Medicare Reimbursement for CPT 12031

CPT 12031 is a procedure code defined by the American Medical Association; its descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both nationally and adjustable by locality, and compares the non-facility (office) and facility (hospital/ASC) payment rates.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$259.86	$133.27
ALASKA* (AK)	$301.13	$166.32
ALABAMA (AL)	$233.14	$122.38
ARKANSAS (AR)	$229.76	$121.02
ARIZONA (AZ)	$252.95	$130.29
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$338.32	$159.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$345.07	$162.52
OXNARD-THOUSAND OAKS-VENTURA (CA)	$292.83	$143.20
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$294.18	$144.42
NAPA (CA)	$319.66	$152.82
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$338.58	$160.09
VALLEJO (CA)	$319.29	$152.44
BAKERSFIELD (CA)	$276.05	$137.31
CHICO (CA)	$275.36	$136.62
FRESNO (CA)	$275.36	$136.62
HANFORD-CORCORAN (CA)	$275.36	$136.62
MADERA (CA)	$275.36	$136.62
MERCED (CA)	$275.36	$136.62
MODESTO (CA)	$275.36	$136.62
REDDING (CA)	$275.36	$136.62
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$277.86	$139.12
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$289.13	$141.90
SALINAS (CA)	$288.05	$141.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$346.13	$163.59
SANTA CRUZ-WATSONVILLE (CA)	$297.88	$144.07
SANTA ROSA-PETALUMA (CA)	$300.89	$145.44
STOCKTON (CA)	$275.36	$136.62
VISALIA (CA)	$275.36	$136.62
YUBA CITY (CA)	$275.36	$136.62
EL CENTRO (CA)	$275.40	$136.65
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$294.96	$143.55
SAN LUIS OBISPO-PASO ROBLES (CA)	$283.40	$139.22
SANTA MARIA-SANTA BARBARA (CA)	$289.17	$141.56
REST OF CALIFORNIA (CA)	$275.36	$136.62
COLORADO (CO)	$270.93	$136.24
CONNECTICUT (CT)	$277.18	$140.84
DC + MD/VA SUBURBS (DC)	$297.54	$148.42
DELAWARE (DE)	$257.16	$132.09
FORT LAUDERDALE (FL)	$268.50	$140.26
MIAMI (FL)	$279.27	$147.49
REST OF FLORIDA (FL)	$255.49	$134.47
ATLANTA (GA)	$264.59	$135.98
REST OF GEORGIA (GA)	$241.13	$128.22
HAWAII, GUAM (HI)	$282.25	$138.32
IOWA (IA)	$239.33	$123.50
IDAHO (ID)	$240.85	$124.38
EAST ST. LOUIS (IL)	$252.69	$136.22
SUBURBAN CHICAGO (IL)	$271.30	$141.29
CHICAGO (IL)	$271.20	$143.98
REST OF ILLINOIS (IL)	$247.91	$132.34
INDIANA (IN)	$242.26	$124.91
KANSAS (KS)	$238.09	$123.66
KENTUCKY (KY)	$238.44	$125.91
NEW ORLEANS (LA)	$249.87	$130.75
REST OF LOUISIANA (LA)	$238.03	$125.99
METROPOLITAN BOSTON (MA)	$297.97	$146.82
REST OF MASSACHUSETTS (MA)	$269.26	$135.96
BALTIMORE/SURR. CNTYS (MD)	$276.38	$140.55
REST OF MARYLAND (MD)	$262.12	$134.02
SOUTHERN MAINE (ME)	$255.34	$129.89
REST OF MAINE (ME)	$241.99	$125.53
DETROIT (MI)	$258.58	$136.42
REST OF MICHIGAN (MI)	$244.58	$129.00
MINNESOTA (MN)	$259.88	$129.61
METROPOLITAN ST. LOUIS (MO)	$250.90	$130.38
METROPOLITAN KANSAS CITY (MO)	$248.27	$129.41
REST OF MISSOURI (MO)	$233.85	$124.73
MISSISSIPPI (MS)	$231.85	$122.86
MONTANA** (MT)	$259.84	$133.25
NORTH CAROLINA (NC)	$244.55	$126.45
NORTH DAKOTA** (ND)	$255.30	$128.71
NEBRASKA (NE)	$240.68	$123.84
NEW HAMPSHIRE (NH)	$266.57	$134.79
NORTHERN NJ (NJ)	$294.41	$147.57
