Medicare Reimbursement for CPT 12006

This page covers CPT code 12006, a procedure code defined by the American Medical Association. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, and distinguishes between non-facility (e.g., office) and facility (e.g., hospital) payment settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$240.15	$109.22
ALASKA* (AK)	$280.86	$141.42
ALABAMA (AL)	$214.60	$100.03
ARKANSAS (AR)	$211.40	$98.93
ARIZONA (AZ)	$233.20	$106.32
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$297.32	$112.71
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$302.66	$113.86
OXNARD-THOUSAND OAKS-VENTURA (CA)	$262.35	$107.59
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$264.21	$109.32
NAPA (CA)	$282.88	$110.31
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$297.90	$113.29
VALLEJO (CA)	$282.04	$109.48
BAKERSFIELD (CA)	$248.92	$105.42
CHICO (CA)	$247.52	$104.02
FRESNO (CA)	$247.52	$104.02
HANFORD-CORCORAN (CA)	$247.52	$104.02
MADERA (CA)	$247.52	$104.02
MERCED (CA)	$247.52	$104.02
MODESTO (CA)	$247.52	$104.02
REDDING (CA)	$247.52	$104.02
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$253.00	$109.50
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$258.73	$106.46
SALINAS (CA)	$257.76	$106.01
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$305.03	$116.23
SANTA CRUZ-WATSONVILLE (CA)	$265.12	$106.04
SANTA ROSA-PETALUMA (CA)	$267.71	$106.93
STOCKTON (CA)	$247.52	$104.02
VISALIA (CA)	$247.52	$104.02
YUBA CITY (CA)	$247.52	$104.02
EL CENTRO (CA)	$247.60	$104.10
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$263.16	$106.57
SAN LUIS OBISPO-PASO ROBLES (CA)	$253.77	$104.64
SANTA MARIA-SANTA BARBARA (CA)	$258.55	$105.88
REST OF CALIFORNIA (CA)	$247.52	$104.02
COLORADO (CO)	$246.65	$107.34
CONNECTICUT (CT)	$256.47	$115.46
DC + MD/VA SUBURBS (DC)	$272.14	$117.90
DELAWARE (DE)	$237.08	$107.72
FORT LAUDERDALE (FL)	$255.81	$123.17
MIAMI (FL)	$272.16	$135.86
REST OF FLORIDA (FL)	$242.33	$117.16
ATLANTA (GA)	$246.13	$113.11
REST OF GEORGIA (GA)	$227.73	$110.94
HAWAII, GUAM (HI)	$252.89	$104.02
IOWA (IA)	$217.53	$97.73
IDAHO (ID)	$219.55	$99.09
EAST ST. LOUIS (IL)	$245.80	$125.34
SUBURBAN CHICAGO (IL)	$257.77	$123.30
CHICAGO (IL)	$263.48	$131.90
REST OF ILLINOIS (IL)	$237.10	$117.56
INDIANA (IN)	$220.79	$99.42
KANSAS (KS)	$217.76	$99.39
KENTUCKY (KY)	$222.58	$106.18
NEW ORLEANS (LA)	$233.90	$110.69
REST OF LOUISIANA (LA)	$222.73	$106.85
METROPOLITAN BOSTON (MA)	$269.66	$113.32
REST OF MASSACHUSETTS (MA)	$245.64	$107.77
BALTIMORE/SURR. CNTYS (MD)	$256.04	$115.55
REST OF MARYLAND (MD)	$241.28	$108.77
SOUTHERN MAINE (ME)	$232.56	$102.81
REST OF MAINE (ME)	$222.09	$101.63
DETROIT (MI)	$246.75	$120.40
REST OF MICHIGAN (MI)	$229.71	$110.17
MINNESOTA (MN)	$232.37	$97.65
METROPOLITAN ST. LOUIS (MO)	$233.21	$108.57
METROPOLITAN KANSAS CITY (MO)	$230.90	$107.95
REST OF MISSOURI (MO)	$219.66	$106.80
MISSISSIPPI (MS)	$215.51	$102.78
MONTANA** (MT)	$240.12	$109.19
NORTH CAROLINA (NC)	$224.27	$102.11
NORTH DAKOTA** (ND)	$230.03	$99.10
NEBRASKA (NE)	$218.37	$97.52
NEW HAMPSHIRE (NH)	$243.98	$107.68
NORTHERN NJ (NJ)	$269.46	$117.58
REST OF NEW JERSEY (NJ)	$258.28	$115.31
NEW MEXICO (NM)	$231.52	$111.45
NEVADA** (NV)	$237.45	$106.39
MANHATTAN (NY)	$278.65	$126.51
NYC SUBURBS/LONG ISLAND (NY)	$287.19	$131.51
POUGHKPSIE/N NYC SUBURBS (NY)	$261.03	$117.66
QUEENS (NY)	$279.11	$124.34
REST OF NEW YORK (NY)	$227.83	$103.44
OHIO (OH)	$227.65	$108.11
OKLAHOMA (OK)	$220.81	$103.89
PORTLAND (OR)	$253.16	$107.70
REST OF OREGON (OR)	$234.51	$104.10
METROPOLITAN PHILADELPHIA (PA)	$250.80	$114.50
REST OF PENNSYLVANIA (PA)	$227.30	$107.11
PUERTO RICO (PR)	$241.50	$109.12
RHODE ISLAND (RI)	$244.59	$109.33
SOUTH CAROLINA (SC)	$226.55	$105.57
SOUTH DAKOTA** (SD)	$228.84	$97.91
TENNESSEE (TN)	$219.04	$100.03
BRAZORIA (TX)	$235.72	$105.97
DALLAS (TX)	$237.85	$107.45
GALVESTON (TX)	$236.83	$106.81
HOUSTON (TX)	$246.16	$116.15
BEAUMONT (TX)	$225.87	$106.72
FORT WORTH (TX)	$236.62	$107.52
AUSTIN (TX)	$246.79	$108.27
REST OF TEXAS (TX)	$231.09	$106.84
UTAH (UT)	$229.70	$106.62
VIRGINIA (VA)	$232.67	$103.97
VIRGIN ISLANDS (VI)	$241.50	$109.12
VERMONT (VT)	$230.28	$100.66
SEATTLE (KING CNTY) (WA)	$273.91	$113.26
REST OF WASHINGTON (WA)	$244.79	$106.92
WISCONSIN (WI)	$222.26	$96.83
WEST VIRGINIA (WV)	$228.46	$114.68
WYOMING** (WY)	$235.72	$104.79

