Medicare Reimbursement for CPT 12045

CPT 12045 is a procedure code used for billing Medicare Part B services; this page does not reproduce the AMA-licensed descriptor. It shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both nationally and adjustable by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$453.58	$268.54
ALASKA* (AK)	$524.23	$327.16
ALABAMA (AL)	$404.94	$243.03
ARKANSAS (AR)	$398.82	$239.87
ARIZONA (AZ)	$440.67	$261.37
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$578.02	$317.11
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$589.05	$322.22
OXNARD-THOUSAND OAKS-VENTURA (CA)	$504.24	$285.52
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$507.10	$288.19
NAPA (CA)	$547.71	$303.83
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$578.81	$317.90
VALLEJO (CA)	$546.57	$302.68
BAKERSFIELD (CA)	$476.33	$273.52
CHICO (CA)	$474.38	$271.57
FRESNO (CA)	$474.38	$271.57
HANFORD-CORCORAN (CA)	$474.38	$271.57
MADERA (CA)	$474.38	$271.57
MERCED (CA)	$474.38	$271.57
MODESTO (CA)	$474.38	$271.57
REDDING (CA)	$474.38	$271.57
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$481.91	$279.11
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$497.33	$282.13
SALINAS (CA)	$495.49	$281.03
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$592.30	$325.47
SANTA CRUZ-WATSONVILLE (CA)	$511.51	$286.69
SANTA ROSA-PETALUMA (CA)	$516.62	$289.39
STOCKTON (CA)	$474.38	$271.57
VISALIA (CA)	$474.38	$271.57
YUBA CITY (CA)	$474.38	$271.57
EL CENTRO (CA)	$474.49	$271.69
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$506.90	$285.59
SAN LUIS OBISPO-PASO ROBLES (CA)	$487.62	$276.86
SANTA MARIA-SANTA BARBARA (CA)	$497.28	$281.52
REST OF CALIFORNIA (CA)	$474.38	$271.57
COLORADO (CO)	$469.64	$272.76
CONNECTICUT (CT)	$484.65	$285.36
DC + MD/VA SUBURBS (DC)	$517.64	$299.67
DELAWARE (DE)	$448.14	$265.32
FORT LAUDERDALE (FL)	$476.48	$289.03
MIAMI (FL)	$501.96	$309.33
REST OF FLORIDA (FL)	$451.79	$274.90
ATLANTA (GA)	$463.58	$275.58
REST OF GEORGIA (GA)	$424.81	$259.76
HAWAII, GUAM (HI)	$485.93	$275.54
IOWA (IA)	$413.31	$244.00
IDAHO (ID)	$416.63	$246.39
EAST ST. LOUIS (IL)	$452.66	$282.42
SUBURBAN CHICAGO (IL)	$480.80	$290.77
CHICAGO (IL)	$486.26	$300.29
REST OF ILLINOIS (IL)	$439.96	$271.01
INDIANA (IN)	$419.09	$247.55
KANSAS (KS)	$412.42	$245.15
KENTUCKY (KY)	$417.41	$252.91
NEW ORLEANS (LA)	$438.59	$264.47
REST OF LOUISIANA (LA)	$417.19	$253.43
METROPOLITAN BOSTON (MA)	$515.77	$294.83
REST OF MASSACHUSETTS (MA)	$467.12	$272.27
BALTIMORE/SURR. CNTYS (MD)	$483.56	$285.01
REST OF MARYLAND (MD)	$456.58	$269.32
SOUTHERN MAINE (ME)	$442.19	$258.81
REST OF MAINE (ME)	$420.11	$249.87
DETROIT (MI)	$458.84	$280.28
REST OF MICHIGAN (MI)	$429.81	$260.87
MINNESOTA (MN)	$446.05	$255.65
METROPOLITAN ST. LOUIS (MO)	$438.85	$262.69
METROPOLITAN KANSAS CITY (MO)	$434.26	$260.51
REST OF MISSOURI (MO)	$410.48	$250.97
MISSISSIPPI (MS)	$404.68	$245.36
MONTANA** (MT)	$453.54	$268.50
NORTH CAROLINA (NC)	$424.51	$251.87
NORTH DAKOTA** (ND)	$439.70	$254.66
NEBRASKA (NE)	$415.33	$244.54
NEW HAMPSHIRE (NH)	$463.29	$270.66
NORTHERN NJ (NJ)	$512.15	$297.50
REST OF NEW JERSEY (NJ)	$489.07	$287.01
NEW MEXICO (NM)	$432.72	$263.04
NEVADA** (NV)	$449.99	$264.76
MANHATTAN (NY)	$525.00	$309.98
NYC SUBURBS/LONG ISLAND (NY)	$539.65	$319.64
POUGHKPSIE/N NYC SUBURBS (NY)	$493.25	$290.63
QUEENS (NY)	$527.79	$309.07
REST OF NEW YORK (NY)	$431.24	$255.45
OHIO (OH)	$426.98	$258.04
OKLAHOMA (OK)	$415.42	$250.18
PORTLAND (OR)	$483.74	$278.16
REST OF OREGON (OR)	$445.41	$261.11
METROPOLITAN PHILADELPHIA (PA)	$472.92	$280.30
REST OF PENNSYLVANIA (PA)	$427.05	$257.18
PUERTO RICO (PR)	$456.62	$269.54
RHODE ISLAND (RI)	$463.54	$272.40
SOUTH CAROLINA (SC)	$426.67	$255.69
SOUTH DAKOTA** (SD)	$438.06	$253.02
TENNESSEE (TN)	$414.73	$246.53
BRAZORIA (TX)	$446.65	$263.27
DALLAS (TX)	$450.13	$265.83
GALVESTON (TX)	$448.39	$264.64
HOUSTON (TX)	$461.20	$277.45
BEAUMONT (TX)	$424.21	$255.82
FORT WORTH (TX)	$447.36	$264.91
AUSTIN (TX)	$469.02	$273.25
REST OF TEXAS (TX)	$435.61	$260.01
UTAH (UT)	$432.72	$258.78
VIRGINIA (VA)	$441.48	$259.58
VIRGIN ISLANDS (VI)	$456.62	$269.54
VERMONT (VT)	$438.95	$255.76
SEATTLE (KING CNTY) (WA)	$525.32	$298.28
REST OF WASHINGTON (WA)	$465.91	$271.06
WISCONSIN (WI)	$424.47	$247.20
WEST VIRGINIA (WV)	$423.32	$262.52
WYOMING** (WY)	$447.51	$262.46

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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 PFS amounts are built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the two allowed amounts differ.

RVUs — work 3.66, practice expense 9.22 (non-facility) / 3.68 (facility), malpractice 0.7 — × 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 Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality GPCIs, modifiers, place of service, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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

Facility rates use lower practice-expense RVUs because Medicare assumes the facility (e.g., hospital) — not the billing physician's office — absorbs overhead costs like equipment, supplies, and staff for that setting.

Does this amount apply everywhere in the country?

No. The national figure is a baseline; actual payment is adjusted using locality-specific GPICs for work, practice expense, and malpractice, so amounts vary by geographic area.

What will Medicare actually pay for this code?

Generally 80% of the allowed amount after the annual Part B deductible, assuming no modifiers, sequestration, or other adjustments apply.

Can I use this figure for claims submission or appeals?

No — this is an informational estimate. Confirm the exact allowed amount and payment rules with your MAC before billing or appealing a denial.

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.