Medicare Reimbursement for CPT Code 11981

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) reimbursed under the Medicare Physician Fee Schedule. It shows the national Medicare-allowed amount for 2026, along with how that amount differs between non-facility (e.g., office) and facility (e.g., hospital) settings. Actual payment in a specific locality will differ based on local wage-index adjustments.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$107.55	$54.78
ALASKA* (AK)	$127.06	$70.86
ALABAMA (AL)	$96.57	$50.40
ARKANSAS (AR)	$95.20	$49.87
ARIZONA (AZ)	$104.57	$53.44
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$133.06	$58.65
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$135.45	$59.35
OXNARD-THOUSAND OAKS-VENTURA (CA)	$117.49	$55.12
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$118.33	$55.90
NAPA (CA)	$126.62	$57.06
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$133.30	$58.89
VALLEJO (CA)	$126.27	$56.72
BAKERSFIELD (CA)	$111.61	$53.77
CHICO (CA)	$111.02	$53.18
FRESNO (CA)	$111.02	$53.18
HANFORD-CORCORAN (CA)	$111.02	$53.18
MADERA (CA)	$111.02	$53.18
MERCED (CA)	$111.02	$53.18
MODESTO (CA)	$111.02	$53.18
REDDING (CA)	$111.02	$53.18
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$113.28	$55.44
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$115.98	$54.60
SALINAS (CA)	$115.54	$54.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$136.42	$60.33
SANTA CRUZ-WATSONVILLE (CA)	$118.72	$54.60
SANTA ROSA-PETALUMA (CA)	$119.88	$55.07
STOCKTON (CA)	$111.02	$53.18
VISALIA (CA)	$111.02	$53.18
YUBA CITY (CA)	$111.02	$53.18
EL CENTRO (CA)	$111.05	$53.21
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$117.89	$54.77
SAN LUIS OBISPO-PASO ROBLES (CA)	$113.75	$53.64
SANTA MARIA-SANTA BARBARA (CA)	$115.87	$54.34
REST OF CALIFORNIA (CA)	$111.02	$53.18
COLORADO (CO)	$110.52	$54.37
CONNECTICUT (CT)	$114.65	$57.81
DC + MD/VA SUBURBS (DC)	$121.64	$59.47
DELAWARE (DE)	$106.27	$54.13
FORT LAUDERDALE (FL)	$114.04	$60.58
MIAMI (FL)	$120.88	$65.94
REST OF FLORIDA (FL)	$108.29	$57.84
ATLANTA (GA)	$110.09	$56.47
REST OF GEORGIA (GA)	$102.04	$54.97
HAWAII, GUAM (HI)	$113.29	$53.29
IOWA (IA)	$97.93	$49.64
IDAHO (ID)	$98.78	$50.23
EAST ST. LOUIS (IL)	$109.59	$61.03
SUBURBAN CHICAGO (IL)	$114.94	$60.74
CHICAGO (IL)	$117.21	$64.17
REST OF ILLINOIS (IL)	$105.98	$57.80
INDIANA (IN)	$99.31	$50.39
KANSAS (KS)	$97.98	$50.27
KENTUCKY (KY)	$99.91	$52.99
NEW ORLEANS (LA)	$104.76	$55.10
REST OF LOUISIANA (LA)	$99.96	$53.25
METROPOLITAN BOSTON (MA)	$120.61	$57.60
REST OF MASSACHUSETTS (MA)	$110.08	$54.51
BALTIMORE/SURR. CNTYS (MD)	$114.44	$57.81
REST OF MARYLAND (MD)	$108.11	$54.70
SOUTHERN MAINE (ME)	$104.39	$52.09
REST OF MAINE (ME)	$99.82	$51.27
DETROIT (MI)	$110.14	$59.22
REST OF MICHIGAN (MI)	$102.93	$54.75
MINNESOTA (MN)	$104.45	$50.15
METROPOLITAN ST. LOUIS (MO)	$104.52	$54.28
METROPOLITAN KANSAS CITY (MO)	$103.52	$53.96
REST OF MISSOURI (MO)	$98.61	$53.12
MISSISSIPPI (MS)	$96.90	$51.46
MONTANA** (MT)	$107.54	$54.76
NORTH CAROLINA (NC)	$100.77	$51.53
NORTH DAKOTA** (ND)	$103.38	$50.61
NEBRASKA (NE)	$98.30	$49.59
NEW HAMPSHIRE (NH)	$109.28	$54.34
NORTHERN NJ (NJ)	$120.52	$59.30
REST OF NEW JERSEY (NJ)	$115.55	$57.92
NEW MEXICO (NM)	$103.69	$55.30
NEVADA** (NV)	$106.44	$53.62
MANHATTAN (NY)	$124.31	$62.99
NYC SUBURBS/LONG ISLAND (NY)	$127.93	$65.18
POUGHKPSIE/N NYC SUBURBS (NY)	$116.72	$58.93
QUEENS (NY)	$124.57	$62.20
REST OF NEW YORK (NY)	$102.29	$52.16
OHIO (OH)	$102.09	$53.90
OKLAHOMA (OK)	$99.20	$52.07
PORTLAND (OR)	$113.39	$54.76
REST OF OREGON (OR)	$105.21	$52.65
METROPOLITAN PHILADELPHIA (PA)	$112.17	$57.24
REST OF PENNSYLVANIA (PA)	$101.96	$53.52
PUERTO RICO (PR)	$108.14	$54.79
RHODE ISLAND (RI)	$109.59	$55.08
SOUTH CAROLINA (SC)	$101.68	$52.91
SOUTH DAKOTA** (SD)	$102.89	$50.12
TENNESSEE (TN)	$98.53	$50.56
BRAZORIA (TX)	$105.73	$53.43
DALLAS (TX)	$106.63	$54.07
GALVESTON (TX)	$106.20	$53.79
HOUSTON (TX)	$110.04	$57.64
BEAUMONT (TX)	$101.34	$53.32
FORT WORTH (TX)	$106.09	$54.06
AUSTIN (TX)	$110.51	$54.67
REST OF TEXAS (TX)	$103.63	$53.55
UTAH (UT)	$103.03	$53.42
VIRGINIA (VA)	$104.41	$52.53
VIRGIN ISLANDS (VI)	$108.14	$54.79
VERMONT (VT)	$103.45	$51.21
SEATTLE (KING CNTY) (WA)	$122.53	$57.77
REST OF WASHINGTON (WA)	$109.72	$54.15
WISCONSIN (WI)	$100.03	$49.47
WEST VIRGINIA (WV)	$102.26	$56.40
WYOMING** (WY)	$105.73	$52.95

