Medicare Reimbursement for CPT 12013

CPT 12013 refers to a specific procedure code recognized by the Medicare Physician Fee Schedule (PFS); the exact clinical descriptor is omitted here because CPT language is licensed by the AMA. This page shows the PFS allowed amount for 2026 at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$145.63	$55.78
ALASKA* (AK)	$167.75	$72.06
ALABAMA (AL)	$129.61	$50.99
ARKANSAS (AR)	$127.60	$50.42
ARIZONA (AZ)	$141.33	$54.26
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$183.93	$57.25
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$187.38	$57.81
OXNARD-THOUSAND OAKS-VENTURA (CA)	$160.97	$54.77
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$161.95	$55.66
NAPA (CA)	$174.50	$56.08
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$184.24	$57.55
VALLEJO (CA)	$174.06	$55.64
BAKERSFIELD (CA)	$152.16	$53.68
CHICO (CA)	$151.42	$52.94
FRESNO (CA)	$151.42	$52.94
HANFORD-CORCORAN (CA)	$151.42	$52.94
MADERA (CA)	$151.42	$52.94
MERCED (CA)	$151.42	$52.94
MODESTO (CA)	$151.42	$52.94
REDDING (CA)	$151.42	$52.94
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$154.32	$55.84
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$158.66	$54.17
SALINAS (CA)	$158.08	$53.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$188.63	$59.07
SANTA CRUZ-WATSONVILLE (CA)	$163.10	$53.94
SANTA ROSA-PETALUMA (CA)	$164.72	$54.39
STOCKTON (CA)	$151.42	$52.94
VISALIA (CA)	$151.42	$52.94
YUBA CITY (CA)	$151.42	$52.94
EL CENTRO (CA)	$151.46	$52.99
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$161.68	$54.22
SAN LUIS OBISPO-PASO ROBLES (CA)	$155.58	$53.25
SANTA MARIA-SANTA BARBARA (CA)	$158.64	$53.87
REST OF CALIFORNIA (CA)	$151.42	$52.94
COLORADO (CO)	$150.33	$54.73
CONNECTICUT (CT)	$155.78	$59.01
DC + MD/VA SUBURBS (DC)	$166.03	$60.19
DELAWARE (DE)	$143.75	$54.98
FORT LAUDERDALE (FL)	$154.17	$63.16
MIAMI (FL)	$163.39	$69.86
REST OF FLORIDA (FL)	$145.90	$60.01
ATLANTA (GA)	$149.11	$57.82
REST OF GEORGIA (GA)	$136.90	$56.75
HAWAII, GUAM (HI)	$155.10	$52.94
IOWA (IA)	$131.96	$49.75
IDAHO (ID)	$133.13	$50.47
EAST ST. LOUIS (IL)	$147.02	$64.36
SUBURBAN CHICAGO (IL)	$155.48	$63.21
CHICAGO (IL)	$158.07	$67.77
REST OF ILLINOIS (IL)	$142.28	$60.25
INDIANA (IN)	$133.92	$50.63
KANSAS (KS)	$131.86	$50.63
KENTUCKY (KY)	$134.11	$54.23
NEW ORLEANS (LA)	$141.14	$56.59
REST OF LOUISIANA (LA)	$134.11	$54.59
METROPOLITAN BOSTON (MA)	$165.06	$57.78
REST OF MASSACHUSETTS (MA)	$149.57	$54.96
BALTIMORE/SURR. CNTYS (MD)	$155.47	$59.06
REST OF MARYLAND (MD)	$146.45	$55.52
SOUTHERN MAINE (ME)	$141.43	$52.39
REST OF MAINE (ME)	$134.47	$51.81
DETROIT (MI)	$148.42	$61.72
REST OF MICHIGAN (MI)	$138.36	$56.33
MINNESOTA (MN)	$142.09	$49.63
METROPOLITAN ST. LOUIS (MO)	$141.00	$55.46
METROPOLITAN KANSAS CITY (MO)	$139.51	$55.14
REST OF MISSOURI (MO)	$132.03	$54.58
MISSISSIPPI (MS)	$129.81	$52.45
MONTANA** (MT)	$145.61	$55.76
NORTH CAROLINA (NC)	$135.88	$52.05
NORTH DAKOTA** (ND)	$140.27	$50.42
NEBRASKA (NE)	$132.56	$49.63
NEW HAMPSHIRE (NH)	$148.47	$54.94
NORTHERN NJ (NJ)	$164.24	$60.02
