Medicare Reimbursement for CPT 12046

CPT 12046 is a procedure code defined by the American Medical Association; its specific descriptor isn't reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both at the national level and adjustable by locality, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) payment rates.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$557.13	$313.30
ALASKA* (AK)	$634.99	$375.31
ALABAMA (AL)	$493.42	$280.07
ARKANSAS (AR)	$485.44	$275.99
ARIZONA (AZ)	$539.97	$303.70
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$704.62	$360.82
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$717.82	$366.22
OXNARD-THOUSAND OAKS-VENTURA (CA)	$616.06	$327.86
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$619.79	$331.35
NAPA (CA)	$668.30	$346.94
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$705.89	$362.09
VALLEJO (CA)	$666.47	$345.11
BAKERSFIELD (CA)	$581.62	$314.38
CHICO (CA)	$578.61	$311.37
FRESNO (CA)	$578.61	$311.37
HANFORD-CORCORAN (CA)	$578.61	$311.37
MADERA (CA)	$578.61	$311.37
MERCED (CA)	$578.61	$311.37
MODESTO (CA)	$578.61	$311.37
REDDING (CA)	$578.61	$311.37
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$590.60	$323.37
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$606.71	$323.14
SALINAS (CA)	$604.49	$321.90
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$723.02	$371.42
SANTA CRUZ-WATSONVILLE (CA)	$624.36	$328.11
SANTA ROSA-PETALUMA (CA)	$630.55	$331.14
STOCKTON (CA)	$578.61	$311.37
VISALIA (CA)	$578.61	$311.37
YUBA CITY (CA)	$578.61	$311.37
EL CENTRO (CA)	$578.79	$311.56
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$618.63	$327.01
SAN LUIS OBISPO-PASO ROBLES (CA)	$594.94	$317.22
SANTA MARIA-SANTA BARBARA (CA)	$606.73	$322.43
REST OF CALIFORNIA (CA)	$578.61	$311.37
COLORADO (CO)	$574.92	$315.49
CONNECTICUT (CT)	$597.02	$334.42
DC + MD/VA SUBURBS (DC)	$636.51	$349.28
DELAWARE (DE)	$549.49	$308.59
FORT LAUDERDALE (FL)	$592.29	$345.29
MIAMI (FL)	$629.90	$376.07
REST OF FLORIDA (FL)	$559.23	$326.14
ATLANTA (GA)	$571.14	$323.41
REST OF GEORGIA (GA)	$523.29	$305.80
HAWAII, GUAM (HI)	$593.41	$316.18
IOWA (IA)	$502.29	$279.19
IDAHO (ID)	$507.03	$282.71
EAST ST. LOUIS (IL)	$564.68	$340.36
SUBURBAN CHICAGO (IL)	$597.24	$346.83
CHICAGO (IL)	$608.45	$363.40
REST OF ILLINOIS (IL)	$545.15	$322.53
INDIANA (IN)	$510.18	$284.15
KANSAS (KS)	$502.11	$281.70
KENTUCKY (KY)	$511.79	$295.03
NEW ORLEANS (LA)	$539.81	$310.37
REST OF LOUISIANA (LA)	$511.88	$296.10
METROPOLITAN BOSTON (MA)	$632.42	$341.30
REST OF MASSACHUSETTS (MA)	$571.90	$315.15
BALTIMORE/SURR. CNTYS (MD)	$595.96	$334.33
REST OF MARYLAND (MD)	$560.02	$313.26
SOUTHERN MAINE (ME)	$539.91	$298.27
REST OF MAINE (ME)	$512.60	$288.28
DETROIT (MI)	$569.50	$334.21
REST OF MICHIGAN (MI)	$528.91	$306.30
MINNESOTA (MN)	$541.80	$290.91
METROPOLITAN ST. LOUIS (MO)	$538.97	$306.85
METROPOLITAN KANSAS CITY (MO)	$533.10	$304.15
REST OF MISSOURI (MO)	$503.75	$293.57
MISSISSIPPI (MS)	$494.58	$284.64
MONTANA** (MT)	$557.05	$313.23
NORTH CAROLINA (NC)	$518.18	$290.69
NORTH DAKOTA** (ND)	$534.91	$291.08
NEBRASKA (NE)	$504.62	$279.56
NEW HAMPSHIRE (NH)	$568.02	$314.20
NORTHERN NJ (NJ)	$629.25	$346.41
REST OF NEW JERSEY (NJ)	$601.29	$335.03
NEW MEXICO (NM)	$533.13	$309.54
NEVADA** (NV)	$551.26	$307.19
MANHATTAN (NY)	$649.53	$366.20
NYC SUBURBS/LONG ISLAND (NY)	$669.92	$380.01
POUGHKPSIE/N NYC SUBURBS (NY)	$607.36	$340.37
QUEENS (NY)	$651.74	$363.53
REST OF NEW YORK (NY)	$527.03	$295.39
OHIO (OH)	$524.39	$301.77
OKLAHOMA (OK)	$508.15	$290.41
PORTLAND (OR)	$591.94	$321.05
REST OF OREGON (OR)	$544.50	$301.65
METROPOLITAN PHILADELPHIA (PA)	$582.44	$328.61
REST OF PENNSYLVANIA (PA)	$523.93	$300.10
PUERTO RICO (PR)	$560.74	$314.23
RHODE ISLAND (RI)	$568.28	$316.41
SOUTH CAROLINA (SC)	$522.65	$297.36
SOUTH DAKOTA** (SD)	$532.29	$288.46
TENNESSEE (TN)	$505.25	$283.61
BRAZORIA (TX)	$546.60	$304.97
DALLAS (TX)	$551.56	$308.70
GALVESTON (TX)	$549.15	$307.03
HOUSTON (TX)	$569.65	$327.53
BEAUMONT (TX)	$520.29	$298.41
FORT WORTH (TX)	$548.24	$307.83
AUSTIN (TX)	$575.17	$317.20
REST OF TEXAS (TX)	$534.13	$302.74
UTAH (UT)	$530.53	$301.33
VIRGINIA (VA)	$539.67	$299.99
VIRGIN ISLANDS (VI)	$560.74	$314.23
VERMONT (VT)	$534.85	$293.46
SEATTLE (KING CNTY) (WA)	$643.49	$344.31
REST OF WASHINGTON (WA)	$570.13	$313.38
WISCONSIN (WI)	$515.29	$281.70
WEST VIRGINIA (WV)	$523.50	$311.62
WYOMING** (WY)	$547.40	$303.57

