Medicare Reimbursement for CPT Code 12057

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and displays its Medicare Physician Fee Schedule allowed amount for 2026. Amounts are shown nationally and can vary by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$648.65	$382.44
ALASKA* (AK)	$757.09	$473.58
ALABAMA (AL)	$580.74	$347.81
ARKANSAS (AR)	$572.21	$343.54
ARIZONA (AZ)	$630.48	$372.53
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$817.18	$441.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$832.43	$448.56
OXNARD-THOUSAND OAKS-VENTURA (CA)	$716.26	$401.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$720.71	$405.79
NAPA (CA)	$775.60	$424.74
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$818.42	$443.07
VALLEJO (CA)	$773.82	$422.96
BAKERSFIELD (CA)	$678.14	$386.38
CHICO (CA)	$675.09	$383.33
FRESNO (CA)	$675.09	$383.33
HANFORD-CORCORAN (CA)	$675.09	$383.33
MADERA (CA)	$675.09	$383.33
MERCED (CA)	$675.09	$383.33
MODESTO (CA)	$675.09	$383.33
REDDING (CA)	$675.09	$383.33
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$686.83	$395.07
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$706.73	$397.14
SALINAS (CA)	$704.09	$395.56
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$837.49	$453.62
SANTA CRUZ-WATSONVILLE (CA)	$725.48	$402.04
SANTA ROSA-PETALUMA (CA)	$732.65	$405.75
STOCKTON (CA)	$675.09	$383.33
VISALIA (CA)	$675.09	$383.33
YUBA CITY (CA)	$675.09	$383.33
EL CENTRO (CA)	$675.27	$383.51
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$719.53	$401.15
SAN LUIS OBISPO-PASO ROBLES (CA)	$693.02	$389.81
SANTA MARIA-SANTA BARBARA (CA)	$706.42	$396.02
REST OF CALIFORNIA (CA)	$675.09	$383.33
COLORADO (CO)	$669.70	$386.45
CONNECTICUT (CT)	$692.30	$405.59
DC + MD/VA SUBURBS (DC)	$737.51	$423.92
DELAWARE (DE)	$640.94	$377.93
FORT LAUDERDALE (FL)	$683.48	$413.82
MIAMI (FL)	$721.40	$444.28
REST OF FLORIDA (FL)	$648.62	$394.12
ATLANTA (GA)	$663.22	$392.75
REST OF GEORGIA (GA)	$610.62	$373.16
HAWAII, GUAM (HI)	$690.43	$387.75
IOWA (IA)	$591.26	$347.68
IDAHO (ID)	$596.11	$351.20
EAST ST. LOUIS (IL)	$652.21	$407.31
SUBURBAN CHICAGO (IL)	$689.37	$415.98
CHICAGO (IL)	$699.24	$431.71
REST OF ILLINOIS (IL)	$632.88	$389.83
INDIANA (IN)	$599.50	$352.73
KANSAS (KS)	$590.57	$349.92
KENTUCKY (KY)	$599.28	$362.62
NEW ORLEANS (LA)	$629.00	$378.50
REST OF LOUISIANA (LA)	$599.18	$363.59
METROPOLITAN BOSTON (MA)	$733.52	$415.67
REST OF MASSACHUSETTS (MA)	$666.47	$386.16
BALTIMORE/SURR. CNTYS (MD)	$690.83	$405.19
REST OF MARYLAND (MD)	$652.62	$383.22
SOUTHERN MAINE (ME)	$631.46	$367.65
REST OF MAINE (ME)	$601.54	$356.63
DETROIT (MI)	$659.03	$402.14
REST OF MICHIGAN (MI)	$617.08	$374.03
MINNESOTA (MN)	$635.10	$361.18
METROPOLITAN ST. LOUIS (MO)	$628.71	$375.28
METROPOLITAN KANSAS CITY (MO)	$622.38	$372.41
REST OF MISSOURI (MO)	$590.17	$360.71
MISSISSIPPI (MS)	$581.20	$352.00
MONTANA** (MT)	$648.57	$382.37
NORTH CAROLINA (NC)	$607.57	$359.20
NORTH DAKOTA** (ND)	$627.02	$360.81
NEBRASKA (NE)	$593.90	$348.20
NEW HAMPSHIRE (NH)	$661.19	$384.07
NORTHERN NJ (NJ)	$730.13	$421.33
REST OF NEW JERSEY (NJ)	$698.34	$407.65
NEW MEXICO (NM)	$621.37	$377.26
NEVADA** (NV)	$642.98	$376.51
MANHATTAN (NY)	$750.01	$440.68
NYC SUBURBS/LONG ISLAND (NY)	$771.13	$454.62
POUGHKPSIE/N NYC SUBURBS (NY)	$704.68	$413.19
QUEENS (NY)	$753.11	$438.45
REST OF NEW YORK (NY)	$616.99	$364.10
OHIO (OH)	$612.67	$369.63
OKLAHOMA (OK)	$595.92	$358.20
PORTLAND (OR)	$688.72	$392.97
REST OF OREGON (OR)	$636.17	$371.02
METROPOLITAN PHILADELPHIA (PA)	$676.28	$399.16
REST OF PENNSYLVANIA (PA)	$612.46	$368.09
PUERTO RICO (PR)	$652.68	$383.55
RHODE ISLAND (RI)	$662.18	$387.19
SOUTH CAROLINA (SC)	$611.50	$365.53
SOUTH DAKOTA** (SD)	$624.47	$358.27
TENNESSEE (TN)	$593.86	$351.88
BRAZORIA (TX)	$638.45	$374.64
DALLAS (TX)	$643.57	$378.43
GALVESTON (TX)	$641.03	$376.69
HOUSTON (TX)	$660.98	$396.64
BEAUMONT (TX)	$608.54	$366.30
FORT WORTH (TX)	$639.87	$377.39
AUSTIN (TX)	$669.06	$387.42
REST OF TEXAS (TX)	$623.85	$371.23
UTAH (UT)	$619.92	$369.69
VIRGINIA (VA)	$630.86	$369.18
VIRGIN ISLANDS (VI)	$652.68	$383.55
VERMONT (VT)	$626.49	$362.95
SEATTLE (KING CNTY) (WA)	$746.38	$419.74
REST OF WASHINGTON (WA)	$664.58	$384.26
WISCONSIN (WI)	$605.94	$350.92
WEST VIRGINIA (WV)	$609.73	$378.40
WYOMING** (WY)	$639.18	$372.97

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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) — work, practice expense, and malpractice — assigned to this procedure code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the same code can have two different allowed amounts depending on place of service.

RVUs — work 5.85, practice expense 12.48 (non-facility) / 4.51 (facility), malpractice 1.09 — × 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 patient or secondary insurance is responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does this code show two different Medicare amounts?

The non-facility amount applies when the service is performed in a setting like a physician's office, while the facility amount applies in settings like a hospital, where the facility itself bills separately for overhead costs. The practice-expense RVU differs between the two.

Will my locality's payment match the national amount shown?

Not necessarily. The national amount uses a standard GPCI set, but actual payment is adjusted using locality-specific GPCI values for work, practice expense, and malpractice, so your local allowed amount may be higher or lower.

Does this amount include the patient's share?

No. The figure represents the Medicare Physician Fee Schedule allowed amount. After the deductible is met, Medicare generally pays 80% of this amount, leaving the remaining 20% as coinsurance unless other insurance applies.

Why might the conversion factor change this amount next year?

The conversion factor is updated annually and can shift due to legislative adjustments, budget-neutrality requirements, and other Medicare Physician Fee Schedule rule changes, which will change the dollar amount even if RVUs stay the same.

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.