Medicare Reimbursement for CPT Code 12056

CPT code 12056 is a procedure code defined by the American Medical Association; its specific descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$623.59	$348.71
ALASKA* (AK)	$722.76	$430.01
ALABAMA (AL)	$557.32	$316.79
ARKANSAS (AR)	$548.99	$312.86
ARIZONA (AZ)	$605.99	$339.63
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$793.29	$405.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$808.39	$411.99
OXNARD-THOUSAND OAKS-VENTURA (CA)	$692.57	$367.65
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$696.55	$371.36
NAPA (CA)	$751.89	$389.59
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$794.38	$406.79
VALLEJO (CA)	$750.32	$388.02
BAKERSFIELD (CA)	$654.55	$353.27
CHICO (CA)	$651.86	$350.58
FRESNO (CA)	$651.86	$350.58
HANFORD-CORCORAN (CA)	$651.86	$350.58
MADERA (CA)	$651.86	$350.58
MERCED (CA)	$651.86	$350.58
MODESTO (CA)	$651.86	$350.58
REDDING (CA)	$651.86	$350.58
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$662.20	$360.92
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$683.21	$363.51
SALINAS (CA)	$680.67	$362.07
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$812.84	$416.45
SANTA CRUZ-WATSONVILLE (CA)	$702.40	$368.40
SANTA ROSA-PETALUMA (CA)	$709.39	$371.83
STOCKTON (CA)	$651.86	$350.58
VISALIA (CA)	$651.86	$350.58
YUBA CITY (CA)	$651.86	$350.58
EL CENTRO (CA)	$652.02	$350.74
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$696.18	$367.42
SAN LUIS OBISPO-PASO ROBLES (CA)	$669.87	$356.77
SANTA MARIA-SANTA BARBARA (CA)	$683.08	$362.56
REST OF CALIFORNIA (CA)	$651.86	$350.58
COLORADO (CO)	$645.45	$352.97
CONNECTICUT (CT)	$666.03	$369.98
DC + MD/VA SUBURBS (DC)	$711.10	$387.28
DELAWARE (DE)	$616.19	$344.60
FORT LAUDERDALE (FL)	$654.95	$376.49
MIAMI (FL)	$689.79	$403.63
REST OF FLORIDA (FL)	$621.29	$358.50
ATLANTA (GA)	$637.26	$357.97
REST OF GEORGIA (GA)	$584.52	$339.31
HAWAII, GUAM (HI)	$667.48	$354.93
IOWA (IA)	$568.66	$317.13
IDAHO (ID)	$573.19	$320.29
EAST ST. LOUIS (IL)	$622.60	$369.70
SUBURBAN CHICAGO (IL)	$660.87	$378.56
CHICAGO (IL)	$668.42	$392.16
REST OF ILLINOIS (IL)	$605.21	$354.23
INDIANA (IN)	$576.54	$321.72
KANSAS (KS)	$567.48	$318.98
KENTUCKY (KY)	$574.38	$330.00
NEW ORLEANS (LA)	$603.24	$344.57
REST OF LOUISIANA (LA)	$574.08	$330.80
METROPOLITAN BOSTON (MA)	$708.40	$380.19
REST OF MASSACHUSETTS (MA)	$642.05	$352.59
BALTIMORE/SURR. CNTYS (MD)	$664.53	$369.58
REST OF MARYLAND (MD)	$627.72	$349.53
SOUTHERN MAINE (ME)	$607.99	$335.58
REST OF MAINE (ME)	$577.97	$325.07
DETROIT (MI)	$630.93	$365.66
REST OF MICHIGAN (MI)	$591.29	$340.32
MINNESOTA (MN)	$613.17	$330.31
METROPOLITAN ST. LOUIS (MO)	$603.55	$341.86
METROPOLITAN KANSAS CITY (MO)	$597.31	$339.19
REST OF MISSOURI (MO)	$564.96	$328.01
MISSISSIPPI (MS)	$557.01	$320.33
MONTANA** (MT)	$623.53	$348.64
NORTH CAROLINA (NC)	$583.96	$327.48
NORTH DAKOTA** (ND)	$604.55	$329.66
NEBRASKA (NE)	$571.40	$317.68
NEW HAMPSHIRE (NH)	$636.76	$350.60
NORTHERN NJ (NJ)	$703.67	$384.80
REST OF NEW JERSEY (NJ)	$672.15	$371.97
NEW MEXICO (NM)	$595.28	$343.20
NEVADA** (NV)	$618.66	$343.49
MANHATTAN (NY)	$721.29	$401.87
NYC SUBURBS/LONG ISLAND (NY)	$741.29	$414.44
POUGHKPSIE/N NYC SUBURBS (NY)	$677.89	$376.89
QUEENS (NY)	$725.05	$400.13
REST OF NEW YORK (NY)	$593.13	$331.98
OHIO (OH)	$587.41	$336.44
OKLAHOMA (OK)	$571.63	$326.15
PORTLAND (OR)	$664.64	$359.24
REST OF OREGON (OR)	$612.40	$338.61
METROPOLITAN PHILADELPHIA (PA)	$650.06	$363.90
REST OF PENNSYLVANIA (PA)	$587.49	$335.14
PUERTO RICO (PR)	$627.72	$349.81
RHODE ISLAND (RI)	$637.23	$353.27
SOUTH CAROLINA (SC)	$586.95	$332.95
SOUTH DAKOTA** (SD)	$602.30	$327.41
TENNESSEE (TN)	$570.63	$320.76
BRAZORIA (TX)	$614.15	$341.74
DALLAS (TX)	$618.92	$345.13
GALVESTON (TX)	$616.53	$343.56
HOUSTON (TX)	$634.10	$361.14
BEAUMONT (TX)	$583.62	$333.47
FORT WORTH (TX)	$615.15	$344.11
AUSTIN (TX)	$644.58	$353.74
REST OF TEXAS (TX)	$599.12	$338.25
UTAH (UT)	$595.19	$336.80
VIRGINIA (VA)	$607.05	$336.83
VIRGIN ISLANDS (VI)	$627.72	$349.81
VERMONT (VT)	$603.57	$331.43
SEATTLE (KING CNTY) (WA)	$721.44	$384.15
REST OF WASHINGTON (WA)	$640.38	$350.92
WISCONSIN (WI)	$583.81	$320.47
WEST VIRGINIA (WV)	$582.55	$343.67
WYOMING** (WY)	$615.26	$340.37

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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 procedure code. Each RVU component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is furnished, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital, ASC) settings, which is why the two amounts shown differ.

RVUs — work 5.17, practice expense 12.54 (non-facility) / 4.31 (facility), malpractice 0.96 — × 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 payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure or bilateral payment rules, sequestration, and annual budget-neutrality adjustments.
Always verify current amounts 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?

Facility amounts use a lower practice expense RVU because Medicare assumes the facility (hospital or ASC) bears some of the overhead costs, whereas non-facility amounts assume the physician's practice bears the full cost of supplies, equipment, and staff.

Will my locality's payment match the national figure?

No. The national amount is a baseline; actual payment is adjusted using locality-specific GPCIs for work, practice expense, and malpractice costs, so amounts can be higher or lower depending on where the service is performed.

Does this amount reflect what the patient will actually owe?

Not directly. Patient responsibility depends on deductible status, coinsurance (typically 20%), secondary insurance, and any applicable modifiers, none of which are reflected in the base PFS allowed amount.

Why might the conversion factor or RVUs change next year?

Medicare updates the conversion factor and RVUs annually based on legislation, budget-neutrality requirements, and periodic reviews of relative value units, which can shift the allowed amount even if the code itself is unchanged.

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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.