Medicare Reimbursement for CPT 13122

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions). It displays the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, shown both nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$128.26	$67.80
ALASKA* (AK)	$153.33	$88.95
ALABAMA (AL)	$115.90	$63.01
ARKANSAS (AR)	$114.36	$62.42
ARIZONA (AZ)	$124.94	$66.36
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$159.21	$73.96
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$162.10	$74.92
OXNARD-THOUSAND OAKS-VENTURA (CA)	$140.48	$69.02
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$141.45	$69.93
NAPA (CA)	$151.44	$71.76
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$159.45	$74.20
VALLEJO (CA)	$151.10	$71.42
BAKERSFIELD (CA)	$133.56	$67.30
CHICO (CA)	$132.95	$66.69
FRESNO (CA)	$132.95	$66.69
HANFORD-CORCORAN (CA)	$132.95	$66.69
MADERA (CA)	$132.95	$66.69
MERCED (CA)	$132.95	$66.69
MODESTO (CA)	$132.95	$66.69
REDDING (CA)	$132.95	$66.69
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$135.22	$68.96
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$138.83	$68.52
SALINAS (CA)	$138.30	$68.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$163.07	$75.89
SANTA CRUZ-WATSONVILLE (CA)	$142.00	$68.55
SANTA ROSA-PETALUMA (CA)	$143.39	$69.15
STOCKTON (CA)	$132.95	$66.69
VISALIA (CA)	$132.95	$66.69
YUBA CITY (CA)	$132.95	$66.69
EL CENTRO (CA)	$132.99	$66.73
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$141.05	$68.74
SAN LUIS OBISPO-PASO ROBLES (CA)	$136.15	$67.29
SANTA MARIA-SANTA BARBARA (CA)	$138.68	$68.19
REST OF CALIFORNIA (CA)	$132.95	$66.69
COLORADO (CO)	$132.05	$67.73
CONNECTICUT (CT)	$136.40	$71.29
DC + MD/VA SUBURBS (DC)	$144.84	$73.62
DELAWARE (DE)	$126.89	$67.16
FORT LAUDERDALE (FL)	$134.90	$73.65
MIAMI (FL)	$142.04	$79.10
REST OF FLORIDA (FL)	$128.51	$70.71
ATLANTA (GA)	$131.00	$69.58
REST OF GEORGIA (GA)	$121.56	$67.64
HAWAII, GUAM (HI)	$135.51	$66.77
IOWA (IA)	$117.70	$62.38
IDAHO (ID)	$118.60	$62.99
EAST ST. LOUIS (IL)	$129.41	$73.79
SUBURBAN CHICAGO (IL)	$136.01	$73.92
CHICAGO (IL)	$138.04	$77.28
REST OF ILLINOIS (IL)	$125.73	$70.53
INDIANA (IN)	$119.22	$63.17
KANSAS (KS)	$117.63	$62.98
KENTUCKY (KY)	$119.40	$65.65
NEW ORLEANS (LA)	$124.82	$67.93
REST OF LOUISIANA (LA)	$119.40	$65.90
METROPOLITAN BOSTON (MA)	$143.86	$71.67
REST OF MASSACHUSETTS (MA)	$131.53	$67.87
BALTIMORE/SURR. CNTYS (MD)	$136.11	$71.24
REST OF MARYLAND (MD)	$129.05	$67.86
SOUTHERN MAINE (ME)	$125.00	$65.09
REST OF MAINE (ME)	$119.65	$64.03
DETROIT (MI)	$130.46	$72.12
REST OF MICHIGAN (MI)	$122.68	$67.49
MINNESOTA (MN)	$125.48	$63.27
METROPOLITAN ST. LOUIS (MO)	$124.70	$67.14
METROPOLITAN KANSAS CITY (MO)	$123.55	$66.79
REST OF MISSOURI (MO)	$117.80	$65.69
MISSISSIPPI (MS)	$116.08	$64.02
MONTANA** (MT)	$128.25	$67.79
NORTH CAROLINA (NC)	$120.74	$64.33
NORTH DAKOTA** (ND)	$124.09	$63.64
NEBRASKA (NE)	$118.16	$62.36
NEW HAMPSHIRE (NH)	$130.44	$67.50
NORTHERN NJ (NJ)	$143.60	$73.47
REST OF NEW JERSEY (NJ)	$137.66	$71.65
NEW MEXICO (NM)	$123.49	$68.05
NEVADA** (NV)	$127.16	$66.65
MANHATTAN (NY)	$147.43	$77.18
NYC SUBURBS/LONG ISLAND (NY)	$151.34	$79.46
POUGHKPSIE/N NYC SUBURBS (NY)	$138.91	$72.71
QUEENS (NY)	$147.91	$76.45
REST OF NEW YORK (NY)	$122.45	$65.02
OHIO (OH)	$121.84	$66.64
OKLAHOMA (OK)	$118.73	$64.74
PORTLAND (OR)	$135.48	$68.31
REST OF OREGON (OR)	$125.88	$65.66
METROPOLITAN PHILADELPHIA (PA)	$133.51	$70.57
REST OF PENNSYLVANIA (PA)	$121.77	$66.27
PUERTO RICO (PR)	$128.97	$67.85
RHODE ISLAND (RI)	$130.85	$68.40
SOUTH CAROLINA (SC)	$121.55	$65.69
SOUTH DAKOTA** (SD)	$123.60	$63.15
TENNESSEE (TN)	$118.23	$63.28
BRAZORIA (TX)	$126.42	$66.51
DALLAS (TX)	$127.39	$67.17
GALVESTON (TX)	$126.91	$66.87
HOUSTON (TX)	$130.75	$70.72
BEAUMONT (TX)	$121.06	$66.04
FORT WORTH (TX)	$126.73	$67.12
AUSTIN (TX)	$131.87	$67.91
REST OF TEXAS (TX)	$123.78	$66.41
UTAH (UT)	$123.07	$66.25
VIRGINIA (VA)	$124.93	$65.50
VIRGIN ISLANDS (VI)	$128.97	$67.85
VERMONT (VT)	$124.05	$64.20
SEATTLE (KING CNTY) (WA)	$146.22	$72.04
REST OF WASHINGTON (WA)	$131.14	$67.48
WISCONSIN (WI)	$120.28	$62.36
WEST VIRGINIA (WV)	$121.53	$68.99
WYOMING** (WY)	$126.44	$65.98

