Medicare Reimbursement for CPT 12017

CPT 12017 is a procedure code used in Medicare billing; the official descriptor is proprietary to the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted for a specific locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$154.31	$154.31
ALASKA* (AK)	$195.99	$195.99
ALABAMA (AL)	$139.92	$139.92
ARKANSAS (AR)	$138.19	$138.19
ARIZONA (AZ)	$149.79	$149.79
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$159.30	$159.30
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$160.92	$160.92
OXNARD-THOUSAND OAKS-VENTURA (CA)	$151.89	$151.89
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$154.33	$154.33
NAPA (CA)	$155.88	$155.88
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$160.19	$160.19
VALLEJO (CA)	$154.60	$154.60
BAKERSFIELD (CA)	$148.47	$148.47
CHICO (CA)	$146.36	$146.36
FRESNO (CA)	$146.36	$146.36
HANFORD-CORCORAN (CA)	$146.36	$146.36
MADERA (CA)	$146.36	$146.36
MERCED (CA)	$146.36	$146.36
MODESTO (CA)	$146.36	$146.36
REDDING (CA)	$146.36	$146.36
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$154.72	$154.72
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$149.98	$149.98
SALINAS (CA)	$149.36	$149.36
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$164.54	$164.54
SANTA CRUZ-WATSONVILLE (CA)	$149.71	$149.71
SANTA ROSA-PETALUMA (CA)	$150.97	$150.97
STOCKTON (CA)	$146.36	$146.36
VISALIA (CA)	$146.36	$146.36
YUBA CITY (CA)	$146.36	$146.36
EL CENTRO (CA)	$146.49	$146.49
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$150.33	$150.33
SAN LUIS OBISPO-PASO ROBLES (CA)	$147.42	$147.42
SANTA MARIA-SANTA BARBARA (CA)	$149.23	$149.23
REST OF CALIFORNIA (CA)	$146.36	$146.36
COLORADO (CO)	$151.43	$151.43
CONNECTICUT (CT)	$163.76	$163.76
DC + MD/VA SUBURBS (DC)	$167.25	$167.25
DELAWARE (DE)	$151.90	$151.90
FORT LAUDERDALE (FL)	$175.68	$175.68
MIAMI (FL)	$195.16	$195.16
REST OF FLORIDA (FL)	$166.33	$166.33
ATLANTA (GA)	$160.25	$160.25
REST OF GEORGIA (GA)	$156.64	$156.64
HAWAII, GUAM (HI)	$146.73	$146.73
IOWA (IA)	$136.50	$136.50
IDAHO (ID)	$138.61	$138.61
EAST ST. LOUIS (IL)	$178.75	$178.75
SUBURBAN CHICAGO (IL)	$175.82	$175.82
CHICAGO (IL)	$188.90	$188.90
REST OF ILLINOIS (IL)	$166.83	$166.83
INDIANA (IN)	$139.12	$139.12
KANSAS (KS)	$139.02	$139.02
KENTUCKY (KY)	$149.35	$149.35
NEW ORLEANS (LA)	$156.40	$156.40
REST OF LOUISIANA (LA)	$150.38	$150.38
METROPOLITAN BOSTON (MA)	$160.49	$160.49
REST OF MASSACHUSETTS (MA)	$151.99	$151.99
BALTIMORE/SURR. CNTYS (MD)	$163.95	$163.95
REST OF MARYLAND (MD)	$153.51	$153.51
SOUTHERN MAINE (ME)	$144.48	$144.48
REST OF MAINE (ME)	$142.49	$142.49
DETROIT (MI)	$171.32	$171.32
REST OF MICHIGAN (MI)	$155.52	$155.52
MINNESOTA (MN)	$136.69	$136.69
METROPOLITAN ST. LOUIS (MO)	$153.18	$153.18
METROPOLITAN KANSAS CITY (MO)	$152.21	$152.21
REST OF MISSOURI (MO)	$150.22	$150.22
MISSISSIPPI (MS)	$144.08	$144.08
MONTANA** (MT)	$154.26	$154.26
NORTH CAROLINA (NC)	$143.25	$143.25
NORTH DAKOTA** (ND)	$138.84	$138.84
NEBRASKA (NE)	$136.20	$136.20
NEW HAMPSHIRE (NH)	$152.07	$152.07
NORTHERN NJ (NJ)	$166.56	$166.56
REST OF NEW JERSEY (NJ)	$163.25	$163.25
NEW MEXICO (NM)	$157.50	$157.50
NEVADA** (NV)	$149.99	$149.99
MANHATTAN (NY)	$180.21	$180.21
NYC SUBURBS/LONG ISLAND (NY)	$187.94	$187.94
POUGHKPSIE/N NYC SUBURBS (NY)	$166.79	$166.79
QUEENS (NY)	$176.95	$176.95
REST OF NEW YORK (NY)	$145.34	$145.34
OHIO (OH)	$152.37	$152.37
OKLAHOMA (OK)	$145.86	$145.86
PORTLAND (OR)	$152.04	$152.04
REST OF OREGON (OR)	$146.48	$146.48
METROPOLITAN PHILADELPHIA (PA)	$162.22	$162.22
REST OF PENNSYLVANIA (PA)	$150.85	$150.85
PUERTO RICO (PR)	$154.19	$154.19
RHODE ISLAND (RI)	$154.28	$154.28
SOUTH CAROLINA (SC)	$148.53	$148.53
SOUTH DAKOTA** (SD)	$137.01	$137.01
TENNESSEE (TN)	$140.00	$140.00
BRAZORIA (TX)	$149.19	$149.19
DALLAS (TX)	$151.45	$151.45
GALVESTON (TX)	$150.49	$150.49
HOUSTON (TX)	$164.76	$164.76
BEAUMONT (TX)	$150.24	$150.24
FORT WORTH (TX)	$151.54	$151.54
AUSTIN (TX)	$152.98	$152.98
REST OF TEXAS (TX)	$150.52	$150.52
UTAH (UT)	$150.17	$150.17
VIRGINIA (VA)	$146.23	$146.23
VIRGIN ISLANDS (VI)	$154.19	$154.19
VERMONT (VT)	$141.19	$141.19
SEATTLE (KING CNTY) (WA)	$160.33	$160.33
REST OF WASHINGTON (WA)	$150.74	$150.74
WISCONSIN (WI)	$135.25	$135.25
WEST VIRGINIA (WV)	$162.30	$162.30
WYOMING** (WY)	$147.54	$147.54

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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 PFS amount is built from three Relative Value Units (RVUs) assigned to a 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 billed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two amounts can diverge even though work and malpractice RVUs stay the same.

RVUs — work 3.1, practice expense 0.74 (non-facility) / 0.74 (facility), malpractice 0.78 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement can differ.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
GPCI values and conversion factors are updated annually and may change mid-year due to legislation.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount different from the non-facility amount for this code?

The practice-expense RVU component is calculated differently depending on setting, since non-facility (e.g., office) overhead costs differ from facility (e.g., hospital) overhead costs. This can make the allowed amounts the same or different depending on the code.

Does this amount reflect what my practice will actually be paid?

No. It's a PFS-based estimate. Final payment depends on the beneficiary's deductible status, applicable modifiers, secondary payers, and any claim-specific adjustments made by your MAC.

Why can't you show the CPT code description?

CPT codes and their descriptors are copyrighted by the American Medical Association (AMA). This page references the code numerically but does not reproduce the licensed descriptor text.

Will this amount change during the year?

It can. Conversion factors, GPCIs, and RVUs are typically updated annually, but mid-year adjustments (e.g., from legislation or budget-neutrality corrections) are possible.

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.