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 payment is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. 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. Practice expense RVUs differ between non-facility and facility settings because facilities (like hospitals) bear some overhead costs separately, which generally results in a lower facility-based payment for the same code.

RVUs — work 2.33, practice expense 4.35 (non-facility) / 0.43 (facility), malpractice 0.51 — × 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 annual Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claims processing adjustments, and sequestration.
Annual updates to RVUs, GPCIs, and the conversion factor, as well as budget-neutrality adjustments, can change this amount from year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility payment lower than the non-facility payment for this code?

In the facility setting, the facility itself (e.g., hospital) incurs many of the practice expense costs, so the practice expense RVU assigned to the billing provider is lower than when the service is performed in a non-facility setting like a private office.

Does this amount reflect what Medicare will actually pay?

No. It's an estimate based on the standard PFS formula. Final payment depends on the beneficiary's deductible status, applicable modifiers, the specific locality, and other claims processing factors.

Why do amounts differ by locality?

Medicare adjusts payment using Geographic Practice Cost Indices (GPCIs), which account for regional differences in the cost of labor, rent, and malpractice insurance.

Will this amount change next year?

Yes, potentially. The conversion factor, RVUs, and GPCIs are reviewed and updated annually by CMS, and budget-neutrality requirements can shift overall payment levels.

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.