Medicare Reimbursement for CPT 13131
CPT 13131 is a procedure code billed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount for this code at the national level and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $384.44 | $204.08 |
| ALASKA* (AK) | $454.94 | $262.85 |
| ALABAMA (AL) | $347.15 | $189.33 |
| ARKANSAS (AR) | $342.44 | $187.51 |
| ARIZONA (AZ) | $374.67 | $199.90 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $489.62 | $235.31 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $499.00 | $238.91 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $427.66 | $214.47 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $430.08 | $216.71 |
| NAPA (CA) | $464.06 | $226.34 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $490.11 | $235.80 |
| VALLEJO (CA) | $463.36 | $225.64 |
| BAKERSFIELD (CA) | $404.99 | $207.32 |
| CHICO (CA) | $403.70 | $206.02 |
| FRESNO (CA) | $403.70 | $206.02 |
| HANFORD-CORCORAN (CA) | $403.70 | $206.02 |
| MADERA (CA) | $403.70 | $206.02 |
| MERCED (CA) | $403.70 | $206.02 |
| MODESTO (CA) | $403.70 | $206.02 |
| REDDING (CA) | $403.70 | $206.02 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $408.38 | $210.70 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $422.66 | $212.90 |
| SALINAS (CA) | $421.06 | $212.02 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $500.99 | $240.91 |
| SANTA CRUZ-WATSONVILLE (CA) | $433.76 | $214.62 |
| SANTA ROSA-PETALUMA (CA) | $438.09 | $216.60 |
| STOCKTON (CA) | $403.70 | $206.02 |
| VISALIA (CA) | $403.70 | $206.02 |
| YUBA CITY (CA) | $403.70 | $206.02 |
| EL CENTRO (CA) | $403.78 | $206.10 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $430.22 | $214.50 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $414.39 | $208.95 |
| SANTA MARIA-SANTA BARBARA (CA) | $422.44 | $212.13 |
| REST OF CALIFORNIA (CA) | $403.70 | $206.02 |
| COLORADO (CO) | $398.66 | $206.75 |
| CONNECTICUT (CT) | $409.03 | $214.77 |
| DC + MD/VA SUBURBS (DC) | $436.87 | $224.40 |
| DELAWARE (DE) | $380.62 | $202.42 |
| FORT LAUDERDALE (FL) | $399.28 | $216.57 |
| MIAMI (FL) | $416.59 | $228.83 |
| REST OF FLORIDA (FL) | $380.73 | $208.31 |
| ATLANTA (GA) | $391.67 | $208.42 |
| REST OF GEORGIA (GA) | $360.36 | $199.48 |
| HAWAII, GUAM (HI) | $412.44 | $207.37 |
| IOWA (IA) | $354.66 | $189.63 |
| IDAHO (ID) | $357.00 | $191.06 |
| EAST ST. LOUIS (IL) | $379.13 | $213.19 |
| SUBURBAN CHICAGO (IL) | $403.09 | $217.86 |
| CHICAGO (IL) | $405.14 | $223.87 |
| REST OF ILLINOIS (IL) | $370.91 | $206.24 |
| INDIANA (IN) | $358.92 | $191.72 |
| KANSAS (KS) | $353.46 | $190.41 |
| KENTUCKY (KY) | $355.64 | $195.30 |
| NEW ORLEANS (LA) | $371.74 | $202.01 |
| REST OF LOUISIANA (LA) | $355.26 | $195.64 |
| METROPOLITAN BOSTON (MA) | $436.06 | $220.70 |
| REST OF MASSACHUSETTS (MA) | $396.64 | $206.72 |
| BALTIMORE/SURR. CNTYS (MD) | $407.93 | $214.40 |
| REST OF MARYLAND (MD) | $387.46 | $204.94 |
| SOUTHERN MAINE (ME) | $376.91 | $198.17 |
| REST OF MAINE (ME) | $359.14 | $193.20 |
| DETROIT (MI) | $385.60 | $211.55 |
| REST OF MICHIGAN (MI) | $364.68 | $200.00 |
| MINNESOTA (MN) | $381.54 | $195.94 |
| METROPOLITAN ST. LOUIS (MO) | $372.54 | $200.84 |
| METROPOLITAN KANSAS CITY (MO) | $368.96 | $199.59 |
| REST OF MISSOURI (MO) | $349.78 | $194.30 |
| MISSISSIPPI (MS) | $346.15 | $190.86 |
| MONTANA** (MT) | $384.42 | $204.05 |
| NORTH CAROLINA (NC) | $362.61 | $194.33 |
| NORTH DAKOTA** (ND) | $375.91 | $195.55 |
| NEBRASKA (NE) | $356.38 | $189.90 |
| NEW HAMPSHIRE (NH) | $392.84 | $205.08 |
| NORTHERN NJ (NJ) | $432.84 | $223.62 |
| REST OF NEW JERSEY (NJ) | $413.56 | $216.60 |
| NEW MEXICO (NM) | $366.71 | $201.31 |