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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 each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, accounting for local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility settings use different practice-expense RVUs because overhead costs differ when a service is performed in a physician's office versus a hospital or facility setting, which is why the two allowed amounts differ.

RVUs — work 4.19, practice expense 11.37 (non-facility) / 4.07 (facility), malpractice 1.12 — × 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 annual Part B deductible is met; the beneficiary or secondary insurance covers the remainder.
Actual payment can vary by locality, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and applicability with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

In the facility setting, the facility (e.g., hospital) absorbs certain overhead and equipment costs separately, so the practice-expense RVU assigned to the professional service is lower, reducing the total allowed amount compared to performing the same service in a non-facility setting like an office.

Does this amount reflect what Medicare will actually pay?

No. The figures shown are PFS allowed amounts calculated using national RVUs, GPCIs, and the conversion factor. Actual payment depends on the beneficiary's deductible status, the 80/20 coinsurance split, locality-specific GPCIs, modifiers, and any sequestration or budget-neutrality adjustments in effect.

Why does the amount change by locality?

Each locality has its own GPCI values for work, practice expense, and malpractice, reflecting regional differences in wages, rents, and liability costs. These indices multiply against the RVUs before the conversion factor is applied, so the same code can price differently across regions.

Where can I find the official descriptor for CPT 12046?

The CPT code descriptor is copyrighted by the American Medical Association. Billers and clinicians should consult the current AMA CPT codebook or a licensed CPT reference tool for the exact language.

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.