Medicare Reimbursement for CPT 12037

CPT 12037 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjustable by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$536.08	$307.62
ALASKA* (AK)	$623.46	$380.15
ALABAMA (AL)	$478.41	$278.50
ARKANSAS (AR)	$471.18	$274.94
ARIZONA (AZ)	$520.48	$299.10
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$669.33	$347.20
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$681.57	$352.13
OXNARD-THOUSAND OAKS-VENTURA (CA)	$588.57	$318.53
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$592.49	$322.22
NAPA (CA)	$636.05	$334.93
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$670.55	$348.42
VALLEJO (CA)	$634.30	$333.18
BAKERSFIELD (CA)	$557.59	$307.20
CHICO (CA)	$554.66	$304.26
FRESNO (CA)	$554.66	$304.26
HANFORD-CORCORAN (CA)	$554.66	$304.26
MADERA (CA)	$554.66	$304.26
MERCED (CA)	$554.66	$304.26
MODESTO (CA)	$554.66	$304.26
REDDING (CA)	$554.66	$304.26
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$566.15	$315.76
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$580.36	$314.66
SALINAS (CA)	$578.19	$313.41
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$686.54	$357.10
SANTA CRUZ-WATSONVILLE (CA)	$595.45	$317.87
SANTA ROSA-PETALUMA (CA)	$601.31	$320.76
STOCKTON (CA)	$554.66	$304.26
VISALIA (CA)	$554.66	$304.26
YUBA CITY (CA)	$554.66	$304.26
EL CENTRO (CA)	$554.84	$304.44
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$590.73	$317.49
SAN LUIS OBISPO-PASO ROBLES (CA)	$569.16	$308.95
SANTA MARIA-SANTA BARBARA (CA)	$580.07	$313.68
REST OF CALIFORNIA (CA)	$554.66	$304.26
COLORADO (CO)	$551.80	$308.72
CONNECTICUT (CT)	$572.83	$326.77
DC + MD/VA SUBURBS (DC)	$608.97	$339.84
DELAWARE (DE)	$529.24	$303.52
FORT LAUDERDALE (FL)	$569.35	$337.91
MIAMI (FL)	$604.56	$366.73
REST OF FLORIDA (FL)	$539.22	$320.81
ATLANTA (GA)	$549.15	$317.04
REST OF GEORGIA (GA)	$506.51	$302.72
HAWAII, GUAM (HI)	$567.26	$307.49
IOWA (IA)	$485.86	$276.82
IDAHO (ID)	$490.26	$280.08
EAST ST. LOUIS (IL)	$545.34	$335.15
SUBURBAN CHICAGO (IL)	$573.92	$339.29
CHICAGO (IL)	$585.19	$355.59
REST OF ILLINOIS (IL)	$526.86	$318.27
INDIANA (IN)	$493.09	$281.30
KANSAS (KS)	$485.97	$279.44
KENTUCKY (KY)	$495.60	$292.50
NEW ORLEANS (LA)	$521.04	$306.06
REST OF LOUISIANA (LA)	$495.79	$293.60
METROPOLITAN BOSTON (MA)	$604.28	$331.50
REST OF MASSACHUSETTS (MA)	$549.32	$308.75
BALTIMORE/SURR. CNTYS (MD)	$571.79	$326.65
REST OF MARYLAND (MD)	$538.83	$307.63
SOUTHERN MAINE (ME)	$519.86	$293.45
REST OF MAINE (ME)	$495.59	$285.40
DETROIT (MI)	$548.79	$328.33
REST OF MICHIGAN (MI)	$511.35	$302.76
MINNESOTA (MN)	$520.71	$285.62
METROPOLITAN ST. LOUIS (MO)	$519.96	$302.47
METROPOLITAN KANSAS CITY (MO)	$514.68	$300.16
REST OF MISSOURI (MO)	$488.60	$291.67
MISSISSIPPI (MS)	$479.87	$283.16
MONTANA** (MT)	$536.01	$307.55
NORTH CAROLINA (NC)	$500.58	$287.43
NORTH DAKOTA** (ND)	$514.86	$286.39
NEBRASKA (NE)	$487.88	$277.01
NEW HAMPSHIRE (NH)	$545.45	$307.62
NORTHERN NJ (NJ)	$602.76	$337.74
REST OF NEW JERSEY (NJ)	$577.11	$327.63
NEW MEXICO (NM)	$515.27	$305.77
NEVADA** (NV)	$530.45	$301.76
MANHATTAN (NY)	$622.11	$356.64
NYC SUBURBS/LONG ISLAND (NY)	$640.90	$369.26
POUGHKPSIE/N NYC SUBURBS (NY)	$582.97	$332.81
QUEENS (NY)	$623.71	$353.67
REST OF NEW YORK (NY)	$508.60	$291.56
OHIO (OH)	$507.02	$298.44
OKLAHOMA (OK)	$492.02	$288.00
PORTLAND (OR)	$566.99	$313.17
REST OF OREGON (OR)	$524.12	$296.57
METROPOLITAN PHILADELPHIA (PA)	$559.75	$321.92
REST OF PENNSYLVANIA (PA)	$506.46	$296.73
PUERTO RICO (PR)	$539.26	$308.28
RHODE ISLAND (RI)	$546.45	$310.45
SOUTH CAROLINA (SC)	$505.09	$293.99
SOUTH DAKOTA** (SD)	$512.35	$283.89
TENNESSEE (TN)	$488.84	$281.17
BRAZORIA (TX)	$526.49	$300.08
DALLAS (TX)	$531.13	$303.58
GALVESTON (TX)	$528.88	$302.02
HOUSTON (TX)	$548.46	$321.60
BEAUMONT (TX)	$503.19	$295.28
FORT WORTH (TX)	$528.22	$302.95
AUSTIN (TX)	$551.90	$310.19
REST OF TEXAS (TX)	$515.41	$298.60
UTAH (UT)	$512.20	$297.44
VIRGINIA (VA)	$519.84	$295.26
VIRGIN ISLANDS (VI)	$539.26	$308.28
VERMONT (VT)	$515.06	$288.88
SEATTLE (KING CNTY) (WA)	$614.27	$333.95
REST OF WASHINGTON (WA)	$547.54	$306.97
WISCONSIN (WI)	$497.18	$278.32
WEST VIRGINIA (WV)	$507.30	$308.76
WYOMING** (WY)	$526.79	$298.33

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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 the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the 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 a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs vary depending on where the service is rendered, which is why this code shows two different national rates.

RVUs — work 4.88, practice expense 10.1 (non-facility) / 3.26 (facility), malpractice 1.07 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure 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, claim-specific circumstances, and sequestration or other federal payment adjustments.
The conversion factor and RVUs are updated annually and may change mid-year due to budget-neutrality adjustments or legislative action.
Always verify the final allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the facility rate differ from the non-facility rate for this code?

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is absorbing certain overhead and equipment costs, whereas the non-facility rate assumes the billing provider bears those costs directly.

Does this amount reflect what Medicare will actually pay?

No. It reflects the allowed amount before the 80/20 coinsurance split, deductible application, and any locality-specific or claim-specific adjustments such as modifiers or sequestration.

Why isn't the CPT code's description shown here?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so they cannot be reproduced on this page. Refer to your CPT codebook or EHR system for the official description.

How often do these RVU and conversion factor values change?

CMS updates RVUs and the conversion factor annually through the Physician Fee Schedule Final Rule, and may apply mid-year adjustments due to legislation or budget-neutrality requirements.

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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.