Medicare Reimbursement for CPT 12034

CPT 12034 is a procedure code defined by the AMA (descriptor not shown here due to licensing restrictions). This page presents the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level, with separate figures for non-facility and facility settings. Actual payment in a given locality will differ based on local cost adjustments.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$334.68	$180.03
ALASKA* (AK)	$391.87	$227.17
ALABAMA (AL)	$300.93	$165.61
ARKANSAS (AR)	$296.66	$163.82
ARIZONA (AZ)	$325.83	$175.98
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$428.55	$210.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$436.83	$213.83
OXNARD-THOUSAND OAKS-VENTURA (CA)	$373.39	$190.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$375.41	$192.46
NAPA (CA)	$405.85	$202.03
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$428.99	$210.94
VALLEJO (CA)	$405.21	$201.39
BAKERSFIELD (CA)	$353.00	$183.51
CHICO (CA)	$351.86	$182.37
FRESNO (CA)	$351.86	$182.37
HANFORD-CORCORAN (CA)	$351.86	$182.37
MADERA (CA)	$351.86	$182.37
MERCED (CA)	$351.86	$182.37
MODESTO (CA)	$351.86	$182.37
REDDING (CA)	$351.86	$182.37
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$356.09	$186.59
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$368.76	$188.91
SALINAS (CA)	$367.38	$188.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$438.64	$215.64
SANTA CRUZ-WATSONVILLE (CA)	$379.00	$191.10
SANTA ROSA-PETALUMA (CA)	$382.79	$192.88
STOCKTON (CA)	$351.86	$182.37
VISALIA (CA)	$351.86	$182.37
YUBA CITY (CA)	$351.86	$182.37
EL CENTRO (CA)	$351.92	$182.43
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$375.68	$190.72
SAN LUIS OBISPO-PASO ROBLES (CA)	$361.52	$185.38
SANTA MARIA-SANTA BARBARA (CA)	$368.66	$188.34
REST OF CALIFORNIA (CA)	$351.86	$182.37
COLORADO (CO)	$347.37	$182.83
CONNECTICUT (CT)	$356.66	$190.10
DC + MD/VA SUBURBS (DC)	$381.39	$199.22
DELAWARE (DE)	$331.15	$178.36
FORT LAUDERDALE (FL)	$348.12	$191.47
MIAMI (FL)	$363.81	$202.82
REST OF FLORIDA (FL)	$331.34	$183.50
ATLANTA (GA)	$341.18	$184.06
REST OF GEORGIA (GA)	$312.90	$174.96
HAWAII, GUAM (HI)	$359.99	$184.16
IOWA (IA)	$307.72	$166.21
IDAHO (ID)	$309.83	$167.55
EAST ST. LOUIS (IL)	$329.90	$187.63
SUBURBAN CHICAGO (IL)	$351.48	$192.66
CHICAGO (IL)	$353.35	$197.93
REST OF ILLINOIS (IL)	$322.45	$181.26
INDIANA (IN)	$311.57	$168.21
KANSAS (KS)	$306.64	$166.84
KENTUCKY (KY)	$308.62	$171.14
NEW ORLEANS (LA)	$323.19	$177.66
REST OF LOUISIANA (LA)	$308.28	$171.42
METROPOLITAN BOSTON (MA)	$380.82	$196.18
REST OF MASSACHUSETTS (MA)	$345.50	$182.65
BALTIMORE/SURR. CNTYS (MD)	$355.72	$189.79
REST OF MARYLAND (MD)	$337.27	$180.77
SOUTHERN MAINE (ME)	$327.85	$174.59
REST OF MAINE (ME)	$311.77	$169.50
DETROIT (MI)	$335.75	$186.51
REST OF MICHIGAN (MI)	$316.80	$175.61
MINNESOTA (MN)	$332.03	$172.89
METROPOLITAN ST. LOUIS (MO)	$323.91	$176.69
METROPOLITAN KANSAS CITY (MO)	$320.67	$175.45
REST OF MISSOURI (MO)	$303.32	$170.01
MISSISSIPPI (MS)	$300.03	$166.88
MONTANA** (MT)	$334.65	$180.00
NORTH CAROLINA (NC)	$314.91	$170.63
NORTH DAKOTA** (ND)	$326.94	$172.29
NEBRASKA (NE)	$309.27	$166.53
NEW HAMPSHIRE (NH)	$342.27	$181.28
NORTHERN NJ (NJ)	$377.63	$198.24
REST OF NEW JERSEY (NJ)	$360.50	$191.62
NEW MEXICO (NM)	$318.64	$176.83
NEVADA** (NV)	$332.73	$177.93
MANHATTAN (NY)	$384.93	$205.23
NYC SUBURBS/LONG ISLAND (NY)	$394.52	$210.65
POUGHKPSIE/N NYC SUBURBS (NY)	$363.13	$193.79
QUEENS (NY)	$387.55	$204.75
REST OF NEW YORK (NY)	$319.57	$172.65
OHIO (OH)	$315.22	$174.03
OKLAHOMA (OK)	$307.72	$169.62
PORTLAND (OR)	$357.84	$186.03
REST OF OREGON (OR)	$329.91	$175.88
METROPOLITAN PHILADELPHIA (PA)	$348.15	$187.16
REST OF PENNSYLVANIA (PA)	$315.53	$173.56
PUERTO RICO (PR)	$336.95	$180.61
RHODE ISLAND (RI)	$342.53	$182.78
SOUTH CAROLINA (SC)	$315.64	$172.75
SOUTH DAKOTA** (SD)	$326.03	$171.38
TENNESSEE (TN)	$308.19	$167.62
BRAZORIA (TX)	$330.56	$177.31
DALLAS (TX)	$332.80	$178.77
GALVESTON (TX)	$331.64	$178.07
HOUSTON (TX)	$338.78	$185.21
BEAUMONT (TX)	$313.52	$172.79
FORT WORTH (TX)	$330.72	$178.24
AUSTIN (TX)	$346.42	$182.81
REST OF TEXAS (TX)	$321.95	$175.19
UTAH (UT)	$319.86	$174.49
VIRGINIA (VA)	$327.03	$175.01
VIRGIN ISLANDS (VI)	$336.95	$180.61
VERMONT (VT)	$325.99	$172.89
SEATTLE (KING CNTY) (WA)	$388.16	$198.41
REST OF WASHINGTON (WA)	$344.74	$181.89
WISCONSIN (WI)	$316.22	$168.07
WEST VIRGINIA (WV)	$310.84	$176.46
WYOMING** (WY)	$331.29	$176.64

