Medicare Reimbursement for CPT 12051

CPT 12051 is a physician procedure code reported under Medicare's Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount at the national level and (where available) by locality, broken out for non-facility and facility settings. Because the CPT descriptor is proprietary to the AMA, this page refers to the code generically rather than restating its definition.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$282.91	$149.30
ALASKA* (AK)	$329.30	$187.01
ALABAMA (AL)	$254.03	$137.12
ARKANSAS (AR)	$250.37	$135.61
ARIZONA (AZ)	$275.39	$145.93
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$365.47	$177.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$372.66	$180.00
OXNARD-THOUSAND OAKS-VENTURA (CA)	$317.30	$159.38
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$318.88	$160.83
NAPA (CA)	$345.69	$169.60
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$365.80	$177.42
VALLEJO (CA)	$345.22	$169.13
BAKERSFIELD (CA)	$299.51	$153.08
CHICO (CA)	$298.65	$152.22
FRESNO (CA)	$298.65	$152.22
HANFORD-CORCORAN (CA)	$298.65	$152.22
MADERA (CA)	$298.65	$152.22
MERCED (CA)	$298.65	$152.22
MODESTO (CA)	$298.65	$152.22
REDDING (CA)	$298.65	$152.22
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$301.80	$155.37
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$313.32	$157.94
SALINAS (CA)	$312.15	$157.30
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$374.00	$181.35
SANTA CRUZ-WATSONVILLE (CA)	$322.44	$160.12
SANTA ROSA-PETALUMA (CA)	$325.69	$161.63
STOCKTON (CA)	$298.65	$152.22
VISALIA (CA)	$298.65	$152.22
YUBA CITY (CA)	$298.65	$152.22
EL CENTRO (CA)	$298.70	$152.27
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$319.43	$159.64
SAN LUIS OBISPO-PASO ROBLES (CA)	$307.14	$154.96
SANTA MARIA-SANTA BARBARA (CA)	$313.30	$157.52
REST OF CALIFORNIA (CA)	$298.65	$152.22
COLORADO (CO)	$294.33	$152.17
CONNECTICUT (CT)	$301.66	$157.76
DC + MD/VA SUBURBS (DC)	$323.23	$165.85
DELAWARE (DE)	$279.94	$147.94
FORT LAUDERDALE (FL)	$293.30	$157.96
MIAMI (FL)	$305.81	$166.73
REST OF FLORIDA (FL)	$279.09	$151.37
ATLANTA (GA)	$288.24	$152.50
REST OF GEORGIA (GA)	$263.45	$144.27
HAWAII, GUAM (HI)	$305.87	$153.96
IOWA (IA)	$260.29	$138.04
IDAHO (ID)	$262.01	$139.09
EAST ST. LOUIS (IL)	$276.94	$154.02
SUBURBAN CHICAGO (IL)	$296.24	$159.03
CHICAGO (IL)	$296.97	$162.70
REST OF ILLINOIS (IL)	$271.19	$149.21
INDIANA (IN)	$263.52	$139.67
KANSAS (KS)	$259.15	$138.37
KENTUCKY (KY)	$260.17	$141.40
NEW ORLEANS (LA)	$272.58	$146.86
REST OF LOUISIANA (LA)	$259.80	$141.56
METROPOLITAN BOSTON (MA)	$323.24	$163.72
REST OF MASSACHUSETTS (MA)	$292.61	$151.93
BALTIMORE/SURR. CNTYS (MD)	$300.82	$157.47
REST OF MARYLAND (MD)	$285.24	$150.03
SOUTHERN MAINE (ME)	$277.55	$145.15
REST OF MAINE (ME)	$263.45	$140.54
DETROIT (MI)	$282.64	$153.71
REST OF MICHIGAN (MI)	$266.98	$145.00
MINNESOTA (MN)	$281.81	$144.33
METROPOLITAN ST. LOUIS (MO)	$273.45	$146.26
METROPOLITAN KANSAS CITY (MO)	$270.64	$145.19
REST OF MISSOURI (MO)	$255.41	$140.25
MISSISSIPPI (MS)	$252.94	$137.91
MONTANA** (MT)	$282.89	$149.28
NORTH CAROLINA (NC)	$266.18	$141.53
NORTH DAKOTA** (ND)	$277.15	$143.55
NEBRASKA (NE)	$261.68	$138.36
NEW HAMPSHIRE (NH)	$289.79	$150.71
NORTHERN NJ (NJ)	$319.92	$164.94
REST OF NEW JERSEY (NJ)	$305.04	$159.14
NEW MEXICO (NM)	$268.47	$145.95
NEVADA** (NV)	$281.49	$147.75
MANHATTAN (NY)	$325.41	$170.17
NYC SUBURBS/LONG ISLAND (NY)	$333.37	$174.51
POUGHKPSIE/N NYC SUBURBS (NY)	$307.10	$160.81
QUEENS (NY)	$327.97	$170.05
REST OF NEW YORK (NY)	$270.16	$143.24
OHIO (OH)	$265.81	$143.83
OKLAHOMA (OK)	$259.62	$140.32
PORTLAND (OR)	$303.55	$155.12
REST OF OREGON (OR)	$279.24	$146.17
METROPOLITAN PHILADELPHIA (PA)	$294.23	$155.15
REST OF PENNSYLVANIA (PA)	$266.19	$143.54
PUERTO RICO (PR)	$284.93	$149.86
RHODE ISLAND (RI)	$289.81	$151.80
SOUTH CAROLINA (SC)	$266.45	$143.00
SOUTH DAKOTA** (SD)	$276.47	$142.87
TENNESSEE (TN)	$260.46	$139.01
BRAZORIA (TX)	$279.60	$147.20
DALLAS (TX)	$281.42	$148.35
GALVESTON (TX)	$280.46	$147.80
HOUSTON (TX)	$285.77	$153.10
BEAUMONT (TX)	$264.45	$142.87
FORT WORTH (TX)	$279.57	$147.84
AUSTIN (TX)	$293.40	$152.05
REST OF TEXAS (TX)	$271.90	$145.11
UTAH (UT)	$270.07	$144.49
VIRGINIA (VA)	$276.70	$145.37
VIRGIN ISLANDS (VI)	$284.93	$149.86
VERMONT (VT)	$276.15	$143.88
SEATTLE (KING CNTY) (WA)	$329.73	$165.80
REST OF WASHINGTON (WA)	$292.04	$151.35
WISCONSIN (WI)	$267.91	$139.92
WEST VIRGINIA (WV)	$261.22	$145.12
WYOMING** (WY)	$280.39	$146.78

