Medicare Reimbursement for CPT 12041

This page covers a specific physician procedure code (CPT 12041), identified generically here because CPT descriptors are proprietary to the AMA. It shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both at the national level and adjusted for locality, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$262.87	$129.26
ALASKA* (AK)	$305.44	$163.16
ALABAMA (AL)	$235.99	$119.08
ARKANSAS (AR)	$232.58	$117.82
ARIZONA (AZ)	$255.90	$126.43
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$340.85	$152.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$347.59	$154.94
OXNARD-THOUSAND OAKS-VENTURA (CA)	$295.49	$137.57
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$296.91	$138.86
NAPA (CA)	$322.23	$146.14
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$341.13	$152.75
VALLEJO (CA)	$321.82	$145.73
BAKERSFIELD (CA)	$278.76	$132.33
CHICO (CA)	$278.01	$131.59
FRESNO (CA)	$278.01	$131.59
HANFORD-CORCORAN (CA)	$278.01	$131.59
MADERA (CA)	$278.01	$131.59
MERCED (CA)	$278.01	$131.59
MODESTO (CA)	$278.01	$131.59
REDDING (CA)	$278.01	$131.59
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$280.73	$134.30
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$291.78	$136.40
SALINAS (CA)	$290.69	$135.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$348.75	$156.10
SANTA CRUZ-WATSONVILLE (CA)	$300.43	$138.10
SANTA ROSA-PETALUMA (CA)	$303.46	$139.40
STOCKTON (CA)	$278.01	$131.59
VISALIA (CA)	$278.01	$131.59
YUBA CITY (CA)	$278.01	$131.59
EL CENTRO (CA)	$278.06	$131.63
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$297.56	$137.77
SAN LUIS OBISPO-PASO ROBLES (CA)	$286.01	$133.84
SANTA MARIA-SANTA BARBARA (CA)	$291.79	$136.01
REST OF CALIFORNIA (CA)	$278.01	$131.59
COLORADO (CO)	$273.76	$131.61
CONNECTICUT (CT)	$280.31	$136.42
DC + MD/VA SUBURBS (DC)	$300.62	$143.24
DELAWARE (DE)	$260.13	$128.13
FORT LAUDERDALE (FL)	$272.03	$136.69
MIAMI (FL)	$283.26	$144.18
REST OF FLORIDA (FL)	$258.88	$131.15
ATLANTA (GA)	$267.73	$131.98
REST OF GEORGIA (GA)	$244.38	$125.20
HAWAII, GUAM (HI)	$284.84	$132.93
IOWA (IA)	$242.02	$119.77
IDAHO (ID)	$243.58	$120.67
EAST ST. LOUIS (IL)	$256.45	$133.53
SUBURBAN CHICAGO (IL)	$274.81	$137.60
CHICAGO (IL)	$275.09	$140.82
REST OF ILLINOIS (IL)	$251.38	$129.40
INDIANA (IN)	$244.99	$121.14
KANSAS (KS)	$240.86	$120.09
KENTUCKY (KY)	$241.50	$122.73
NEW ORLEANS (LA)	$253.02	$127.30
REST OF LOUISIANA (LA)	$241.12	$122.88
METROPOLITAN BOSTON (MA)	$300.85	$141.32
REST OF MASSACHUSETTS (MA)	$272.13	$131.44
BALTIMORE/SURR. CNTYS (MD)	$279.52	$136.16
REST OF MARYLAND (MD)	$265.10	$129.89
SOUTHERN MAINE (ME)	$258.11	$125.71
REST OF MAINE (ME)	$244.83	$121.91
DETROIT (MI)	$262.08	$133.15
REST OF MICHIGAN (MI)	$247.76	$125.78
MINNESOTA (MN)	$262.38	$124.90
METROPOLITAN ST. LOUIS (MO)	$253.95	$126.76
METROPOLITAN KANSAS CITY (MO)	$251.32	$125.87
REST OF MISSOURI (MO)	$236.97	$121.81
MISSISSIPPI (MS)	$234.83	$119.79
MONTANA** (MT)	$262.85	$129.24
NORTH CAROLINA (NC)	$247.39	$122.73
NORTH DAKOTA** (ND)	$257.91	$124.30
NEBRASKA (NE)	$243.35	$120.03
NEW HAMPSHIRE (NH)	$269.45	$130.37
NORTHERN NJ (NJ)	$297.51	$142.53
REST OF NEW JERSEY (NJ)	$283.53	$137.63
NEW MEXICO (NM)	$249.10	$126.59
NEVADA** (NV)	$261.66	$127.92
MANHATTAN (NY)	$302.28	$147.03
NYC SUBURBS/LONG ISLAND (NY)	$309.57	$150.71
POUGHKPSIE/N NYC SUBURBS (NY)	$285.37	$139.08
QUEENS (NY)	$304.80	$146.88
REST OF NEW YORK (NY)	$251.08	$124.16
OHIO (OH)	$246.75	$124.77
OKLAHOMA (OK)	$241.10	$121.79
PORTLAND (OR)	$282.47	$134.04
REST OF OREGON (OR)	$259.64	$126.57
METROPOLITAN PHILADELPHIA (PA)	$273.34	$134.26
REST OF PENNSYLVANIA (PA)	$247.15	$124.50
PUERTO RICO (PR)	$264.79	$129.71
RHODE ISLAND (RI)	$269.40	$131.39
SOUTH CAROLINA (SC)	$247.47	$124.02
SOUTH DAKOTA** (SD)	$257.32	$123.72
TENNESSEE (TN)	$242.07	$120.62
BRAZORIA (TX)	$259.90	$127.50
DALLAS (TX)	$261.55	$128.48
GALVESTON (TX)	$260.67	$128.01
HOUSTON (TX)	$265.25	$132.58
BEAUMONT (TX)	$245.53	$123.95
FORT WORTH (TX)	$259.80	$128.07
AUSTIN (TX)	$272.84	$131.49
REST OF TEXAS (TX)	$252.57	$125.78
UTAH (UT)	$250.85	$125.26
VIRGINIA (VA)	$257.25	$125.92
VIRGIN ISLANDS (VI)	$264.79	$129.71
VERMONT (VT)	$256.88	$124.61
SEATTLE (KING CNTY) (WA)	$306.99	$143.06
REST OF WASHINGTON (WA)	$271.62	$130.94
WISCONSIN (WI)	$249.27	$121.28
WEST VIRGINIA (WV)	$242.09	$125.99
WYOMING** (WY)	$260.69	$127.09