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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: 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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs): 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 furnished, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs are typically higher in the non-facility setting (reflecting office overhead) and lower in the facility setting (where the facility itself bears more of the overhead cost), which is why non-facility and facility allowed amounts differ for the same code.

RVUs — work 1.11, practice expense 1.9 (non-facility) / 0.32 (facility), malpractice 0.21 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national unadjusted or locality-adjusted RVUs and the current conversion factor — it is not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the patient or secondary insurance is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the amount shown nationally may not match what a specific Medicare Administrative Contractor (MAC) pays in your area.
Always verify final payment determinations with your local MAC before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount for this code?

The practice-expense RVU component is different depending on setting, since non-facility (e.g., office) claims include overhead costs that facility claims do not, as those costs are instead billed separately by the facility.

Is this the exact amount my practice will be paid?

No. The figure is a national estimate calculated from standard RVUs, GPCIs, and the conversion factor. Actual payment depends on your specific locality, any modifiers applied, and current claims-processing adjustments.

Why isn't the CPT code description shown?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page cannot display or reproduce the official descriptor text.

Does this amount include the patient's share?

No. The Medicare Physician Fee Schedule allowed amount reflects the total approved payment; Medicare generally covers 80% after the deductible, with the remaining 20% typically owed by the patient or a secondary payer.

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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.