Medicare Reimbursement for CPT 12005

CPT 12005 is a procedure code billed under Medicare Part B; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$211.09	$89.85
ALASKA* (AK)	$245.33	$116.20
ALABAMA (AL)	$188.29	$82.20
ARKANSAS (AR)	$185.43	$81.28
ARIZONA (AZ)	$204.91	$87.43
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$263.29	$92.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$268.10	$93.26
OXNARD-THOUSAND OAKS-VENTURA (CA)	$231.61	$88.30
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$233.16	$89.73
NAPA (CA)	$250.23	$90.43
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$263.78	$92.83
VALLEJO (CA)	$249.53	$89.73
BAKERSFIELD (CA)	$219.43	$86.54
CHICO (CA)	$218.25	$85.36
FRESNO (CA)	$218.25	$85.36
HANFORD-CORCORAN (CA)	$218.25	$85.36
MADERA (CA)	$218.25	$85.36
MERCED (CA)	$218.25	$85.36
MODESTO (CA)	$218.25	$85.36
REDDING (CA)	$218.25	$85.36
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$222.87	$89.98
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$228.35	$87.34
SALINAS (CA)	$227.50	$86.98
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$270.09	$95.26
SANTA CRUZ-WATSONVILLE (CA)	$234.29	$86.97
SANTA ROSA-PETALUMA (CA)	$236.59	$87.70
STOCKTON (CA)	$218.25	$85.36
VISALIA (CA)	$218.25	$85.36
YUBA CITY (CA)	$218.25	$85.36
EL CENTRO (CA)	$218.32	$85.44
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$232.43	$87.42
SAN LUIS OBISPO-PASO ROBLES (CA)	$223.95	$85.85
SANTA MARIA-SANTA BARBARA (CA)	$228.24	$86.87
REST OF CALIFORNIA (CA)	$218.25	$85.36
COLORADO (CO)	$217.20	$88.20
CONNECTICUT (CT)	$225.60	$95.02
DC + MD/VA SUBURBS (DC)	$239.78	$96.96
DELAWARE (DE)	$208.37	$88.58
FORT LAUDERDALE (FL)	$224.42	$101.60
MIAMI (FL)	$238.49	$112.27
REST OF FLORIDA (FL)	$212.48	$96.57
ATLANTA (GA)	$216.29	$93.11
REST OF GEORGIA (GA)	$199.53	$91.38
HAWAII, GUAM (HI)	$223.21	$85.36
IOWA (IA)	$191.16	$80.22
IDAHO (ID)	$192.92	$81.37
EAST ST. LOUIS (IL)	$215.05	$103.50
SUBURBAN CHICAGO (IL)	$226.21	$101.69
CHICAGO (IL)	$230.80	$108.95
REST OF ILLINOIS (IL)	$207.64	$96.95
INDIANA (IN)	$194.03	$81.64
KANSAS (KS)	$191.24	$81.63
KENTUCKY (KY)	$195.15	$87.37
NEW ORLEANS (LA)	$205.22	$91.13
REST OF LOUISIANA (LA)	$195.24	$87.94
METROPOLITAN BOSTON (MA)	$237.87	$93.10
REST OF MASSACHUSETTS (MA)	$216.23	$88.56
BALTIMORE/SURR. CNTYS (MD)	$225.20	$95.11
REST OF MARYLAND (MD)	$212.15	$89.45
SOUTHERN MAINE (ME)	$204.60	$84.45
REST OF MAINE (ME)	$195.06	$83.51
DETROIT (MI)	$216.31	$99.30
REST OF MICHIGAN (MI)	$201.41	$90.71
MINNESOTA (MN)	$204.83	$80.07
METROPOLITAN ST. LOUIS (MO)	$204.76	$89.33
METROPOLITAN KANSAS CITY (MO)	$202.67	$88.83
REST OF MISSOURI (MO)	$192.42	$87.91
MISSISSIPPI (MS)	$188.91	$84.52
MONTANA** (MT)	$211.06	$89.82
NORTH CAROLINA (NC)	$197.02	$83.90
NORTH DAKOTA** (ND)	$202.56	$81.32
NEBRASKA (NE)	$191.95	$80.04
NEW HAMPSHIRE (NH)	$214.74	$88.52
NORTHERN NJ (NJ)	$237.33	$96.68
REST OF NEW JERSEY (NJ)	$227.25	$94.85
NEW MEXICO (NM)	$202.97	$91.79
NEVADA** (NV)	$208.83	$87.46
MANHATTAN (NY)	$245.10	$104.21
NYC SUBURBS/LONG ISLAND (NY)	$252.57	$108.41
POUGHKPSIE/N NYC SUBURBS (NY)	$229.59	$96.83
QUEENS (NY)	$245.68	$102.37
REST OF NEW YORK (NY)	$200.20	$85.01
OHIO (OH)	$199.67	$88.98
OKLAHOMA (OK)	$193.70	$85.43
PORTLAND (OR)	$223.16	$88.46
REST OF OREGON (OR)	$206.30	$85.54
METROPOLITAN PHILADELPHIA (PA)	$220.46	$94.24
REST OF PENNSYLVANIA (PA)	$199.43	$88.13
PUERTO RICO (PR)	$212.34	$89.76
RHODE ISLAND (RI)	$215.14	$89.89
SOUTH CAROLINA (SC)	$198.86	$86.83
SOUTH DAKOTA** (SD)	$201.56	$80.31
TENNESSEE (TN)	$192.38	$82.17
BRAZORIA (TX)	$207.25	$87.10
DALLAS (TX)	$209.10	$88.34
GALVESTON (TX)	$208.21	$87.81
HOUSTON (TX)	$216.08	$95.68
BEAUMONT (TX)	$198.14	$87.81
FORT WORTH (TX)	$207.96	$88.41
AUSTIN (TX)	$217.28	$89.00
REST OF TEXAS (TX)	$202.94	$87.88
UTAH (UT)	$201.67	$87.70
VIRGINIA (VA)	$204.62	$85.43
VIRGIN ISLANDS (VI)	$212.34	$89.76
VERMONT (VT)	$202.67	$82.64
SEATTLE (KING CNTY) (WA)	$241.77	$93.00
REST OF WASHINGTON (WA)	$215.52	$87.85
WISCONSIN (WI)	$195.59	$79.43
WEST VIRGINIA (WV)	$199.91	$94.55
WYOMING** (WY)	$207.36	$86.11

