Medicare Reimbursement for CPT 13120

CPT 13120 is a physician procedure code reimbursed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$351.04	$198.40
ALASKA* (AK)	$413.11	$250.54
ALABAMA (AL)	$316.39	$182.83
ARKANSAS (AR)	$312.02	$180.90
ARIZONA (AZ)	$341.99	$194.08
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$449.33	$234.10
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$458.01	$237.90
OXNARD-THOUSAND OAKS-VENTURA (CA)	$391.64	$211.21
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$393.76	$213.18
NAPA (CA)	$425.57	$224.38
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$449.76	$234.53
VALLEJO (CA)	$424.94	$223.76
BAKERSFIELD (CA)	$370.46	$203.17
CHICO (CA)	$369.32	$202.03
FRESNO (CA)	$369.32	$202.03
HANFORD-CORCORAN (CA)	$369.32	$202.03
MADERA (CA)	$369.32	$202.03
MERCED (CA)	$369.32	$202.03
MODESTO (CA)	$369.32	$202.03
REDDING (CA)	$369.32	$202.03
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$373.45	$206.16
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$386.94	$209.42
SALINAS (CA)	$385.48	$208.57
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$459.77	$239.66
SANTA CRUZ-WATSONVILLE (CA)	$397.49	$212.03
SANTA ROSA-PETALUMA (CA)	$401.47	$214.02
STOCKTON (CA)	$369.32	$202.03
VISALIA (CA)	$369.32	$202.03
YUBA CITY (CA)	$369.32	$202.03
EL CENTRO (CA)	$369.39	$202.09
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$394.08	$211.52
SAN LUIS OBISPO-PASO ROBLES (CA)	$379.35	$205.49
SANTA MARIA-SANTA BARBARA (CA)	$386.80	$208.82
REST OF CALIFORNIA (CA)	$369.32	$202.03
COLORADO (CO)	$364.45	$202.04
CONNECTICUT (CT)	$373.76	$209.37
DC + MD/VA SUBURBS (DC)	$399.66	$219.85
DELAWARE (DE)	$347.49	$196.68
FORT LAUDERDALE (FL)	$364.33	$209.70
MIAMI (FL)	$380.01	$221.11
REST OF FLORIDA (FL)	$347.17	$201.24
ATLANTA (GA)	$357.64	$202.56
REST OF GEORGIA (GA)	$328.30	$192.14
HAWAII, GUAM (HI)	$377.64	$204.09
IOWA (IA)	$323.57	$183.91
IDAHO (ID)	$325.70	$185.27
EAST ST. LOUIS (IL)	$345.26	$204.83
SUBURBAN CHICAGO (IL)	$367.87	$211.11
CHICAGO (IL)	$369.38	$215.98
REST OF ILLINOIS (IL)	$337.91	$198.54
INDIANA (IN)	$327.50	$186.00
KANSAS (KS)	$322.37	$184.38
KENTUCKY (KY)	$324.09	$188.39
NEW ORLEANS (LA)	$339.01	$195.38
REST OF LOUISIANA (LA)	$323.70	$188.61
METROPOLITAN BOSTON (MA)	$399.19	$216.94
REST OF MASSACHUSETTS (MA)	$362.51	$201.77
BALTIMORE/SURR. CNTYS (MD)	$372.75	$208.97
REST OF MARYLAND (MD)	$353.85	$199.38
SOUTHERN MAINE (ME)	$344.26	$192.99
REST OF MAINE (ME)	$327.59	$187.16
DETROIT (MI)	$351.59	$204.29
REST OF MICHIGAN (MI)	$332.40	$193.04
MINNESOTA (MN)	$348.87	$191.80
METROPOLITAN ST. LOUIS (MO)	$339.88	$194.56
METROPOLITAN KANSAS CITY (MO)	$336.53	$193.20
REST OF MISSOURI (MO)	$318.54	$186.96
MISSISSIPPI (MS)	$315.32	$183.90
MONTANA** (MT)	$351.02	$198.38
NORTH CAROLINA (NC)	$330.84	$188.43
NORTH DAKOTA** (ND)	$343.50	$190.86
NEBRASKA (NE)	$325.20	$184.31
NEW HAMPSHIRE (NH)	$359.02	$200.12
NORTHERN NJ (NJ)	$395.84	$218.77
REST OF NEW JERSEY (NJ)	$377.93	$211.25
NEW MEXICO (NM)	$334.24	$194.27
NEVADA** (NV)	$349.16	$196.36
MANHATTAN (NY)	$402.98	$225.61
NYC SUBURBS/LONG ISLAND (NY)	$412.72	$231.23
POUGHKPSIE/N NYC SUBURBS (NY)	$380.59	$213.45
QUEENS (NY)	$405.82	$225.40
REST OF NEW YORK (NY)	$335.62	$190.61
OHIO (OH)	$330.86	$191.50
OKLAHOMA (OK)	$323.27	$186.96
PORTLAND (OR)	$375.36	$205.77
REST OF OREGON (OR)	$346.34	$194.31
METROPOLITAN PHILADELPHIA (PA)	$364.95	$206.05
REST OF PENNSYLVANIA (PA)	$331.23	$191.10
PUERTO RICO (PR)	$353.42	$199.10
RHODE ISLAND (RI)	$359.37	$201.69
SOUTH CAROLINA (SC)	$331.42	$190.38
SOUTH DAKOTA** (SD)	$342.62	$189.97
TENNESSEE (TN)	$323.95	$185.20
BRAZORIA (TX)	$346.99	$195.73
DALLAS (TX)	$349.26	$197.22
GALVESTON (TX)	$348.07	$196.50
HOUSTON (TX)	$355.03	$203.45
BEAUMONT (TX)	$329.16	$190.26
FORT WORTH (TX)	$347.09	$196.58
AUSTIN (TX)	$363.33	$201.83
REST OF TEXAS (TX)	$337.92	$193.06
UTAH (UT)	$335.76	$192.28
VIRGINIA (VA)	$343.35	$193.30
VIRGIN ISLANDS (VI)	$353.42	$199.10
VERMONT (VT)	$342.44	$191.33
SEATTLE (KING CNTY) (WA)	$406.90	$219.61
REST OF WASHINGTON (WA)	$361.73	$201.00
WISCONSIN (WI)	$332.47	$186.24
WEST VIRGINIA (WV)	$325.97	$193.33
WYOMING** (WY)	$347.74	$195.10

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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

The Medicare PFS amount for a code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher when the physician's office bears more of the overhead, compared to when the service is performed in a facility that bills separately for overhead costs.

RVUs — work 3.15, practice expense 6.98 (non-facility) / 2.41 (facility), malpractice 0.38 — × 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 payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality adjustments to the conversion factor.
Always verify the current, locality-specific 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 for this code?

The practice-expense RVU is lower in the facility setting because the facility, not the physician's office, absorbs most of the overhead costs (equipment, supplies, staff time) for the service.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-allowed amount before the standard 20% coinsurance and deductible are applied, and before any locality, modifier, or policy-specific adjustments.

Why might the amount shown differ from what appears on my remittance advice?

Remittance amounts can reflect sequestration, secondary payer adjustments, multiple-procedure reductions, or a different locality's GPCIs than the national figures shown here.

Where can I find the official RVUs and GPCIs used for this calculation?

CMS publishes the annual PFS Relative Value File and GPCI tables, which your MAC uses to calculate locality-specific payment amounts.

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.