REST OF NEW JERSEY (NJ)	$157.00	$58.89
NEW MEXICO (NM)	$139.40	$57.01
NEVADA** (NV)	$144.22	$54.28
MANHATTAN (NY)	$169.15	$64.74
NYC SUBURBS/LONG ISLAND (NY)	$174.21	$67.38
POUGHKPSIE/N NYC SUBURBS (NY)	$158.51	$60.13
QUEENS (NY)	$169.79	$63.59
REST OF NEW YORK (NY)	$138.11	$52.75
OHIO (OH)	$137.27	$55.24
OKLAHOMA (OK)	$133.25	$53.02
PORTLAND (OR)	$154.71	$54.89
REST OF OREGON (OR)	$142.56	$53.07
METROPOLITAN PHILADELPHIA (PA)	$152.06	$58.52
REST OF PENNSYLVANIA (PA)	$137.19	$54.71
PUERTO RICO (PR)	$146.56	$55.72
RHODE ISLAND (RI)	$148.61	$55.79
SOUTH CAROLINA (SC)	$136.91	$53.89
SOUTH DAKOTA** (SD)	$139.64	$49.79
TENNESSEE (TN)	$132.64	$50.97
BRAZORIA (TX)	$143.09	$54.05
DALLAS (TX)	$144.32	$54.83
GALVESTON (TX)	$143.72	$54.50
HOUSTON (TX)	$148.66	$59.44
BEAUMONT (TX)	$136.27	$54.51
FORT WORTH (TX)	$143.47	$54.88
AUSTIN (TX)	$150.30	$55.24
REST OF TEXAS (TX)	$139.81	$54.55
UTAH (UT)	$138.90	$54.44
VIRGINIA (VA)	$141.33	$53.01
VIRGIN ISLANDS (VI)	$146.56	$55.72
VERMONT (VT)	$140.20	$51.25
SEATTLE (KING CNTY) (WA)	$167.95	$57.71
REST OF WASHINGTON (WA)	$149.12	$54.51
WISCONSIN (WI)	$135.32	$49.24
WEST VIRGINIA (WV)	$136.83	$58.75
WYOMING** (WY)	$143.28	$53.43

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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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the same code can have two different allowed amounts. The conversion factor and RVU values are updated annually and can shift due to legislative or budget-neutrality adjustments.

RVUs — work 1.19, practice expense 2.9 (non-facility) / 0.21 (facility), malpractice 0.27 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount 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 rest.
Modifiers, bilateral indicators, multiple-procedure reductions, and sequestration can change the actual paid amount.
Amounts vary by locality due to GPCI differences and may change mid-year or annually due to budget-neutrality adjustments.
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 for this code?

The practice-expense RVU is lower in the facility setting because the facility itself (e.g., hospital) bears many overhead costs, such as supplies and staff time, instead of the billing physician's practice.

Does this page tell me what my practice will actually be paid?

No. It shows the standard PFS-calculated allowed amount. Actual payment depends on your specific locality, any applicable modifiers, your contract status, sequestration, and other claim-specific factors.

Why do allowed amounts change year to year?

Medicare updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments required by law, all of which can raise or lower the allowed amount even if the code itself doesn't change.

Where can I find the official CPT descriptor for this code?

The full clinical description of CPT 12013 is maintained by the American Medical Association (AMA) and is not reproduced here due to licensing restrictions; consult your CPT codebook or AMA resources.

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.