Medicare Reimbursement for CPT 12053

CPT 12053 is a physician procedure code; this page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, nationally and by locality. Amounts are broken out by non-facility (e.g., office) and facility (e.g., hospital) settings, since payment can differ depending on where the service is performed.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$361.06	$187.05
ALASKA* (AK)	$422.73	$237.40
ALABAMA (AL)	$324.81	$172.54
ARKANSAS (AR)	$320.23	$170.74
ARIZONA (AZ)	$351.60	$182.97
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$463.76	$218.39
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$472.78	$221.84
OXNARD-THOUSAND OAKS-VENTURA (CA)	$403.60	$197.91
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$405.72	$199.86
NAPA (CA)	$439.01	$209.66
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$464.20	$218.83
VALLEJO (CA)	$438.37	$209.02
BAKERSFIELD (CA)	$381.43	$190.71
CHICO (CA)	$380.28	$189.55
FRESNO (CA)	$380.28	$189.55
HANFORD-CORCORAN (CA)	$380.28	$189.55
MADERA (CA)	$380.28	$189.55
MERCED (CA)	$380.28	$189.55
MODESTO (CA)	$380.28	$189.55
REDDING (CA)	$380.28	$189.55
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$384.51	$193.79
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$398.64	$196.26
SALINAS (CA)	$397.15	$195.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$474.59	$223.65
SANTA CRUZ-WATSONVILLE (CA)	$409.83	$198.39
SANTA ROSA-PETALUMA (CA)	$413.94	$200.24
STOCKTON (CA)	$380.28	$189.55
VISALIA (CA)	$380.28	$189.55
YUBA CITY (CA)	$380.28	$189.55
EL CENTRO (CA)	$380.34	$189.62
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$406.18	$198.05
SAN LUIS OBISPO-PASO ROBLES (CA)	$390.81	$192.60
SANTA MARIA-SANTA BARBARA (CA)	$398.55	$195.65
REST OF CALIFORNIA (CA)	$380.28	$189.55
COLORADO (CO)	$375.12	$189.96
CONNECTICUT (CT)	$384.72	$197.30
DC + MD/VA SUBURBS (DC)	$411.69	$206.69
DELAWARE (DE)	$357.33	$185.40
FORT LAUDERDALE (FL)	$374.77	$198.49
MIAMI (FL)	$391.02	$209.87
REST OF FLORIDA (FL)	$356.84	$190.48
ATLANTA (GA)	$367.91	$191.11
REST OF GEORGIA (GA)	$337.12	$181.90
HAWAII, GUAM (HI)	$389.12	$191.26
IOWA (IA)	$332.40	$173.17
IDAHO (ID)	$334.61	$174.52
EAST ST. LOUIS (IL)	$354.69	$194.59
SUBURBAN CHICAGO (IL)	$378.45	$199.74
CHICAGO (IL)	$379.88	$204.99
REST OF ILLINOIS (IL)	$347.10	$188.22
INDIANA (IN)	$336.50	$175.18
KANSAS (KS)	$331.10	$173.79
KENTUCKY (KY)	$332.78	$178.08
NEW ORLEANS (LA)	$348.39	$184.64
REST OF LOUISIANA (LA)	$332.36	$178.35
METROPOLITAN BOSTON (MA)	$411.36	$203.58
REST OF MASSACHUSETTS (MA)	$373.05	$189.80
BALTIMORE/SURR. CNTYS (MD)	$383.67	$196.95
REST OF MARYLAND (MD)	$363.97	$187.86
SOUTHERN MAINE (ME)	$354.05	$181.60
REST OF MAINE (ME)	$336.55	$176.46
DETROIT (MI)	$361.43	$193.50
REST OF MICHIGAN (MI)	$341.44	$182.56
MINNESOTA (MN)	$358.99	$179.93
METROPOLITAN ST. LOUIS (MO)	$349.34	$183.67
METROPOLITAN KANSAS CITY (MO)	$345.83	$182.43
REST OF MISSOURI (MO)	$326.94	$176.93
MISSISSIPPI (MS)	$323.63	$173.80
MONTANA** (MT)	$361.04	$187.02
NORTH CAROLINA (NC)	$339.96	$177.60
NORTH DAKOTA** (ND)	$353.33	$179.31
NEBRASKA (NE)	$334.11	$173.49
NEW HAMPSHIRE (NH)	$369.47	$188.32
NORTHERN NJ (NJ)	$407.62	$205.76
REST OF NEW JERSEY (NJ)	$388.98	$198.95
NEW MEXICO (NM)	$343.36	$183.79
NEVADA** (NV)	$359.13	$184.94
MANHATTAN (NY)	$414.96	$212.76
NYC SUBURBS/LONG ISLAND (NY)	$425.11	$218.20
POUGHKPSIE/N NYC SUBURBS (NY)	$391.70	$201.15
QUEENS (NY)	$417.99	$212.30
REST OF NEW YORK (NY)	$344.95	$179.64
OHIO (OH)	$339.87	$180.99
OKLAHOMA (OK)	$331.96	$176.56
PORTLAND (OR)	$386.56	$193.22
REST OF OREGON (OR)	$356.22	$182.89
METROPOLITAN PHILADELPHIA (PA)	$375.47	$194.32
REST OF PENNSYLVANIA (PA)	$340.27	$180.52
PUERTO RICO (PR)	$363.56	$187.63
RHODE ISLAND (RI)	$369.70	$189.94
SOUTH CAROLINA (SC)	$340.50	$179.71
SOUTH DAKOTA** (SD)	$352.41	$178.40
TENNESSEE (TN)	$332.75	$174.57
BRAZORIA (TX)	$356.82	$184.37
DALLAS (TX)	$359.16	$185.84
GALVESTON (TX)	$357.94	$185.13
HOUSTON (TX)	$365.07	$192.27
BEAUMONT (TX)	$338.10	$179.75
FORT WORTH (TX)	$356.88	$185.30
AUSTIN (TX)	$373.99	$189.87
REST OF TEXAS (TX)	$347.31	$182.17
UTAH (UT)	$345.05	$181.47
VIRGINIA (VA)	$353.07	$182.01
VIRGIN ISLANDS (VI)	$363.56	$187.63
VERMONT (VT)	$352.18	$179.90
SEATTLE (KING CNTY) (WA)	$419.42	$205.90
REST OF WASHINGTON (WA)	$372.27	$189.03
WISCONSIN (WI)	$341.77	$175.06
WEST VIRGINIA (WV)	$334.61	$183.38
WYOMING** (WY)	$357.68	$183.66

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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 billed, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice expense RVUs differ between non-facility and facility settings because the practice absorbs different overhead costs depending on where the service takes place; this is why non-facility and facility allowed amounts differ.

RVUs — work 3.09, practice expense 7.33 (non-facility) / 2.12 (facility), malpractice 0.39 — × 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 deductible is met; the patient or secondary insurance is responsible for the remainder.
Actual payment can vary by locality, modifiers appended to the code, sequestration reductions, and annual budget-neutrality 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 amount differ from the non-facility amount?

The practice expense RVU is lower in the facility setting because the facility (e.g., hospital) bears certain overhead and equipment costs instead of the billing physician's practice.

Does this amount reflect what my specific locality will be paid?

No. The national amount uses standardized GPCI inputs; actual payment depends on the GPCIs for the specific locality where the service was rendered.

Will modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the final allowed amount, and are not reflected in this base estimate.

Is this the amount Medicare will actually pay?

This is an estimated allowed amount. Medicare generally pays 80% of this figure after the deductible, and the final payment may be affected by sequestration or other adjustments.

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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.