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 PFS amounts are 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 Index (GPCI) for the specific locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ depending on whether the service is reported in a non-facility setting (e.g., physician office) or a facility setting (e.g., hospital outpatient), which is why two different allowed amounts are shown. These figures are recalculated each year as RVUs, GPCIs, and the conversion factor are updated.

RVUs — work 1.92, practice expense 3.97 (non-facility) / 0.34 (facility), malpractice 0.43 — × 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 Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality adjustments.
Confirm final allowed amounts and coverage rules 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 for this code?

The two settings use different practice-expense RVUs, reflecting that overhead costs (staff, supplies, equipment) are billed separately by the facility when the service is performed in a hospital or other facility setting, versus being included in the physician's payment in a non-facility setting.

Does this amount reflect what my specific locality will be paid?

The national figure is a baseline; the locality-specific figure on this page applies the GPCI adjustments for that area. Actual contractor pricing may vary slightly due to rounding, add-on policies, or local coverage determinations.

Why might the fee schedule amount change year to year for the same code?

RVUs, GPCIs, and the conversion factor are reviewed and updated annually by CMS, often as part of budget-neutrality adjustments across the fee schedule, so the allowed amount can shift even if the code itself is unchanged.

Can I use this figure to predict my exact Medicare payment?

No — it's an estimate based on standard PFS inputs. Modifiers, multiple-procedure reductions, sequestration, and MAC-specific pricing rules can all change the final reimbursed amount.

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.