Medicare Reimbursement for CPT Code 12047

CPT code 12047 is a procedure code recognized under the Medicare Physician Fee Schedule (PFS); because CPT descriptors are AMA-licensed, this page refers to it generically rather than reproducing the official description. The figures shown reflect the national Medicare PFS allowed amount for this code, along with locality-adjusted estimates, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$610.23	$345.70
ALASKA* (AK)	$697.93	$416.20
ALABAMA (AL)	$540.81	$309.34
ARKANSAS (AR)	$532.12	$304.88
ARIZONA (AZ)	$591.45	$335.11
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$767.17	$394.18
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$781.37	$399.91
OXNARD-THOUSAND OAKS-VENTURA (CA)	$672.37	$359.69
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$676.64	$363.69
NAPA (CA)	$728.25	$379.59
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$768.64	$395.64
VALLEJO (CA)	$726.14	$377.48
BAKERSFIELD (CA)	$635.41	$345.48
CHICO (CA)	$631.94	$342.01
FRESNO (CA)	$631.94	$342.01
HANFORD-CORCORAN (CA)	$631.94	$342.01
MADERA (CA)	$631.94	$342.01
MERCED (CA)	$631.94	$342.01
MODESTO (CA)	$631.94	$342.01
REDDING (CA)	$631.94	$342.01
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$645.76	$355.83
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$662.20	$354.54
SALINAS (CA)	$659.77	$353.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$787.36	$405.90
SANTA CRUZ-WATSONVILLE (CA)	$680.88	$359.47
SANTA ROSA-PETALUMA (CA)	$687.61	$362.76
STOCKTON (CA)	$631.94	$342.01
VISALIA (CA)	$631.94	$342.01
YUBA CITY (CA)	$631.94	$342.01
EL CENTRO (CA)	$632.16	$342.23
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$674.88	$358.50
SAN LUIS OBISPO-PASO ROBLES (CA)	$649.39	$348.09
SANTA MARIA-SANTA BARBARA (CA)	$662.13	$353.68
REST OF CALIFORNIA (CA)	$631.94	$342.01
COLORADO (CO)	$628.71	$347.24
CONNECTICUT (CT)	$653.76	$368.85
DC + MD/VA SUBURBS (DC)	$696.05	$384.43
DELAWARE (DE)	$601.82	$340.46
FORT LAUDERDALE (FL)	$650.32	$382.35
MIAMI (FL)	$692.75	$417.37
REST OF FLORIDA (FL)	$614.05	$361.16
ATLANTA (GA)	$625.87	$357.10
REST OF GEORGIA (GA)	$574.68	$338.71
HAWAII, GUAM (HI)	$647.69	$346.92
IOWA (IA)	$549.76	$307.71
IDAHO (ID)	$555.06	$311.69
EAST ST. LOUIS (IL)	$621.46	$378.09
SUBURBAN CHICAGO (IL)	$655.58	$383.91
CHICAGO (IL)	$669.19	$403.33
REST OF ILLINOIS (IL)	$599.19	$357.67
INDIANA (IN)	$558.46	$313.24
KANSAS (KS)	$549.90	$310.76
KENTUCKY (KY)	$561.53	$326.35
NEW ORLEANS (LA)	$592.15	$343.22
REST OF LOUISIANA (LA)	$561.76	$327.64
METROPOLITAN BOSTON (MA)	$690.84	$374.98
REST OF MASSACHUSETTS (MA)	$625.58	$347.02
BALTIMORE/SURR. CNTYS (MD)	$652.65	$368.81
REST OF MARYLAND (MD)	$613.18	$345.47
SOUTHERN MAINE (ME)	$590.68	$328.53
REST OF MAINE (ME)	$561.48	$318.11
DETROIT (MI)	$625.59	$370.31
REST OF MICHIGAN (MI)	$580.49	$338.97
MINNESOTA (MN)	$591.67	$319.46
METROPOLITAN ST. LOUIS (MO)	$590.84	$339.00
METROPOLITAN KANSAS CITY (MO)	$584.49	$336.09
REST OF MISSOURI (MO)	$553.11	$325.08
MISSISSIPPI (MS)	$542.58	$314.81
MONTANA** (MT)	$610.15	$345.61
NORTH CAROLINA (NC)	$567.49	$320.68