REST OF NEW JERSEY (NJ)	$280.42	$142.18
NEW MEXICO (NM)	$245.88	$129.80
NEVADA** (NV)	$258.76	$132.05
MANHATTAN (NY)	$298.83	$151.73
NYC SUBURBS/LONG ISLAND (NY)	$305.96	$155.45
POUGHKPSIE/N NYC SUBURBS (NY)	$282.17	$143.56
QUEENS (NY)	$301.47	$151.84
REST OF NEW YORK (NY)	$248.23	$127.97
OHIO (OH)	$243.65	$128.07
OKLAHOMA (OK)	$238.13	$125.09
PORTLAND (OR)	$279.70	$139.06
REST OF OREGON (OR)	$256.83	$130.75
METROPOLITAN PHILADELPHIA (PA)	$270.18	$138.40
REST OF PENNSYLVANIA (PA)	$244.10	$127.89
PUERTO RICO (PR)	$261.80	$133.82
RHODE ISLAND (RI)	$266.44	$135.67
SOUTH CAROLINA (SC)	$244.49	$127.52
SOUTH DAKOTA** (SD)	$254.76	$128.17
TENNESSEE (TN)	$239.28	$124.21
BRAZORIA (TX)	$257.01	$131.56
DALLAS (TX)	$258.61	$132.52
GALVESTON (TX)	$257.75	$132.05
HOUSTON (TX)	$261.96	$136.26
BEAUMONT (TX)	$242.48	$127.28
FORT WORTH (TX)	$256.84	$132.02
AUSTIN (TX)	$269.96	$136.03
REST OF TEXAS (TX)	$249.57	$129.44
UTAH (UT)	$247.85	$128.86
VIRGINIA (VA)	$254.42	$129.98
VIRGIN ISLANDS (VI)	$261.80	$133.82
VERMONT (VT)	$254.19	$128.87
SEATTLE (KING CNTY) (WA)	$304.17	$148.84
REST OF WASHINGTON (WA)	$268.78	$135.48
WISCONSIN (WI)	$246.69	$125.41
WEST VIRGINIA (WV)	$238.67	$128.66
WYOMING** (WY)	$257.86	$131.27

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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) — physician work, practice expense, and malpractice — assigned to each code. 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 national Conversion Factor to produce a dollar allowed amount. Non-facility and facility rates differ mainly because the practice-expense RVU is lower when the service is performed in a facility setting (e.g., hospital), since the facility itself bears some of the overhead cost.

RVUs — work 1.95, practice expense 5.6 (non-facility) / 1.81 (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 insurer is responsible for the remainder.
Actual payment varies by locality GPCI values, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
Always confirm the exact allowed amount and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility rate lower than the non-facility rate?

The facility rate uses a lower practice-expense RVU because overhead costs (equipment, supplies, staff time) are assumed to be borne by the facility rather than the billing physician's office.

Does this amount reflect what Medicare will actually pay?

No. It is the Medicare-allowed amount before the 80/20 coinsurance split, deductible status, and any applicable modifiers or local adjustments are applied.

Why might my locality's amount differ from the national figure?

Each locality has its own Geographic Practice Cost Index values for work, practice expense, and malpractice, which adjust the RVUs before the conversion factor is applied.

Can this figure change during the year?

Yes. CMS can apply budget-neutrality adjustments, sequestration, or mid-year policy changes that alter the effective paid amount even though the published RVUs and conversion factor stay fixed for the year.

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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.