Look up another code or locality →

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 fee for a given code starts with three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting regional differences in cost of living and practice costs. The adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital outpatient) settings use different practice-expense RVUs because overhead costs differ, which is why the two amounts shown differ.

RVUs — work 2.9, practice expense 6.73 (non-facility) / 2.1 (facility), malpractice 0.39 — × 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 patient meets their annual deductible; the patient or secondary insurer is generally responsible for the remainder.
Actual payment depends on the provider's specific locality GPCIs, which can raise or lower the amount shown here.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can change the final paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts change year to year.
Always confirm final payment amounts with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The practice-expense RVU is lower in the facility setting because the facility (e.g., hospital) absorbs certain overhead and supply costs separately, whereas in a non-facility setting the billing provider bears those costs directly.

Will my locality's payment match the national amount shown?

Not necessarily. The national amount uses a GPCI value of 1.0 as a baseline; your actual locality-specific payment will be higher or lower depending on local GPCI adjustments for work, practice expense, and malpractice.

Does this amount reflect what the patient will owe?

No. This figure is the Medicare-allowed amount before cost-sharing. Patients are generally responsible for any unmet deductible plus 20% coinsurance, unless they have supplemental coverage.

Why might the amount change next year?

CMS updates the conversion factor and may revise RVUs annually, and budget-neutrality adjustments required by law can shift payments for many codes, including this one.

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.