NORTH DAKOTA** (ND)	$584.64	$320.11
NEBRASKA (NE)	$552.19	$308.02
NEW HAMPSHIRE (NH)	$621.49	$346.11
NORTHERN NJ (NJ)	$688.26	$381.40
REST OF NEW JERSEY (NJ)	$658.20	$369.33
NEW MEXICO (NM)	$585.21	$342.63
NEVADA** (NV)	$603.44	$338.65
MANHATTAN (NY)	$711.55	$404.16
NYC SUBURBS/LONG ISLAND (NY)	$734.19	$419.65
POUGHKPSIE/N NYC SUBURBS (NY)	$665.10	$375.43
QUEENS (NY)	$713.46	$400.78
REST OF NEW YORK (NY)	$577.15	$325.84
OHIO (OH)	$575.27	$333.75
OKLAHOMA (OK)	$557.20	$320.97
PORTLAND (OR)	$646.83	$352.93
REST OF OREGON (OR)	$595.81	$332.34
METROPOLITAN PHILADELPHIA (PA)	$638.09	$362.71
REST OF PENNSYLVANIA (PA)	$574.59	$331.74
PUERTO RICO (PR)	$614.05	$346.61
RHODE ISLAND (RI)	$622.04	$348.77
SOUTH CAROLINA (SC)	$572.93	$328.50
SOUTH DAKOTA** (SD)	$581.62	$317.09
TENNESSEE (TN)	$553.36	$312.89
BRAZORIA (TX)	$598.39	$336.24
DALLAS (TX)	$603.94	$340.47
GALVESTON (TX)	$601.27	$338.59
HOUSTON (TX)	$624.89	$362.20
BEAUMONT (TX)	$570.65	$329.92
FORT WORTH (TX)	$600.45	$339.62
AUSTIN (TX)	$629.18	$349.30
REST OF TEXAS (TX)	$585.36	$334.31
UTAH (UT)	$581.49	$332.83
VIRGINIA (VA)	$590.67	$330.63
VIRGIN ISLANDS (VI)	$614.05	$346.61
VERMONT (VT)	$584.89	$323.00
SEATTLE (KING CNTY) (WA)	$702.54	$377.95
REST OF WASHINGTON (WA)	$623.54	$344.99
WISCONSIN (WI)	$563.37	$309.95
WEST VIRGINIA (WV)	$575.64	$345.76
WYOMING** (WY)	$599.03	$334.50

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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 pricing for each code starts with three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (staff, supplies, equipment) are generally higher when the service is performed in a physician's office versus a hospital or other facility.

RVUs — work 4.83, practice expense 12.15 (non-facility) / 4.23 (facility), malpractice 1.29 — × 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 is responsible for the remainder.
Actual payment can vary by locality, modifiers, place of service, and claim-specific circumstances.
Annual updates to RVUs, GPCIs, and the conversion factor, as well as budget-neutrality adjustments and sequestration, can change amounts year to year.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (not the physician's office) is bearing overhead costs like staff, supplies, and equipment for the service.

Why might my locality's allowed amount differ from the national figure?

Each locality has its own GPCIs for work, practice expense, and malpractice, reflecting regional differences in wages and costs, which adjust the RVUs before the conversion factor is applied.

Does this amount reflect what the patient will owe?

No. The allowed amount is the basis for payment; the patient (or secondary payer) is typically responsible for 20% coinsurance after the deductible, subject to plan-specific rules.

Can modifiers change the reimbursement for this code?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the final payment from the base PFS amount shown here.

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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.