Medicare Reimbursement for CPT 12011

CPT 12011 is a procedure code billed under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted for locality, and separately for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$139.62	$54.44
ALASKA* (AK)	$159.85	$69.14
ALABAMA (AL)	$124.13	$49.61
ARKANSAS (AR)	$122.19	$49.02
ARIZONA (AZ)	$135.50	$52.96
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$178.35	$58.26
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$181.77	$58.95
OXNARD-THOUSAND OAKS-VENTURA (CA)	$155.38	$54.71
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$156.25	$55.49
NAPA (CA)	$168.93	$56.68
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$178.61	$58.52
VALLEJO (CA)	$168.56	$56.30
BAKERSFIELD (CA)	$146.60	$53.25
CHICO (CA)	$145.97	$52.62
FRESNO (CA)	$145.97	$52.62
HANFORD-CORCORAN (CA)	$145.97	$52.62
MADERA (CA)	$145.97	$52.62
MERCED (CA)	$145.97	$52.62
MODESTO (CA)	$145.97	$52.62
REDDING (CA)	$145.97	$52.62
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$148.44	$55.09
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$153.14	$54.09
SALINAS (CA)	$152.58	$53.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$182.83	$60.01
SANTA CRUZ-WATSONVILLE (CA)	$157.68	$54.19
SANTA ROSA-PETALUMA (CA)	$159.25	$54.66
STOCKTON (CA)	$145.97	$52.62
VISALIA (CA)	$145.97	$52.62
YUBA CITY (CA)	$145.97	$52.62
EL CENTRO (CA)	$146.01	$52.66
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$156.19	$54.32
SAN LUIS OBISPO-PASO ROBLES (CA)	$150.15	$53.14
SANTA MARIA-SANTA BARBARA (CA)	$153.16	$53.85
REST OF CALIFORNIA (CA)	$145.97	$52.62
COLORADO (CO)	$144.57	$53.95
CONNECTICUT (CT)	$149.41	$57.68
DC + MD/VA SUBURBS (DC)	$159.66	$59.33
DELAWARE (DE)	$137.85	$53.70
FORT LAUDERDALE (FL)	$147.09	$60.81
MIAMI (FL)	$155.35	$66.68
REST OF FLORIDA (FL)	$139.20	$57.78
ATLANTA (GA)	$142.82	$56.28
REST OF GEORGIA (GA)	$130.59	$54.62
HAWAII, GUAM (HI)	$149.70	$52.86
IOWA (IA)	$126.72	$48.79
IDAHO (ID)	$127.79	$49.43
EAST ST. LOUIS (IL)	$139.63	$61.27
SUBURBAN CHICAGO (IL)	$148.41	$60.94
CHICAGO (IL)	$150.29	$64.70
REST OF ILLINOIS (IL)	$135.48	$57.72
INDIANA (IN)	$128.57	$49.62
KANSAS (KS)	$126.47	$49.48
KENTUCKY (KY)	$128.17	$52.46
NEW ORLEANS (LA)	$134.93	$54.78
REST OF LOUISIANA (LA)	$128.12	$52.74
METROPOLITAN BOSTON (MA)	$159.05	$57.36
REST OF MASSACHUSETTS (MA)	$143.76	$54.08
BALTIMORE/SURR. CNTYS (MD)	$149.09	$57.70
REST OF MARYLAND (MD)	$140.50	$54.31
SOUTHERN MAINE (ME)	$135.91	$51.50
REST OF MAINE (ME)	$128.94	$50.58
DETROIT (MI)	$141.48	$59.29
REST OF MICHIGAN (MI)	$132.15	$54.39
MINNESOTA (MN)	$137.03	$49.38
METROPOLITAN ST. LOUIS (MO)	$134.97	$53.88
METROPOLITAN KANSAS CITY (MO)	$133.51	$53.53
REST OF MISSOURI (MO)	$126.00	$52.58
MISSISSIPPI (MS)	$124.10	$50.77
MONTANA** (MT)	$139.60	$54.43
NORTH CAROLINA (NC)	$130.33	$50.86
NORTH DAKOTA** (ND)	$135.05	$49.88
NEBRASKA (NE)	$127.35	$48.74
NEW HAMPSHIRE (NH)	$142.64	$53.98
NORTHERN NJ (NJ)	$157.88	$59.08
REST OF NEW JERSEY (NJ)	$150.69	$57.68
NEW MEXICO (NM)	$133.09	$54.99
NEVADA** (NV)	$138.43	$53.17
MANHATTAN (NY)	$162.09	$63.12
NYC SUBURBS/LONG ISLAND (NY)	$166.79	$65.52
POUGHKPSIE/N NYC SUBURBS (NY)	$152.03	$58.76
QUEENS (NY)	$162.92	$62.25
REST OF NEW YORK (NY)	$132.47	$51.56
OHIO (OH)	$131.22	$53.46
OKLAHOMA (OK)	$127.50	$51.44
PORTLAND (OR)	$148.99	$54.37
REST OF OREGON (OR)	$136.95	$52.11
METROPOLITAN PHILADELPHIA (PA)	$145.71	$57.04
REST OF PENNSYLVANIA (PA)	$131.22	$53.03
PUERTO RICO (PR)	$140.57	$54.46
RHODE ISLAND (RI)	$142.65	$54.67
SOUTH CAROLINA (SC)	$131.08	$52.38
SOUTH DAKOTA** (SD)	$134.51	$49.34
TENNESSEE (TN)	$127.21	$49.79
BRAZORIA (TX)	$137.33	$52.92
DALLAS (TX)	$138.45	$53.62
GALVESTON (TX)	$137.89	$53.32
HOUSTON (TX)	$142.10	$57.53
BEAUMONT (TX)	$130.32	$52.82
FORT WORTH (TX)	$137.58	$53.60
AUSTIN (TX)	$144.45	$54.33
REST OF TEXAS (TX)	$133.91	$53.09
UTAH (UT)	$133.00	$52.94
VIRGINIA (VA)	$135.70	$51.98
VIRGIN ISLANDS (VI)	$140.57	$54.46
VERMONT (VT)	$134.85	$50.53
SEATTLE (KING CNTY) (WA)	$162.01	$57.50
REST OF WASHINGTON (WA)	$143.38	$53.70
WISCONSIN (WI)	$130.22	$48.62
WEST VIRGINIA (WV)	$130.19	$56.18
WYOMING** (WY)	$137.62	$52.45

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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 allowed amount is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is furnished, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital outpatient, ASC) settings because overhead costs differ, which is why the same code can have two different allowed amounts depending on place of service.

RVUs — work 1.04, practice expense 2.91 (non-facility) / 0.36 (facility), malpractice 0.23 — × 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 payer is generally responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Always verify final payment rules and amounts with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the allowed amount differ between non-facility and facility settings?

The practice-expense RVU component is lower in the facility setting because the facility (not the billing physician) absorbs certain overhead costs like equipment and supplies.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare Physician Fee Schedule allowed amount before adjustments for deductible status, coinsurance, modifiers, sequestration, or locality-specific finalization.

Why can't you show the CPT code description?

CPT code descriptors are copyrighted by the American Medical Association and cannot be reproduced here; the code is referenced generically as a procedure code.

Why do amounts change year to year?

The conversion factor, RVUs, and GPCIs are updated annually by CMS, which can raise or lower 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.