Medicare Reimbursement for CPT 12002

CPT 12002 is a procedure code used in Medicare billing; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$139.28	$57.45
ALASKA* (AK)	$160.34	$73.19
ALABAMA (AL)	$124.03	$52.43
ARKANSAS (AR)	$122.11	$51.82
ARIZONA (AZ)	$135.21	$55.91
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$176.81	$61.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$180.16	$62.16
OXNARD-THOUSAND OAKS-VENTURA (CA)	$154.44	$57.71
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$155.35	$58.54
NAPA (CA)	$167.63	$59.77
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$177.09	$61.70
VALLEJO (CA)	$167.23	$59.38
BAKERSFIELD (CA)	$145.89	$56.21
CHICO (CA)	$145.23	$55.55
FRESNO (CA)	$145.23	$55.55
HANFORD-CORCORAN (CA)	$145.23	$55.55
MADERA (CA)	$145.23	$55.55
MERCED (CA)	$145.23	$55.55
MODESTO (CA)	$145.23	$55.55
REDDING (CA)	$145.23	$55.55
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$147.81	$58.12
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$152.25	$57.08
SALINAS (CA)	$151.69	$56.84
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$181.27	$63.27
SANTA CRUZ-WATSONVILLE (CA)	$156.59	$57.17
SANTA ROSA-PETALUMA (CA)	$158.15	$57.66
STOCKTON (CA)	$145.23	$55.55
VISALIA (CA)	$145.23	$55.55
YUBA CITY (CA)	$145.23	$55.55
EL CENTRO (CA)	$145.27	$55.59
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$155.18	$57.31
SAN LUIS OBISPO-PASO ROBLES (CA)	$149.28	$56.08
SANTA MARIA-SANTA BARBARA (CA)	$152.24	$56.82
REST OF CALIFORNIA (CA)	$145.23	$55.55
COLORADO (CO)	$144.00	$56.93
CONNECTICUT (CT)	$148.96	$60.83
DC + MD/VA SUBURBS (DC)	$158.96	$62.56
DELAWARE (DE)	$137.53	$56.68
FORT LAUDERDALE (FL)	$146.98	$64.09
MIAMI (FL)	$155.40	$70.21
REST OF FLORIDA (FL)	$139.17	$60.94
ATLANTA (GA)	$142.51	$59.37
REST OF GEORGIA (GA)	$130.65	$57.65
HAWAII, GUAM (HI)	$148.81	$55.77
IOWA (IA)	$126.44	$51.57
IDAHO (ID)	$127.52	$52.24
EAST ST. LOUIS (IL)	$139.87	$64.59
SUBURBAN CHICAGO (IL)	$148.27	$64.23
CHICAGO (IL)	$150.39	$68.15
REST OF ILLINOIS (IL)	$135.60	$60.89
INDIANA (IN)	$128.29	$52.43
KANSAS (KS)	$126.26	$52.29
KENTUCKY (KY)	$128.15	$55.40
NEW ORLEANS (LA)	$134.81	$57.81
REST OF LOUISIANA (LA)	$128.11	$55.69
METROPOLITAN BOSTON (MA)	$158.19	$60.49
REST OF MASSACHUSETTS (MA)	$143.24	$57.07
BALTIMORE/SURR. CNTYS (MD)	$148.65	$60.84
REST OF MARYLAND (MD)	$140.13	$57.31
SOUTHERN MAINE (ME)	$135.48	$54.38
REST OF MAINE (ME)	$128.72	$53.43
DETROIT (MI)	$141.48	$62.52
REST OF MICHIGAN (MI)	$132.12	$57.41
MINNESOTA (MN)	$136.37	$52.16
METROPOLITAN ST. LOUIS (MO)	$134.78	$56.87
METROPOLITAN KANSAS CITY (MO)	$133.35	$56.51
REST OF MISSOURI (MO)	$126.08	$55.54
MISSISSIPPI (MS)	$124.10	$53.64
MONTANA** (MT)	$139.27	$57.43
NORTH CAROLINA (NC)	$130.08	$53.73
NORTH DAKOTA** (ND)	$134.52	$52.69
NEBRASKA (NE)	$127.04	$51.51
NEW HAMPSHIRE (NH)	$142.14	$56.95
NORTHERN NJ (NJ)	$157.23	$62.31
REST OF NEW JERSEY (NJ)	$150.21	$60.85
NEW MEXICO (NM)	$133.08	$58.04
NEVADA** (NV)	$138.04	$56.12
MANHATTAN (NY)	$161.61	$66.52
NYC SUBURBS/LONG ISLAND (NY)	$166.33	$69.03
POUGHKPSIE/N NYC SUBURBS (NY)	$151.58	$61.98
QUEENS (NY)	$162.34	$65.61
REST OF NEW YORK (NY)	$132.19	$54.45
OHIO (OH)	$131.15	$56.44
OKLAHOMA (OK)	$127.42	$54.34
PORTLAND (OR)	$148.28	$57.36
REST OF OREGON (OR)	$136.52	$55.02
METROPOLITAN PHILADELPHIA (PA)	$145.36	$60.17
REST OF PENNSYLVANIA (PA)	$131.12	$56.00
PUERTO RICO (PR)	$140.20	$57.47
RHODE ISLAND (RI)	$142.23	$57.70
SOUTH CAROLINA (SC)	$130.92	$55.31
SOUTH DAKOTA** (SD)	$133.96	$52.13
TENNESSEE (TN)	$127.00	$52.61
BRAZORIA (TX)	$136.97	$55.87
DALLAS (TX)	$138.10	$56.60
GALVESTON (TX)	$137.54	$56.28
HOUSTON (TX)	$141.93	$60.67
BEAUMONT (TX)	$130.24	$55.77
FORT WORTH (TX)	$137.26	$56.58
AUSTIN (TX)	$143.91	$57.33
REST OF TEXAS (TX)	$133.70	$56.04
UTAH (UT)	$132.81	$55.89
VIRGINIA (VA)	$135.32	$54.88
VIRGIN ISLANDS (VI)	$140.20	$57.47
VERMONT (VT)	$134.38	$53.37
SEATTLE (KING CNTY) (WA)	$161.05	$60.64
REST OF WASHINGTON (WA)	$142.84	$56.67
WISCONSIN (WI)	$129.78	$51.38
WEST VIRGINIA (WV)	$130.40	$59.29
WYOMING** (WY)	$137.20	$55.37

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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 payment for this procedure code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital outpatient) settings use different practice-expense RVUs, which is why the same code can have two different payment amounts depending on place of service.

RVUs — work 1.11, practice expense 2.82 (non-facility) / 0.37 (facility), malpractice 0.24 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only; actual Medicare payment may differ based on your specific locality and contractor.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify current rates with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does CPT 12002 pay differently in the office versus a hospital?

The practice-expense RVU component is lower in facility settings because the facility, rather than the physician's practice, bears certain overhead costs like staff and supplies. This results in a lower facility payment compared to non-facility.

Does this amount reflect what Medicare actually pays?

It reflects the Medicare-allowed amount before patient responsibility. Medicare generally reimburses 80% of this amount after the deductible, with the remaining 20% owed by the patient or secondary payer.

Will this amount change during the year?

The conversion factor and RVUs are typically set annually, but mid-year adjustments, sequestration, or budget-neutrality corrections can still affect the final payment.

Why isn't the CPT description shown?

CPT code descriptors are copyrighted by the American Medical Association (AMA) and cannot be republished without a license, so this page refers to the code generically.

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.