Medicare Reimbursement for CPT 12052

CPT 12052 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated national Medicare-allowed amount for this code, along with non-facility and facility rates, which can be adjusted for a specific locality.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$311.96	$172.68
ALASKA* (AK)	$367.09	$218.75
ALABAMA (AL)	$281.15	$159.28
ARKANSAS (AR)	$277.26	$157.61
ARIZONA (AZ)	$303.91	$168.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$399.22	$202.84
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$406.94	$206.09
OXNARD-THOUSAND OAKS-VENTURA (CA)	$347.99	$183.36
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$349.88	$185.11
NAPA (CA)	$378.12	$194.55
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$399.61	$203.22
VALLEJO (CA)	$377.57	$193.99
BAKERSFIELD (CA)	$329.18	$176.53
CHICO (CA)	$328.17	$175.51
FRESNO (CA)	$328.17	$175.51
HANFORD-CORCORAN (CA)	$328.17	$175.51
MADERA (CA)	$328.17	$175.51
MERCED (CA)	$328.17	$175.51
MODESTO (CA)	$328.17	$175.51
REDDING (CA)	$328.17	$175.51
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$331.86	$179.21
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$343.82	$181.83
SALINAS (CA)	$342.52	$181.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$408.51	$207.67
SANTA CRUZ-WATSONVILLE (CA)	$353.18	$183.96
SANTA ROSA-PETALUMA (CA)	$356.72	$185.68
STOCKTON (CA)	$328.17	$175.51
VISALIA (CA)	$328.17	$175.51
YUBA CITY (CA)	$328.17	$175.51
EL CENTRO (CA)	$328.22	$175.57
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$350.16	$183.58
SAN LUIS OBISPO-PASO ROBLES (CA)	$337.07	$178.43
SANTA MARIA-SANTA BARBARA (CA)	$343.69	$181.29
REST OF CALIFORNIA (CA)	$328.17	$175.51
COLORADO (CO)	$323.85	$175.66
CONNECTICUT (CT)	$332.17	$182.16
DC + MD/VA SUBURBS (DC)	$355.16	$191.09
DELAWARE (DE)	$308.80	$171.19
FORT LAUDERDALE (FL)	$323.83	$182.74
MIAMI (FL)	$337.82	$192.83
REST OF FLORIDA (FL)	$308.56	$175.41
ATLANTA (GA)	$317.84	$176.33
REST OF GEORGIA (GA)	$291.78	$167.54
HAWAII, GUAM (HI)	$335.55	$177.19
IOWA (IA)	$287.51	$160.07
IDAHO (ID)	$289.41	$161.27
EAST ST. LOUIS (IL)	$306.91	$178.77
SUBURBAN CHICAGO (IL)	$326.98	$183.94
CHICAGO (IL)	$328.36	$188.38
REST OF ILLINOIS (IL)	$300.34	$173.18
INDIANA (IN)	$291.01	$161.90
KANSAS (KS)	$286.45	$160.54
KENTUCKY (KY)	$288.01	$164.19
NEW ORLEANS (LA)	$301.29	$170.23
REST OF LOUISIANA (LA)	$287.67	$164.41
METROPOLITAN BOSTON (MA)	$354.72	$188.42
REST OF MASSACHUSETTS (MA)	$322.13	$175.47
BALTIMORE/SURR. CNTYS (MD)	$331.27	$181.82
REST OF MARYLAND (MD)	$314.45	$173.50
SOUTHERN MAINE (ME)	$305.91	$167.88
REST OF MAINE (ME)	$291.10	$162.97
DETROIT (MI)	$312.51	$178.10
REST OF MICHIGAN (MI)	$295.41	$168.25
MINNESOTA (MN)	$309.98	$166.65
METROPOLITAN ST. LOUIS (MO)	$302.05	$169.45
METROPOLITAN KANSAS CITY (MO)	$299.07	$168.29
REST OF MISSOURI (MO)	$283.09	$163.03
MISSISSIPPI (MS)	$280.22	$160.29
MONTANA** (MT)	$311.94	$172.66
NORTH CAROLINA (NC)	$293.99	$164.04
NORTH DAKOTA** (ND)	$305.22	$165.94
NEBRASKA (NE)	$288.96	$160.40
NEW HAMPSHIRE (NH)	$319.04	$174.04
NORTHERN NJ (NJ)	$351.76	$190.20
REST OF NEW JERSEY (NJ)	$335.86	$183.76
NEW MEXICO (NM)	$297.06	$169.34
NEVADA** (NV)	$310.27	$170.85
MANHATTAN (NY)	$358.15	$196.31
NYC SUBURBS/LONG ISLAND (NY)	$366.82	$201.22
POUGHKPSIE/N NYC SUBURBS (NY)	$338.23	$185.72
QUEENS (NY)	$360.66	$196.03
REST OF NEW YORK (NY)	$298.24	$165.92
OHIO (OH)	$294.04	$166.87
OKLAHOMA (OK)	$287.27	$162.90
PORTLAND (OR)	$333.54	$178.80
REST OF OREGON (OR)	$307.76	$169.04
METROPOLITAN PHILADELPHIA (PA)	$324.33	$179.34
REST OF PENNSYLVANIA (PA)	$294.36	$166.50
PUERTO RICO (PR)	$314.07	$173.26
RHODE ISLAND (RI)	$319.35	$175.47
SOUTH CAROLINA (SC)	$294.52	$165.83
SOUTH DAKOTA** (SD)	$304.42	$165.14
TENNESSEE (TN)	$287.86	$161.25
BRAZORIA (TX)	$308.35	$170.32
DALLAS (TX)	$310.37	$171.64
GALVESTON (TX)	$309.31	$171.00
HOUSTON (TX)	$315.53	$177.23
BEAUMONT (TX)	$292.52	$165.77
FORT WORTH (TX)	$308.44	$171.11
AUSTIN (TX)	$322.87	$175.51
REST OF TEXAS (TX)	$300.30	$168.12
UTAH (UT)	$298.38	$167.46
VIRGINIA (VA)	$305.11	$168.19
VIRGIN ISLANDS (VI)	$314.07	$173.26
VERMONT (VT)	$304.28	$166.39
SEATTLE (KING CNTY) (WA)	$361.57	$190.67
REST OF WASHINGTON (WA)	$321.44	$174.78
WISCONSIN (WI)	$295.41	$161.98
WEST VIRGINIA (WV)	$289.73	$168.69
WYOMING** (WY)	$309.01	$169.73

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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 allowed amount for this procedure code is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ depending on whether the service is performed in a non-facility setting (such as a physician's office) or a facility setting (such as a hospital), which is why two separate rates are shown. These figures update annually and can shift due to national budget-neutrality adjustments.

RVUs — work 2.8, practice expense 6.2 (non-facility) / 2.03 (facility), malpractice 0.34 — × 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 the annual Part B deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration, and other claim-specific adjustments.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the facility rate differ from the non-facility rate for CPT 12052?

The facility rate uses lower practice-expense RVUs because Medicare assumes the facility (not the physician's office) incurs most of the overhead costs, such as supplies and staff time.

Does this amount reflect what Medicare will actually pay?

No. This is an estimated allowed amount. Medicare generally reimburses 80% of the allowed amount after the deductible, and the final payment can be affected by locality, modifiers, and sequestration.

Why might the amount change year to year?

The conversion factor, RVUs, and GPCIs are all updated annually by CMS, and budget-neutrality adjustments can shift payment amounts even if the code's relative value stays the same.

Where can I find the exact rate for my locality?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules that apply the correct GPCIs for your area.

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.