Medicare Reimbursement for CPT 11980

CPT 11980 is a procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-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)	$96.53	$48.43
ALASKA* (AK)	$115.77	$64.55
ALABAMA (AL)	$87.38	$45.30
ARKANSAS (AR)	$86.23	$44.92
ARIZONA (AZ)	$94.08	$47.47
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$119.91	$52.10
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$122.09	$52.74
OXNARD-THOUSAND OAKS-VENTURA (CA)	$105.79	$48.94
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$106.52	$49.62
NAPA (CA)	$114.05	$50.66
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$120.08	$52.27
VALLEJO (CA)	$113.81	$50.42
BAKERSFIELD (CA)	$100.60	$47.89
CHICO (CA)	$100.17	$47.45
FRESNO (CA)	$100.17	$47.45
HANFORD-CORCORAN (CA)	$100.17	$47.45
MADERA (CA)	$100.17	$47.45
MERCED (CA)	$100.17	$47.45
MODESTO (CA)	$100.17	$47.45
REDDING (CA)	$100.17	$47.45
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$101.79	$49.08
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$104.58	$48.65
SALINAS (CA)	$104.18	$48.44
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$122.79	$53.43
SANTA CRUZ-WATSONVILLE (CA)	$106.95	$48.51
SANTA ROSA-PETALUMA (CA)	$107.99	$48.93
STOCKTON (CA)	$100.17	$47.45
VISALIA (CA)	$100.17	$47.45
YUBA CITY (CA)	$100.17	$47.45
EL CENTRO (CA)	$100.19	$47.48
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$106.24	$48.71
SAN LUIS OBISPO-PASO ROBLES (CA)	$102.56	$47.78
SANTA MARIA-SANTA BARBARA (CA)	$104.46	$48.38
REST OF CALIFORNIA (CA)	$100.17	$47.45
COLORADO (CO)	$99.43	$48.25
CONNECTICUT (CT)	$102.59	$50.79
DC + MD/VA SUBURBS (DC)	$108.95	$52.29
DELAWARE (DE)	$95.53	$48.01
FORT LAUDERDALE (FL)	$101.30	$52.58
MIAMI (FL)	$106.48	$56.41
REST OF FLORIDA (FL)	$96.59	$50.61
ATLANTA (GA)	$98.54	$49.67
REST OF GEORGIA (GA)	$91.47	$48.56
HAWAII, GUAM (HI)	$102.06	$47.37
IOWA (IA)	$88.77	$44.76
IDAHO (ID)	$89.43	$45.18
EAST ST. LOUIS (IL)	$97.15	$52.90
SUBURBAN CHICAGO (IL)	$102.15	$52.76
CHICAGO (IL)	$103.55	$55.21
REST OF ILLINOIS (IL)	$94.50	$50.58
INDIANA (IN)	$89.88	$45.30
KANSAS (KS)	$88.69	$45.21
KENTUCKY (KY)	$89.91	$47.15
NEW ORLEANS (LA)	$93.92	$48.66
REST OF LOUISIANA (LA)	$89.90	$47.34
METROPOLITAN BOSTON (MA)	$108.26	$50.84
REST OF MASSACHUSETTS (MA)	$99.04	$48.39
BALTIMORE/SURR. CNTYS (MD)	$102.36	$50.75
REST OF MARYLAND (MD)	$97.14	$48.47
SOUTHERN MAINE (ME)	$94.18	$46.51
REST OF MAINE (ME)	$90.17	$45.92
DETROIT (MI)	$98.01	$51.60
REST OF MICHIGAN (MI)	$92.32	$48.41
MINNESOTA (MN)	$94.62	$45.13
METROPOLITAN ST. LOUIS (MO)	$93.86	$48.07
METROPOLITAN KANSAS CITY (MO)	$93.01	$47.85
REST OF MISSOURI (MO)	$88.70	$47.24
MISSISSIPPI (MS)	$87.47	$46.06
MONTANA** (MT)	$96.52	$48.42
NORTH CAROLINA (NC)	$90.98	$46.11
NORTH DAKOTA** (ND)	$93.55	$45.46
NEBRASKA (NE)	$89.12	$44.72
NEW HAMPSHIRE (NH)	$98.19	$48.12
NORTHERN NJ (NJ)	$108.05	$52.25
REST OF NEW JERSEY (NJ)	$103.58	$51.05
NEW MEXICO (NM)	$92.91	$48.80
NEVADA** (NV)	$95.75	$47.60
MANHATTAN (NY)	$110.79	$54.90
NYC SUBURBS/LONG ISLAND (NY)	$113.65	$56.46
POUGHKPSIE/N NYC SUBURBS (NY)	$104.49	$51.82
QUEENS (NY)	$111.18	$54.33
REST OF NEW YORK (NY)	$92.25	$46.56
OHIO (OH)	$91.72	$47.80
OKLAHOMA (OK)	$89.44	$46.49
PORTLAND (OR)	$102.01	$48.57
REST OF OREGON (OR)	$94.82	$46.91
METROPOLITAN PHILADELPHIA (PA)	$100.43	$50.36
REST OF PENNSYLVANIA (PA)	$91.68	$47.53
PUERTO RICO (PR)	$97.07	$48.44
RHODE ISLAND (RI)	$98.51	$48.82
SOUTH CAROLINA (SC)	$91.54	$47.10
SOUTH DAKOTA** (SD)	$93.20	$45.10
TENNESSEE (TN)	$89.13	$45.41
BRAZORIA (TX)	$95.21	$47.55
DALLAS (TX)	$95.92	$48.01
GALVESTON (TX)	$95.56	$47.80
HOUSTON (TX)	$98.31	$50.55
BEAUMONT (TX)	$91.15	$47.38
FORT WORTH (TX)	$95.42	$48.00
AUSTIN (TX)	$99.26	$48.38
REST OF TEXAS (TX)	$93.20	$47.55
UTAH (UT)	$92.67	$47.46
VIRGINIA (VA)	$94.11	$46.83
VIRGIN ISLANDS (VI)	$97.07	$48.44
VERMONT (VT)	$93.50	$45.88
SEATTLE (KING CNTY) (WA)	$110.06	$51.05
REST OF WASHINGTON (WA)	$98.75	$48.11
WISCONSIN (WI)	$90.72	$44.64
WEST VIRGINIA (WV)	$91.38	$49.58
WYOMING** (WY)	$95.23	$47.13

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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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility amounts differ because the practice-expense RVU is lower in facility settings, since the facility (not the billing physician) absorbs certain overhead costs. Work and malpractice RVUs generally remain the same across settings.

RVUs — work 1.07, practice expense 1.67 (non-facility) / 0.23 (facility), malpractice 0.15 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current-year rates and locality-specific figures 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 facility rate uses a lower practice-expense RVU because overhead costs (equipment, supplies, staff time) are borne by the facility rather than the billing provider, unlike in a non-facility (e.g., office) setting.

Does this amount reflect what Medicare will actually pay?

No. It is a calculated estimate based on national RVUs and the conversion factor. Actual payment depends on the patient's specific locality GPCIs, any modifiers applied, deductible status, and other adjustments.

Why do allowed amounts change each year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and applies budget-neutrality adjustments required by law, which can raise or lower the allowed amount from year to year.

Can I use this figure to predict my exact reimbursement?

Not precisely. Use it as a general reference; your Medicare Administrative Contractor's locality-specific fee schedule is the authoritative source for actual payment rates.

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.