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 9 units per patient per day — Date of Service Edit: Clinical. 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 PFS amounts are built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. 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 national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings differ mainly in the practice-expense RVU, since overhead costs assumed by the practice differ depending on where the service is rendered. This is why the same code typically yields a higher non-facility amount than facility amount.

RVUs — work 1.4, practice expense 2.23 (non-facility) / 0.42 (facility), malpractice 0.21 — × 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 their deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applied modifiers, claims adjustment (e.g., sequestration), and annual budget-neutrality adjustments.
Always confirm current rates and applicable adjustments with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount?

The facility amount assumes the hospital or facility absorbs certain overhead and equipment costs, so the practice-expense RVU used in the calculation is lower than when the same service is performed in a non-facility setting like a physician's office.

Will I be paid exactly the national amount shown?

No. The national amount uses a standard GPCI input, but actual payments are adjusted using the GPCIs specific to the locality where the service was furnished, so local amounts will differ from the national figure.

Does this amount include the patient's share?

No. The figure represents the total Medicare-allowed amount. Under Part B, Medicare generally pays 80% of this allowed amount after the deductible is met, with the remaining 20% being the patient's (or secondary payer's) responsibility.

Why might my MAC's payment differ from this estimate?

Payments can be affected by modifiers, multiple-procedure reductions, sequestration, bundling edits, and annual budget-neutrality adjustments applied by CMS, none of which are reflected in this baseline estimate.

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.