| NEVADA** (NV) | $382.29 | $201.75 |
| MANHATTAN (NY) | $440.90 | $231.32 |
| NYC SUBURBS/LONG ISLAND (NY) | $451.50 | $237.05 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $416.54 | $219.04 |
| QUEENS (NY) | $443.80 | $230.61 |
| REST OF NEW YORK (NY) | $367.75 | $196.41 |
| OHIO (OH) | $362.94 | $198.27 |
| OKLAHOMA (OK) | $354.65 | $193.59 |
| PORTLAND (OR) | $410.30 | $209.91 |
| REST OF OREGON (OR) | $379.18 | $199.54 |
| METROPOLITAN PHILADELPHIA (PA) | $399.59 | $211.83 |
| REST OF PENNSYLVANIA (PA) | $363.28 | $197.70 |
| PUERTO RICO (PR) | $386.96 | $204.61 |
| RHODE ISLAND (RI) | $393.40 | $207.09 |
| SOUTH CAROLINA (SC) | $363.40 | $196.75 |
| SOUTH DAKOTA** (SD) | $374.91 | $194.54 |
| TENNESSEE (TN) | $355.18 | $191.23 |
| BRAZORIA (TX) | $380.02 | $201.28 |
| DALLAS (TX) | $382.51 | $202.86 |
| GALVESTON (TX) | $381.21 | $202.10 |
| HOUSTON (TX) | $389.08 | $209.98 |
| BEAUMONT (TX) | $361.06 | $196.93 |
| FORT WORTH (TX) | $380.21 | $202.37 |
| AUSTIN (TX) | $397.46 | $206.64 |
| REST OF TEXAS (TX) | $370.38 | $199.21 |
| UTAH (UT) | $368.07 | $198.53 |
| VIRGINIA (VA) | $376.00 | $198.70 |
| VIRGIN ISLANDS (VI) | $386.96 | $204.61 |
| VERMONT (VT) | $374.86 | $196.30 |
| SEATTLE (KING CNTY) (WA) | $444.31 | $223.00 |
| REST OF WASHINGTON (WA) | $395.76 | $205.84 |
| WISCONSIN (WI) | $364.07 | $191.28 |
| WEST VIRGINIA (WV) | $358.08 | $201.34 |
| WYOMING** (WY) | $380.71 | $200.35 |
Look up another code or locality →
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 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 provider's locality to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice expense RVUs differ between non-facility and facility settings because overhead costs (staff, supplies, equipment) are typically higher when the service is performed outside a hospital or facility, while facility settings assume the facility itself bears certain overhead costs. This is why the same code can show two different allowed amounts depending on site of service.
RVUs — work 3.64, practice expense 7.44 (non-facility) / 2.04 (facility), malpractice 0.43 — × 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 insurance covers the remainder.
- Actual payment can vary by locality, applicable modifiers, claim-specific adjustments, and sequestration.
- Annual updates to RVUs, GPCIs, and the conversion factor — including budget-neutrality adjustments — can change this amount from year to year.
- Always verify final payment amounts and coverage policy with your local Medicare Administrative Contractor (MAC).
Frequently asked
Why is the facility amount different from the non-facility amount?
The facility amount uses a lower practice expense RVU because the hospital or facility, rather than the billing provider, absorbs certain overhead and resource costs when the service is performed there.
Does this amount reflect what Medicare will actually pay?
No. It is an estimate based on standard PFS formulas. Actual reimbursement depends on your specific locality, any modifiers applied, deductible status, and other claim-level factors.
Why do GPCIs matter for this code?
GPCIs adjust the work, practice expense, and malpractice RVUs to reflect cost-of-living and practice cost differences across different geographic areas, so the same code can be priced differently in different localities.
Why might this amount change next year?
CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, all of which can shift the allowed amount for a given code.
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.
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