Medicare Reimbursement for CPT 12001

CPT 12001 is a procedure code reported to Medicare for payment purposes; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both at the national level and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$113.90	$44.09
ALASKA* (AK)	$130.12	$55.78
ALABAMA (AL)	$101.23	$40.14
ARKANSAS (AR)	$99.63	$39.67
ARIZONA (AZ)	$110.54	$42.89
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$146.05	$47.62
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$148.86	$48.20
OXNARD-THOUSAND OAKS-VENTURA (CA)	$127.05	$44.53
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$127.73	$45.15
NAPA (CA)	$138.26	$46.26
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$146.25	$47.82
VALLEJO (CA)	$137.97	$45.96
BAKERSFIELD (CA)	$119.79	$43.28
CHICO (CA)	$119.30	$42.79
FRESNO (CA)	$119.30	$42.79
HANFORD-CORCORAN (CA)	$119.30	$42.79
MADERA (CA)	$119.30	$42.79
MERCED (CA)	$119.30	$42.79
MODESTO (CA)	$119.30	$42.79
REDDING (CA)	$119.30	$42.79
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$121.23	$44.72
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$125.21	$44.03
SALINAS (CA)	$124.76	$43.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$149.70	$49.04
SANTA CRUZ-WATSONVILLE (CA)	$128.99	$44.17
SANTA ROSA-PETALUMA (CA)	$130.28	$44.56
STOCKTON (CA)	$119.30	$42.79
VISALIA (CA)	$119.30	$42.79
YUBA CITY (CA)	$119.30	$42.79
EL CENTRO (CA)	$119.33	$42.82
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$127.74	$44.25
SAN LUIS OBISPO-PASO ROBLES (CA)	$122.76	$43.25
SANTA MARIA-SANTA BARBARA (CA)	$125.24	$43.84
REST OF CALIFORNIA (CA)	$119.30	$42.79
COLORADO (CO)	$118.06	$43.79
CONNECTICUT (CT)	$121.91	$46.72
DC + MD/VA SUBURBS (DC)	$130.38	$48.15
DELAWARE (DE)	$112.46	$43.49
FORT LAUDERDALE (FL)	$119.80	$49.09
MIAMI (FL)	$126.39	$53.72
REST OF FLORIDA (FL)	$113.38	$46.64
ATLANTA (GA)	$116.48	$45.55
REST OF GEORGIA (GA)	$106.36	$44.09
HAWAII, GUAM (HI)	$122.39	$43.02
IOWA (IA)	$103.43	$39.56
IDAHO (ID)	$104.29	$40.07
EAST ST. LOUIS (IL)	$113.55	$49.33
SUBURBAN CHICAGO (IL)	$120.90	$49.21
CHICAGO (IL)	$122.28	$52.12
REST OF ILLINOIS (IL)	$110.28	$46.54
INDIANA (IN)	$104.93	$40.22
KANSAS (KS)	$103.19	$40.08
KENTUCKY (KY)	$104.45	$42.39
NEW ORLEANS (LA)	$109.97	$44.28
REST OF LOUISIANA (LA)	$104.39	$42.61
METROPOLITAN BOSTON (MA)	$129.97	$46.62
REST OF MASSACHUSETTS (MA)	$117.38	$43.87
BALTIMORE/SURR. CNTYS (MD)	$121.64	$46.73
REST OF MARYLAND (MD)	$114.64	$44.00
SOUTHERN MAINE (ME)	$110.95	$41.77
REST OF MAINE (ME)	$105.18	$40.96
DETROIT (MI)	$115.20	$47.84
REST OF MICHIGAN (MI)	$107.67	$43.93
MINNESOTA (MN)	$112.00	$40.17
METROPOLITAN ST. LOUIS (MO)	$110.05	$43.59
METROPOLITAN KANSAS CITY (MO)	$108.85	$43.30
REST OF MISSOURI (MO)	$102.63	$42.46
MISSISSIPPI (MS)	$101.14	$41.03
MONTANA** (MT)	$113.89	$44.08
NORTH CAROLINA (NC)	$106.33	$41.20
NORTH DAKOTA** (ND)	$110.33	$40.52
NEBRASKA (NE)	$103.96	$39.53
NEW HAMPSHIRE (NH)	$116.45	$43.78
NORTHERN NJ (NJ)	$128.91	$47.93
REST OF NEW JERSEY (NJ)	$122.98	$46.75
NEW MEXICO (NM)	$108.42	$44.41
NEVADA** (NV)	$112.97	$43.10
MANHATTAN (NY)	$132.21	$51.10
NYC SUBURBS/LONG ISLAND (NY)	$136.02	$53.01
POUGHKPSIE/N NYC SUBURBS (NY)	$124.04	$47.60
QUEENS (NY)	$132.96	$50.44
REST OF NEW YORK (NY)	$108.09	$41.77
OHIO (OH)	$106.94	$43.21
OKLAHOMA (OK)	$103.94	$41.60
PORTLAND (OR)	$121.73	$44.17
REST OF OREGON (OR)	$111.79	$42.26
METROPOLITAN PHILADELPHIA (PA)	$118.85	$46.18
REST OF PENNSYLVANIA (PA)	$106.97	$42.88
PUERTO RICO (PR)	$114.69	$44.12
RHODE ISLAND (RI)	$116.42	$44.31
SOUTH CAROLINA (SC)	$106.88	$42.38
SOUTH DAKOTA** (SD)	$109.90	$40.10
TENNESSEE (TN)	$103.79	$40.33
BRAZORIA (TX)	$112.07	$42.89
DALLAS (TX)	$112.97	$43.44
GALVESTON (TX)	$112.52	$43.20
HOUSTON (TX)	$115.81	$46.49
BEAUMONT (TX)	$106.23	$42.70
FORT WORTH (TX)	$112.24	$43.41
AUSTIN (TX)	$117.94	$44.08
REST OF TEXAS (TX)	$109.21	$42.96
UTAH (UT)	$108.45	$42.83
VIRGINIA (VA)	$110.76	$42.14
VIRGIN ISLANDS (VI)	$114.69	$44.12
VERMONT (VT)	$110.12	$41.01
SEATTLE (KING CNTY) (WA)	$132.44	$46.78
REST OF WASHINGTON (WA)	$117.08	$43.57
WISCONSIN (WI)	$106.36	$39.48
WEST VIRGINIA (WV)	$105.94	$45.28
WYOMING** (WY)	$112.33	$42.53