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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) assigned to the code: work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, reflecting local 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 settings differ primarily in the PE RVU, since practice expenses are typically higher when the physician's office bears the overhead, versus a facility (like a hospital) absorbing those costs.

RVUs — work 2.05, practice expense 5.57 (non-facility) / 1.57 (facility), malpractice 0.25 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment can differ based on locality, specific MAC policies, and claim-level factors.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary insurer is responsible for the remainder.
Modifiers (e.g., bilateral, multiple procedure, assistant surgeon) can increase or reduce the final payment.
Annual budget-neutrality adjustments and sequestration (currently applied to Medicare claims) can change the effective payment amount.
Always confirm final allowed amounts and payment policy with your Medicare Administrative Contractor (MAC) or the current year's PFS lookup tool.

Frequently asked

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

The facility rate uses a lower practice expense RVU because the hospital or facility — not the physician's office — bears most of the overhead costs (equipment, supplies, staff) for the service.

Why might the amount I'm paid differ from the national figure shown here?

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust for local labor, rent, and malpractice insurance costs, so the same code can pay differently depending on the locality where it's billed.

Does this amount reflect what the patient or secondary payer owes?

No — the figures shown represent the full Medicare allowed amount. Medicare generally pays 80% of that after the deductible, with the remaining 20% typically owed by the patient or a secondary payer.

Can modifiers change this fee?

Yes. Modifiers such as those for bilateral procedures, multiple procedures, or reduced services can adjust the final reimbursement up or down from the base PFS amount shown here.

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.