Medicare Reimbursement for CPT 12004

CPT 12004 is a procedure code reportable under Medicare Part B; the official AMA descriptor is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount at the national level and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$161.99	$72.15
ALASKA* (AK)	$187.20	$91.51
ALABAMA (AL)	$144.18	$65.57
ARKANSAS (AR)	$141.95	$64.78
ARIZONA (AZ)	$157.18	$70.11
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$202.83	$76.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$206.55	$76.99
OXNARD-THOUSAND OAKS-VENTURA (CA)	$178.11	$71.91
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$179.28	$72.99
NAPA (CA)	$192.66	$74.24
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$203.20	$76.51
VALLEJO (CA)	$192.12	$73.70
BAKERSFIELD (CA)	$168.58	$70.10
CHICO (CA)	$167.68	$69.21
FRESNO (CA)	$167.68	$69.21
HANFORD-CORCORAN (CA)	$167.68	$69.21
MADERA (CA)	$167.68	$69.21
MERCED (CA)	$167.68	$69.21
MODESTO (CA)	$167.68	$69.21
REDDING (CA)	$167.68	$69.21
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$171.22	$72.75
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$175.55	$71.06
SALINAS (CA)	$174.90	$70.76
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$208.08	$78.52
SANTA CRUZ-WATSONVILLE (CA)	$180.27	$71.10
SANTA ROSA-PETALUMA (CA)	$182.04	$71.71
STOCKTON (CA)	$167.68	$69.21
VISALIA (CA)	$167.68	$69.21
YUBA CITY (CA)	$167.68	$69.21
EL CENTRO (CA)	$167.73	$69.26
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$178.77	$71.32
SAN LUIS OBISPO-PASO ROBLES (CA)	$172.16	$69.82
SANTA MARIA-SANTA BARBARA (CA)	$175.49	$70.73
REST OF CALIFORNIA (CA)	$167.68	$69.21
COLORADO (CO)	$166.81	$71.21
CONNECTICUT (CT)	$173.27	$76.50
DC + MD/VA SUBURBS (DC)	$184.31	$78.47
DELAWARE (DE)	$159.86	$71.09
FORT LAUDERDALE (FL)	$172.26	$81.24
MIAMI (FL)	$183.12	$89.59
REST OF FLORIDA (FL)	$162.95	$77.06
ATLANTA (GA)	$166.02	$74.73
REST OF GEORGIA (GA)	$152.86	$72.71
HAWAII, GUAM (HI)	$171.63	$69.47
IOWA (IA)	$146.49	$64.28
IDAHO (ID)	$147.85	$65.19
EAST ST. LOUIS (IL)	$164.83	$82.17
SUBURBAN CHICAGO (IL)	$173.64	$81.37
CHICAGO (IL)	$177.12	$86.82
REST OF ILLINOIS (IL)	$159.13	$77.10
INDIANA (IN)	$148.72	$65.43
KANSAS (KS)	$146.52	$65.30
KENTUCKY (KY)	$149.49	$69.61
NEW ORLEANS (LA)	$157.34	$72.80
REST OF LOUISIANA (LA)	$149.55	$70.03
METROPOLITAN BOSTON (MA)	$182.92	$75.64
REST OF MASSACHUSETTS (MA)	$166.03	$71.42
BALTIMORE/SURR. CNTYS (MD)	$172.96	$76.55
REST OF MARYLAND (MD)	$162.81	$71.88
SOUTHERN MAINE (ME)	$156.99	$67.95
REST OF MAINE (ME)	$149.49	$66.83
DETROIT (MI)	$165.91	$79.20
REST OF MICHIGAN (MI)	$154.35	$72.32
MINNESOTA (MN)	$157.26	$64.80
METROPOLITAN ST. LOUIS (MO)	$157.01	$71.48
METROPOLITAN KANSAS CITY (MO)	$155.38	$71.02
REST OF MISSOURI (MO)	$147.33	$69.88
MISSISSIPPI (MS)	$144.63	$67.27
MONTANA** (MT)	$161.97	$72.12
NORTH CAROLINA (NC)	$151.03	$67.20
NORTH DAKOTA** (ND)	$155.45	$65.60
NEBRASKA (NE)	$147.11	$64.18
NEW HAMPSHIRE (NH)	$164.89	$71.36
NORTHERN NJ (NJ)	$182.36	$78.14
REST OF NEW JERSEY (NJ)	$174.52	$76.41
NEW MEXICO (NM)	$155.56	$73.17
NEVADA** (NV)	$160.26	$70.32
MANHATTAN (NY)	$188.33	$83.92
NYC SUBURBS/LONG ISLAND (NY)	$194.13	$87.30
POUGHKPSIE/N NYC SUBURBS (NY)	$176.31	$77.93
QUEENS (NY)	$188.83	$82.62
REST OF NEW YORK (NY)	$153.51	$68.15
OHIO (OH)	$153.02	$70.98
OKLAHOMA (OK)	$148.39	$68.15
PORTLAND (OR)	$171.49	$71.67
REST OF OREGON (OR)	$158.30	$68.81
METROPOLITAN PHILADELPHIA (PA)	$169.24	$75.70
REST OF PENNSYLVANIA (PA)	$152.84	$70.36
PUERTO RICO (PR)	$162.98	$72.14
RHODE ISLAND (RI)	$165.13	$72.32
SOUTH CAROLINA (SC)	$152.42	$69.40
SOUTH DAKOTA** (SD)	$154.68	$64.83
TENNESSEE (TN)	$147.41	$65.74
BRAZORIA (TX)	$159.01	$69.97
DALLAS (TX)	$160.43	$70.94
GALVESTON (TX)	$159.74	$70.52
HOUSTON (TX)	$165.78	$76.56
BEAUMONT (TX)	$151.83	$70.07
FORT WORTH (TX)	$159.53	$70.94
AUSTIN (TX)	$166.88	$71.82
REST OF TEXAS (TX)	$155.61	$70.34
UTAH (UT)	$154.62	$70.16
VIRGINIA (VA)	$156.98	$68.66
VIRGIN ISLANDS (VI)	$162.98	$72.14
VERMONT (VT)	$155.51	$66.56
SEATTLE (KING CNTY) (WA)	$185.97	$75.73
REST OF WASHINGTON (WA)	$165.49	$70.88
WISCONSIN (WI)	$149.99	$63.92
WEST VIRGINIA (WV)	$153.09	$75.02
WYOMING** (WY)	$159.13	$69.28

Look up another code or locality →

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) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility amounts differ primarily because the practice-expense RVU is lower when the service is performed in a facility, since the facility itself bears certain overhead costs.

RVUs — work 1.4, practice expense 3.12 (non-facility) / 0.43 (facility), malpractice 0.33 — × 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 patient meets the Part B deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality changes to RVUs or the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

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 like staff, supplies, and equipment are assumed to be covered separately by the facility rather than the billing physician.

Does this amount apply in every state or region?

No. The national figure is a baseline; actual payment is adjusted using locality-specific GPICs, so the real allowed amount can be higher or lower depending on where the service is performed.

Will the patient owe the full difference between billed and allowed amounts?

Participating providers generally must accept the Medicare allowed amount as payment in full (after coinsurance and deductible), though non-participating providers may have different billing limits.

Why might the amount change next year?

RVUs, GPCIs, and the conversion factor are updated annually and can shift due to CMS rulemaking, including budget-neutrality adjustments across the fee schedule.

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.