Medicare Reimbursement for CPT 12035
CPT 12035 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital outpatient) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $414.17 | $224.45 |
| ALASKA* (AK) | $479.99 | $277.94 |
| ALABAMA (AL) | $370.24 | $204.24 |
| ARKANSAS (AR) | $364.71 | $201.74 |
| ARIZONA (AZ) | $402.52 | $218.69 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $527.71 | $260.20 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $537.78 | $264.21 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $460.43 | $236.19 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $463.04 | $238.61 |
| NAPA (CA) | $500.06 | $250.01 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $528.41 | $260.91 |
| VALLEJO (CA) | $499.05 | $249.00 |
| BAKERSFIELD (CA) | $435.08 | $227.15 |
| CHICO (CA) | $433.34 | $225.41 |
| FRESNO (CA) | $433.34 | $225.41 |
| HANFORD-CORCORAN (CA) | $433.34 | $225.41 |
| MADERA (CA) | $433.34 | $225.41 |
| MERCED (CA) | $433.34 | $225.41 |
| MODESTO (CA) | $433.34 | $225.41 |
| REDDING (CA) | $433.34 | $225.41 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $440.02 | $232.09 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $454.23 | $233.59 |
| SALINAS (CA) | $452.54 | $232.66 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $540.66 | $267.09 |
| SANTA CRUZ-WATSONVILLE (CA) | $467.06 | $236.55 |
| SANTA ROSA-PETALUMA (CA) | $471.72 | $238.75 |
| STOCKTON (CA) | $433.34 | $225.41 |
| VISALIA (CA) | $433.34 | $225.41 |
| YUBA CITY (CA) | $433.34 | $225.41 |
| EL CENTRO (CA) | $433.44 | $225.51 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $462.90 | $236.00 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $445.36 | $229.27 |
| SANTA MARIA-SANTA BARBARA (CA) | $454.16 | $232.95 |
| REST OF CALIFORNIA (CA) | $433.34 | $225.41 |
| COLORADO (CO) | $428.89 | $227.04 |
| CONNECTICUT (CT) | $442.32 | $238.00 |
| DC + MD/VA SUBURBS (DC) | $472.42 | $248.94 |
| DELAWARE (DE) | $409.29 | $221.85 |
| FORT LAUDERDALE (FL) | $434.54 | $242.35 |
| MIAMI (FL) | $457.30 | $259.80 |
| REST OF FLORIDA (FL) | $412.29 | $230.92 |
| ATLANTA (GA) | $423.15 | $230.40 |
| REST OF GEORGIA (GA) | $387.95 | $218.73 |
| HAWAII, GUAM (HI) | $443.75 | $228.04 |
| IOWA (IA) | $377.92 | $204.33 |
| IDAHO (ID) | $380.89 | $206.35 |
| EAST ST. LOUIS (IL) | $412.80 | $238.26 |
| SUBURBAN CHICAGO (IL) | $438.50 | $243.66 |
| CHICAGO (IL) | $443.18 | $252.52 |
| REST OF ILLINOIS (IL) | $401.51 | $228.30 |
| INDIANA (IN) | $383.12 | $207.25 |
| KANSAS (KS) | $377.06 | $205.56 |
| KENTUCKY (KY) | $381.38 | $212.72 |
| NEW ORLEANS (LA) | $400.49 | $221.97 |
| REST OF LOUISIANA (LA) | $381.15 | $213.25 |
| METROPOLITAN BOSTON (MA) | $470.80 | $244.28 |
| REST OF MASSACHUSETTS (MA) | $426.61 | $226.83 |
| BALTIMORE/SURR. CNTYS (MD) | $441.31 | $237.74 |
| REST OF MARYLAND (MD) | $416.97 | $224.97 |
| SOUTHERN MAINE (ME) | $404.01 | $216.00 |
| REST OF MAINE (ME) | $383.98 | $209.44 |
| DETROIT (MI) | $418.59 | $235.52 |
| REST OF MICHIGAN (MI) | $392.52 | $219.31 |
| MINNESOTA (MN) | $407.70 | $212.48 |
| METROPOLITAN ST. LOUIS (MO) | $400.79 | $220.18 |
| METROPOLITAN KANSAS CITY (MO) | $396.64 | $218.50 |
| REST OF MISSOURI (MO) | $375.05 | $211.52 |
| MISSISSIPPI (MS) | $369.91 | $206.56 |
| MONTANA** (MT) | $414.13 | $224.41 |
| NORTH CAROLINA (NC) | $387.96 | $210.96 |
| NORTH DAKOTA** (ND) | $401.87 | $212.15 |
| NEBRASKA (NE) | $379.76 | $204.65 |
| NEW HAMPSHIRE (NH) | $423.04 | $225.55 |
| NORTHERN NJ (NJ) | $467.49 | $247.41 |