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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 a 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 furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar-per-RVU figure set by CMS) to produce the allowed amount. Non-facility amounts use a higher practice-expense RVU because the billing physician's office bears overhead costs; facility amounts use a lower practice-expense RVU because the facility (e.g., hospital) absorbs those costs separately.

RVUs — work 0.82, practice expense 2.41 (non-facility) / 0.32 (facility), malpractice 0.18 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment can differ based on your specific Medicare Administrative Contractor (MAC) and locality.
Medicare typically pays 80% of the allowed amount after the patient's annual deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Conversion factors and RVUs are updated annually and can change mid-year due to legislative action.
Always verify current rates and policies with your MAC or the CMS PFS lookup tool before billing or appealing a denial.

Frequently asked

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

The facility rate uses a lower practice-expense RVU because overhead costs (equipment, supplies, staff time) are billed separately by the facility, whereas the non-facility rate assumes the physician's office absorbs those costs.

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

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust for regional differences in wages, rents, and malpractice costs, so the same code can pay differently across localities.

Does this amount reflect what Medicare will actually pay?

No — it's an estimate based on standard PFS inputs. Actual reimbursement depends on claim-specific factors such as modifiers, place of service, sequestration, and any budget-neutrality adjustments in effect for the year.

Where can I find the official descriptor for CPT 12001?

CPT code descriptors are copyrighted by the American Medical Association (AMA); consult your current CPT codebook or a licensed CPT reference for the official language.

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.