Medicare Reimbursement for CPT 12007

CPT 12007 is a procedure code billed under Medicare Part B; the exact clinical description 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, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$255.85	$133.94
ALASKA* (AK)	$302.96	$173.12
ALABAMA (AL)	$229.29	$122.61
ARKANSAS (AR)	$225.98	$121.26
ARIZONA (AZ)	$248.51	$130.38
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$310.58	$138.68
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$315.91	$140.12
OXNARD-THOUSAND OAKS-VENTURA (CA)	$276.28	$132.18
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$278.50	$134.28
NAPA (CA)	$296.33	$135.65
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$311.28	$139.38
VALLEJO (CA)	$295.32	$134.64
BAKERSFIELD (CA)	$263.05	$129.43
CHICO (CA)	$261.35	$127.73
FRESNO (CA)	$261.35	$127.73
HANFORD-CORCORAN (CA)	$261.35	$127.73
MADERA (CA)	$261.35	$127.73
MERCED (CA)	$261.35	$127.73
MODESTO (CA)	$261.35	$127.73
REDDING (CA)	$261.35	$127.73
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$268.01	$134.39
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$272.57	$130.78
SALINAS (CA)	$271.53	$130.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$318.79	$142.99
SANTA CRUZ-WATSONVILLE (CA)	$278.46	$130.34
SANTA ROSA-PETALUMA (CA)	$281.14	$131.43
STOCKTON (CA)	$261.35	$127.73
VISALIA (CA)	$261.35	$127.73
YUBA CITY (CA)	$261.35	$127.73
EL CENTRO (CA)	$261.45	$127.83
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$276.76	$130.95
SAN LUIS OBISPO-PASO ROBLES (CA)	$267.39	$128.54
SANTA MARIA-SANTA BARBARA (CA)	$272.23	$130.08
REST OF CALIFORNIA (CA)	$261.35	$127.73
COLORADO (CO)	$261.45	$131.73
CONNECTICUT (CT)	$272.92	$141.62
DC + MD/VA SUBURBS (DC)	$288.33	$144.71
DELAWARE (DE)	$252.54	$132.09
FORT LAUDERDALE (FL)	$274.41	$150.91
MIAMI (FL)	$293.28	$166.37
REST OF FLORIDA (FL)	$260.08	$143.53
ATLANTA (GA)	$262.55	$138.68
REST OF GEORGIA (GA)	$244.64	$135.89
HAWAII, GUAM (HI)	$266.40	$127.78
IOWA (IA)	$231.41	$119.86
IDAHO (ID)	$233.69	$121.53
EAST ST. LOUIS (IL)	$265.60	$153.44
SUBURBAN CHICAGO (IL)	$276.30	$151.09
CHICAGO (IL)	$284.03	$161.51
REST OF ILLINOIS (IL)	$255.28	$143.97
INDIANA (IN)	$234.94	$121.93
KANSAS (KS)	$232.08	$121.87
KENTUCKY (KY)	$238.48	$130.10
NEW ORLEANS (LA)	$250.37	$135.65
REST OF LOUISIANA (LA)	$238.81	$130.92
METROPOLITAN BOSTON (MA)	$284.73	$139.16
REST OF MASSACHUSETTS (MA)	$260.61	$132.24
BALTIMORE/SURR. CNTYS (MD)	$272.54	$141.72
REST OF MARYLAND (MD)	$256.79	$133.41
SOUTHERN MAINE (ME)	$246.94	$126.13
REST OF MAINE (ME)	$236.77	$124.61
DETROIT (MI)	$265.14	$147.49
REST OF MICHIGAN (MI)	$246.29	$134.98
MINNESOTA (MN)	$245.35	$119.90
METROPOLITAN ST. LOUIS (MO)	$249.14	$133.08
METROPOLITAN KANSAS CITY (MO)	$246.80	$132.32
REST OF MISSOURI (MO)	$235.91	$130.82
MISSISSIPPI (MS)	$230.90	$125.93
MONTANA** (MT)	$255.81	$133.90
NORTH CAROLINA (NC)	$238.95	$125.21
NORTH DAKOTA** (ND)	$243.55	$121.64
NEBRASKA (NE)	$232.14	$119.62
NEW HAMPSHIRE (NH)	$259.03	$132.12
NORTHERN NJ (NJ)	$285.71	$144.29
REST OF NEW JERSEY (NJ)	$274.58	$141.45
NEW MEXICO (NM)	$248.34	$136.55
NEVADA** (NV)	$252.53	$130.50
MANHATTAN (NY)	$296.82	$155.15
NYC SUBURBS/LONG ISLAND (NY)	$306.22	$161.27
POUGHKPSIE/N NYC SUBURBS (NY)	$277.81	$144.32
QUEENS (NY)	$296.65	$152.54
REST OF NEW YORK (NY)	$242.67	$126.85
OHIO (OH)	$243.78	$132.48
OKLAHOMA (OK)	$236.19	$127.32
PORTLAND (OR)	$267.67	$132.22
REST OF OREGON (OR)	$249.14	$127.71
METROPOLITAN PHILADELPHIA (PA)	$267.31	$140.40
REST OF PENNSYLVANIA (PA)	$243.18	$131.26
PUERTO RICO (PR)	$257.09	$133.83
RHODE ISLAND (RI)	$260.05	$134.11
SOUTH CAROLINA (SC)	$242.06	$129.41
SOUTH DAKOTA** (SD)	$242.10	$120.19
TENNESSEE (TN)	$233.47	$122.65
BRAZORIA (TX)	$250.79	$129.97
DALLAS (TX)	$253.20	$131.77
GALVESTON (TX)	$252.06	$131.00
HOUSTON (TX)	$263.41	$142.35
BEAUMONT (TX)	$241.72	$130.78
FORT WORTH (TX)	$252.06	$131.86
AUSTIN (TX)	$261.83	$132.85
REST OF TEXAS (TX)	$246.67	$130.97
UTAH (UT)	$245.30	$130.70
VIRGINIA (VA)	$247.37	$127.53
VIRGIN ISLANDS (VI)	$257.09	$133.83
VERMONT (VT)	$244.21	$123.52
SEATTLE (KING CNTY) (WA)	$288.71	$139.12
REST OF WASHINGTON (WA)	$259.58	$131.21
WISCONSIN (WI)	$235.61	$118.82
WEST VIRGINIA (WV)	$246.36	$140.41
WYOMING** (WY)	$250.47	$128.55

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) — work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Practice-expense RVUs differ between non-facility and facility settings because facilities (like hospitals) absorb some overhead costs that physician offices would otherwise bear, which is why the two amounts differ.

RVUs — work 2.83, practice expense 4.21 (non-facility) / 0.56 (facility), malpractice 0.62 — × 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 patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Always verify the current allowed amount and any applicable edits 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 CPT 12007?

The practice-expense RVU is lower in the facility setting because the facility, not the physician's office, bears much of the overhead cost. This generally results in a lower allowed amount for the professional service when performed in a facility.

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

No — the national amount is a baseline. The locality-adjusted figure, calculated using that area's GPCIs, reflects a closer estimate of what Medicare will allow in a given region.

Will I be paid this full amount?

No. Medicare generally pays 80% of the allowed amount after the Part B deductible is satisfied, and the final payment can be further affected by modifiers, sequestration, or claim-specific adjustments.

Why might the allowed amount change year to year?

Each year CMS updates RVUs, GPCIs, and the conversion factor, and may apply budget-neutrality adjustments, all of which can shift the allowed amount even if the code itself hasn't changed.

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.