGIA (GA)	$140.08	$80.79
HAWAII, GUAM (HI)	$153.16	$77.59
IOWA (IA)	$133.92	$73.10
IDAHO (ID)	$135.07	$73.92
EAST ST. LOUIS (IL)	$150.51	$89.36
SUBURBAN CHICAGO (IL)	$156.89	$88.63
CHICAGO (IL)	$160.41	$93.61
REST OF ILLINOIS (IL)	$145.44	$84.76
INDIANA (IN)	$135.75	$74.13
KANSAS (KS)	$134.12	$74.04
KENTUCKY (KY)	$137.07	$77.98
NEW ORLEANS (LA)	$143.36	$80.82
REST OF LOUISIANA (LA)	$137.18	$78.36
METROPOLITAN BOSTON (MA)	$163.14	$83.78
REST OF MASSACHUSETTS (MA)	$149.69	$79.70
BALTIMORE/SURR. CNTYS (MD)	$155.66	$84.34
REST OF MARYLAND (MD)	$147.33	$80.07
SOUTHERN MAINE (ME)	$142.23	$76.36
REST OF MAINE (ME)	$136.56	$75.41
DETROIT (MI)	$150.76	$86.62
REST OF MICHIGAN (MI)	$141.09	$80.41
MINNESOTA (MN)	$141.85	$73.46
METROPOLITAN ST. LOUIS (MO)	$142.88	$79.61
METROPOLITAN KANSAS CITY (MO)	$141.61	$79.20
REST OF MISSOURI (MO)	$135.54	$78.24
MISSISSIPPI (MS)	$133.10	$75.88
MONTANA** (MT)	$146.61	$80.14
NORTH CAROLINA (NC)	$137.75	$75.74
NORTH DAKOTA** (ND)	$140.68	$74.21
NEBRASKA (NE)	$134.35	$73.00
NEW HAMPSHIRE (NH)	$148.60	$79.40
NORTHERN NJ (NJ)	$163.53	$86.43
REST OF NEW JERSEY (NJ)	$157.15	$84.57
NEW MEXICO (NM)	$142.13	$81.18
NEVADA** (NV)	$145.04	$78.50
MANHATTAN (NY)	$168.94	$91.70
NYC SUBURBS/LONG ISLAND (NY)	$173.77	$94.74
POUGHKPSIE/N NYC SUBURBS (NY)	$158.81	$86.02
QUEENS (NY)	$169.06	$90.50
REST OF NEW YORK (NY)	$139.73	$76.58
OHIO (OH)	$139.88	$79.20
OKLAHOMA (OK)	$136.00	$76.64
PORTLAND (OR)	$153.71	$79.86
REST OF OREGON (OR)	$143.34	$77.14
METROPOLITAN PHILADELPHIA (PA)	$152.83	$83.64
REST OF PENNSYLVANIA (PA)	$139.64	$78.63
PUERTO RICO (PR)	$147.34	$80.14
RHODE ISLAND (RI)	$149.24	$80.58
SOUTH CAROLINA (SC)	$139.16	$77.75
SOUTH DAKOTA** (SD)	$139.98	$73.51
TENNESSEE (TN)	$134.85	$74.43
BRAZORIA (TX)	$144.18	$78.31
DALLAS (TX)	$145.42	$79.21
GALVESTON (TX)	$144.82	$78.82
HOUSTON (TX)	$150.31	$84.31
BEAUMONT (TX)	$138.85	$78.37
FORT WORTH (TX)	$144.76	$79.22
AUSTIN (TX)	$150.16	$79.83
REST OF TEXAS (TX)	$141.65	$78.58
UTAH (UT)	$140.90	$78.42
VIRGINIA (VA)	$142.35	$77.01
VIRGIN ISLANDS (VI)	$147.34	$80.14
VERMONT (VT)	$140.90	$75.09
SEATTLE (KING CNTY) (WA)	$165.52	$83.96
REST OF WASHINGTON (WA)	$149.15	$79.16
WISCONSIN (WI)	$136.40	$72.72
WEST VIRGINIA (WV)	$140.67	$82.91
WYOMING** (WY)	$144.02	$77.56

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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

Medicare's PFS amount is built from three Relative Value Units (RVUs) assigned to the 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, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility rates (e.g., office) typically include higher practice-expense RVUs than facility rates (e.g., hospital), because facility settings shift certain overhead costs to the facility itself. This is why the same code can have two different allowed amounts depending on place of service.

RVUs — work 1.74, practice expense 2.35 (non-facility) / 0.36 (facility), malpractice 0.3 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and locality-specific GPCI values can change the final paid amount.
Annual conversion factor updates and CMS budget-neutrality adjustments cause fee schedule amounts to change each year.
Always confirm the exact allowed amount and coverage 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 for this code?

The practice-expense RVU is lower in the facility setting because overhead costs (equipment, staff, supplies) are assumed to be borne by the facility rather than the billing physician, which lowers the total RVUs and the resulting allowed amount.

Does this fee schedule amount reflect what Medicare actually pays?

It reflects the allowed amount before patient cost-sharing. Medicare generally pays 80% of this amount after the deductible, with the patient or secondary insurance covering the rest, subject to any applicable modifiers or adjustments.

Why might my locality's amount differ from the national figure?

Local Geographic Practice Cost Indices (GPCIs) adjust the work, practice-expense, and malpractice RVUs to reflect regional cost differences, so the same code can be reimbursed differently across localities.

Will this amount change next year?

Yes. CMS updates the conversion factor and may revise RVUs annually, and budget-neutrality adjustments can shift amounts even if the code's RVUs stay the same.

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.