| REST OF NEW JERSEY (NJ) | $446.46 | $239.28 |
| NEW MEXICO (NM) | $395.13 | $221.16 |
| NEVADA** (NV) | $410.99 | $221.09 |
| MANHATTAN (NY) | $478.89 | $258.43 |
| NYC SUBURBS/LONG ISLAND (NY) | $492.05 | $266.47 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $450.20 | $242.46 |
| QUEENS (NY) | $481.49 | $257.25 |
| REST OF NEW YORK (NY) | $394.04 | $213.81 |
| OHIO (OH) | $390.01 | $216.80 |
| OKLAHOMA (OK) | $379.64 | $210.22 |
| PORTLAND (OR) | $441.72 | $230.95 |
| REST OF OREGON (OR) | $406.90 | $217.94 |
| METROPOLITAN PHILADELPHIA (PA) | $431.68 | $234.18 |
| REST OF PENNSYLVANIA (PA) | $390.11 | $215.95 |
| PUERTO RICO (PR) | $416.94 | $225.13 |
| RHODE ISLAND (RI) | $423.32 | $227.35 |
| SOUTH CAROLINA (SC) | $389.82 | $214.52 |
| SOUTH DAKOTA** (SD) | $400.42 | $210.70 |
| TENNESSEE (TN) | $379.14 | $206.69 |
| BRAZORIA (TX) | $408.01 | $220.00 |
| DALLAS (TX) | $411.14 | $222.18 |
| GALVESTON (TX) | $409.56 | $221.17 |
| HOUSTON (TX) | $420.91 | $232.52 |
| BEAUMONT (TX) | $387.54 | $214.90 |
| FORT WORTH (TX) | $408.61 | $221.55 |
| AUSTIN (TX) | $428.25 | $227.53 |
| REST OF TEXAS (TX) | $397.90 | $217.86 |
| UTAH (UT) | $395.28 | $216.95 |
| VIRGINIA (VA) | $403.33 | $216.84 |
| VIRGIN ISLANDS (VI) | $416.94 | $225.13 |
| VERMONT (VT) | $401.15 | $213.33 |
| SEATTLE (KING CNTY) (WA) | $479.54 | $246.75 |
| REST OF WASHINGTON (WA) | $425.52 | $225.75 |
| WISCONSIN (WI) | $388.10 | $206.35 |
| WEST VIRGINIA (WV) | $386.47 | $221.61 |
| WYOMING** (WY) | $408.79 | $219.07 |
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
Each code is assigned Relative Value Units (RVUs) for physician work, practice expense, and malpractice risk. These RVUs are each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific Medicare locality, then summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because facility settings assume the facility absorbs certain overhead costs, which generally results in a lower facility rate. The conversion factor is updated annually and applies uniformly across all codes before geographic adjustment.
RVUs — work 3.41, practice expense 8.37 (non-facility) / 2.69 (facility), malpractice 0.62 — × 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 deductible; the patient or secondary insurer is responsible for the remainder.
- Actual payment can vary based on locality, applicable modifiers, sequestration, and annual budget-neutrality adjustments.
- Always verify the current allowed amount and any applicable edits with your Medicare Administrative Contractor (MAC).
Frequently asked
Why is the facility amount lower than the non-facility amount?
The facility rate uses lower practice-expense RVUs because the facility, rather than the billing physician's practice, incurs costs like equipment, supplies, and staff time.
Does this amount reflect what the patient will actually pay?
No. This reflects the Medicare-allowed amount. The patient's share depends on deductible status, coinsurance, and any secondary coverage.
Will this amount change during the year?
The conversion factor and RVUs are typically set annually, but mid-year adjustments can occur due to legislation, sequestration, or correction notices.
Why isn't the CPT code description shown here?
CPT code descriptors are licensed by the American Medical Association and cannot be reproduced without a license, so this page refers to the code generically.
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.
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