Look up another code or locality →

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 — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because the resource costs differ — practices typically absorb more overhead in the non-facility setting, which is why non-facility amounts are usually higher. The result is the same work and malpractice RVU inputs, but a different final allowed amount depending on where the service is furnished.

RVUs — work 2.27, practice expense 5.91 (non-facility) / 1.91 (facility), malpractice 0.29 — × 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 patient meets their deductible; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the actual allowed amount can differ from the national figure shown here.
Always verify final payment rules and amounts with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the non-facility amount different from the facility amount for the same code?

The practice-expense RVU differs by setting because the resources and overhead a provider bears differ between an office (non-facility) and a hospital or ASC (facility), where the facility itself bills separately for overhead costs.

Does this amount reflect what Medicare will actually pay?

No — it reflects the PFS allowed amount before the standard 80/20 cost-sharing split, deductible application, and any applicable modifiers or adjustments are applied.

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

The PFS formula applies Geographic Practice Cost Indices (GPCIs) specific to each Medicare locality, which adjust the work, practice-expense, and malpractice RVUs to reflect regional cost differences before the conversion factor is applied.

Can this amount change during the year?

Yes — budget-neutrality adjustments, sequestration, and periodic CMS updates to RVUs or the conversion factor can all affect the final paid amount even within the same calendar year.

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.