Medicare Reimbursement for CPT Code 12018

CPT code 12018 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount nationally and by locality, broken out by non-facility and facility settings. Because CPT descriptors are proprietary to the AMA, this page refers to the code generically rather than reproducing its official description.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$174.02	$174.02
ALASKA* (AK)	$221.37	$221.37
ALABAMA (AL)	$157.88	$157.88
ARKANSAS (AR)	$155.95	$155.95
ARIZONA (AZ)	$168.95	$168.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$179.38	$179.38
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$181.19	$181.19
OXNARD-THOUSAND OAKS-VENTURA (CA)	$171.15	$171.15
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$173.91	$173.91
NAPA (CA)	$175.57	$175.57
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$180.38	$180.38
VALLEJO (CA)	$174.13	$174.13
BAKERSFIELD (CA)	$167.36	$167.36
CHICO (CA)	$164.98	$164.98
FRESNO (CA)	$164.98	$164.98
HANFORD-CORCORAN (CA)	$164.98	$164.98
MADERA (CA)	$164.98	$164.98
MERCED (CA)	$164.98	$164.98
MODESTO (CA)	$164.98	$164.98
REDDING (CA)	$164.98	$164.98
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$174.41	$174.41
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$169.02	$169.02
SALINAS (CA)	$168.33	$168.33
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$185.27	$185.27
SANTA CRUZ-WATSONVILLE (CA)	$168.67	$168.67
SANTA ROSA-PETALUMA (CA)	$170.08	$170.08
STOCKTON (CA)	$164.98	$164.98
VISALIA (CA)	$164.98	$164.98
YUBA CITY (CA)	$164.98	$164.98
EL CENTRO (CA)	$165.12	$165.12
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$169.39	$169.39
SAN LUIS OBISPO-PASO ROBLES (CA)	$166.14	$166.14
SANTA MARIA-SANTA BARBARA (CA)	$168.16	$168.16
REST OF CALIFORNIA (CA)	$164.98	$164.98
COLORADO (CO)	$170.72	$170.72
CONNECTICUT (CT)	$184.63	$184.63
DC + MD/VA SUBURBS (DC)	$188.50	$188.50
DELAWARE (DE)	$171.31	$171.31
FORT LAUDERDALE (FL)	$198.12	$198.12
MIAMI (FL)	$220.07	$220.07
REST OF FLORIDA (FL)	$187.61	$187.61
ATLANTA (GA)	$180.71	$180.71
REST OF GEORGIA (GA)	$176.74	$176.74
HAWAII, GUAM (HI)	$165.35	$165.35
IOWA (IA)	$154.00	$154.00
IDAHO (ID)	$156.36	$156.36
EAST ST. LOUIS (IL)	$201.66	$201.66
SUBURBAN CHICAGO (IL)	$198.26	$198.26
CHICAGO (IL)	$213.04	$213.04
REST OF ILLINOIS (IL)	$188.21	$188.21
INDIANA (IN)	$156.94	$156.94
KANSAS (KS)	$156.84	$156.84
KENTUCKY (KY)	$168.52	$168.52
NEW ORLEANS (LA)	$176.42	$176.42
REST OF LOUISIANA (LA)	$169.67	$169.67
METROPOLITAN BOSTON (MA)	$180.85	$180.85
REST OF MASSACHUSETTS (MA)	$171.37	$171.37
BALTIMORE/SURR. CNTYS (MD)	$184.84	$184.84
REST OF MARYLAND (MD)	$173.11	$173.11
SOUTHERN MAINE (ME)	$162.93	$162.93
REST OF MAINE (ME)	$160.74	$160.74
DETROIT (MI)	$193.24	$193.24
REST OF MICHIGAN (MI)	$175.46	$175.46
MINNESOTA (MN)	$154.11	$154.11
METROPOLITAN ST. LOUIS (MO)	$172.78	$172.78
METROPOLITAN KANSAS CITY (MO)	$171.69	$171.69
REST OF MISSOURI (MO)	$169.52	$169.52
MISSISSIPPI (MS)	$162.59	$162.59
MONTANA** (MT)	$173.96	$173.96
NORTH CAROLINA (NC)	$161.60	$161.60
NORTH DAKOTA** (ND)	$156.56	$156.56
NEBRASKA (NE)	$153.65	$153.65
NEW HAMPSHIRE (NH)	$171.45	$171.45
NORTHERN NJ (NJ)	$187.75	$187.75
REST OF NEW JERSEY (NJ)	$184.06	$184.06
NEW MEXICO (NM)	$177.68	$177.68
NEVADA** (NV)	$169.14	$169.14
MANHATTAN (NY)	$203.15	$203.15
NYC SUBURBS/LONG ISLAND (NY)	$211.85	$211.85
POUGHKPSIE/N NYC SUBURBS (NY)	$188.05	$188.05
QUEENS (NY)	$199.46	$199.46
REST OF NEW YORK (NY)	$163.94	$163.94
OHIO (OH)	$171.90	$171.90
OKLAHOMA (OK)	$164.57	$164.57
PORTLAND (OR)	$171.38	$171.38
REST OF OREGON (OR)	$165.18	$165.18
METROPOLITAN PHILADELPHIA (PA)	$182.92	$182.92
REST OF PENNSYLVANIA (PA)	$170.18	$170.18
PUERTO RICO (PR)	$173.88	$173.88
RHODE ISLAND (RI)	$173.97	$173.97
SOUTH CAROLINA (SC)	$167.55	$167.55
SOUTH DAKOTA** (SD)	$154.50	$154.50
TENNESSEE (TN)	$157.95	$157.95
BRAZORIA (TX)	$168.25	$168.25
DALLAS (TX)	$170.79	$170.79
GALVESTON (TX)	$169.71	$169.71
HOUSTON (TX)	$185.82	$185.82
BEAUMONT (TX)	$169.50	$169.50
FORT WORTH (TX)	$170.91	$170.91
AUSTIN (TX)	$172.47	$172.47
REST OF TEXAS (TX)	$169.79	$169.79
UTAH (UT)	$169.40	$169.40
VIRGINIA (VA)	$164.92	$164.92
VIRGIN ISLANDS (VI)	$173.88	$173.88
VERMONT (VT)	$159.23	$159.23
SEATTLE (KING CNTY) (WA)	$180.66	$180.66
REST OF WASHINGTON (WA)	$169.96	$169.96
WISCONSIN (WI)	$152.54	$152.54
WEST VIRGINIA (WV)	$183.14	$183.14
WYOMING** (WY)	$166.38	$166.38

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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: work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility amounts can differ because the PE RVU is typically lower in facility settings (e.g., hospitals), where the facility itself bears some practice expense costs.

RVUs — work 3.52, practice expense 0.81 (non-facility) / 0.81 (facility), malpractice 0.88 — × 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, sequestration reductions, and annual budget-neutrality adjustments.
Always verify final allowed amounts and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the amount differ by locality?

Medicare applies locality-specific Geographic Practice Cost Indices (GPCIs) to the work, practice expense, and malpractice RVUs to account for regional differences in costs, so the same code can price differently across the country.

Why are non-facility and facility amounts the same for this code?

When the practice expense RVU is identical for both settings, as shown here, the resulting non-facility and facility allowed amounts will also be the same.

Does this amount include the patient's share?

No. The figure shown is the total Medicare-allowed amount; Medicare generally pays 80% of this after the deductible, with the remaining 20% owed by the patient or secondary coverage.

Will this amount change during the year?

The conversion factor and RVUs are typically updated annually, but mid-year adjustments (e.g., sequestration or legislative changes) can also affect final payment.

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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.