Medicare Reimbursement for CPT 17004

CPT 17004 is a physician procedure code reported 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 separately for non-facility (e.g., office) and facility (e.g., hospital, ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$162.33	$82.83
ALASKA* (AK)	$190.12	$105.46
ALABAMA (AL)	$146.29	$76.73
ARKANSAS (AR)	$144.26	$75.97
ARIZONA (AZ)	$158.19	$81.16
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$210.51	$98.42
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$214.68	$100.05
OXNARD-THOUSAND OAKS-VENTURA (CA)	$182.55	$88.59
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$183.43	$89.38
NAPA (CA)	$199.02	$94.25
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$210.66	$98.57
VALLEJO (CA)	$198.81	$94.03
BAKERSFIELD (CA)	$172.35	$85.23
CHICO (CA)	$171.94	$84.82
FRESNO (CA)	$171.94	$84.82
HANFORD-CORCORAN (CA)	$171.94	$84.82
MADERA (CA)	$171.94	$84.82
MERCED (CA)	$171.94	$84.82
MODESTO (CA)	$171.94	$84.82
REDDING (CA)	$171.94	$84.82
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$173.37	$86.24
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$180.38	$87.93
SALINAS (CA)	$179.70	$87.57
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$215.28	$100.65
SANTA CRUZ-WATSONVILLE (CA)	$185.60	$89.01
SANTA ROSA-PETALUMA (CA)	$187.47	$89.85
STOCKTON (CA)	$171.94	$84.82
VISALIA (CA)	$171.94	$84.82
YUBA CITY (CA)	$171.94	$84.82
EL CENTRO (CA)	$171.97	$84.84
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$183.88	$88.80
SAN LUIS OBISPO-PASO ROBLES (CA)	$176.81	$86.27
SANTA MARIA-SANTA BARBARA (CA)	$180.36	$87.67
REST OF CALIFORNIA (CA)	$171.94	$84.82
COLORADO (CO)	$169.16	$84.58
CONNECTICUT (CT)	$172.85	$87.24
DC + MD/VA SUBURBS (DC)	$185.39	$91.75
DELAWARE (DE)	$160.75	$82.21
FORT LAUDERDALE (FL)	$167.31	$86.78
MIAMI (FL)	$173.61	$90.86
REST OF FLORIDA (FL)	$159.53	$83.53
ATLANTA (GA)	$165.15	$84.38
REST OF GEORGIA (GA)	$150.93	$80.02
HAWAII, GUAM (HI)	$176.01	$85.63
IOWA (IA)	$150.09	$77.35
IDAHO (ID)	$150.98	$77.85
EAST ST. LOUIS (IL)	$157.67	$84.54
SUBURBAN CHICAGO (IL)	$169.05	$87.41
CHICAGO (IL)	$168.83	$88.94
REST OF ILLINOIS (IL)	$154.92	$82.34
INDIANA (IN)	$151.83	$78.14
KANSAS (KS)	$149.30	$77.44
KENTUCKY (KY)	$149.39	$78.72
NEW ORLEANS (LA)	$156.24	$81.43
REST OF LOUISIANA (LA)	$149.12	$78.77
METROPOLITAN BOSTON (MA)	$185.65	$90.74
REST OF MASSACHUSETTS (MA)	$168.16	$84.46
BALTIMORE/SURR. CNTYS (MD)	$172.34	$87.04
REST OF MARYLAND (MD)	$163.78	$83.33
SOUTHERN MAINE (ME)	$159.71	$80.93
REST OF MAINE (ME)	$151.63	$78.49
DETROIT (MI)	$161.34	$84.63
REST OF MICHIGAN (MI)	$153.04	$80.46
MINNESOTA (MN)	$162.56	$80.76
METROPOLITAN ST. LOUIS (MO)	$156.90	$81.22
METROPOLITAN KANSAS CITY (MO)	$155.32	$80.68
REST OF MISSOURI (MO)	$146.59	$78.07
MISSISSIPPI (MS)	$145.46	$77.01
MONTANA** (MT)	$162.32	$82.83
NORTH CAROLINA (NC)	$153.17	$79.01
NORTH DAKOTA** (ND)	$159.75	$80.26
NEBRASKA (NE)	$150.91	$77.54
NEW HAMPSHIRE (NH)	$166.43	$83.67
NORTHERN NJ (NJ)	$183.56	$91.35
REST OF NEW JERSEY (NJ)	$174.96	$88.15
NEW MEXICO (NM)	$153.80	$80.91
NEVADA** (NV)	$161.72	$82.14
MANHATTAN (NY)	$186.08	$93.71
NYC SUBURBS/LONG ISLAND (NY)	$190.31	$95.80
POUGHKPSIE/N NYC SUBURBS (NY)	$176.01	$88.96
QUEENS (NY)	$187.72	$93.76
REST OF NEW YORK (NY)	$155.38	$79.86
OHIO (OH)	$152.51	$79.93
OKLAHOMA (OK)	$149.24	$78.26
PORTLAND (OR)	$174.50	$86.18
REST OF OREGON (OR)	$160.59	$81.41
METROPOLITAN PHILADELPHIA (PA)	$168.61	$85.86
REST OF PENNSYLVANIA (PA)	$152.80	$79.83
PUERTO RICO (PR)	$163.51	$83.14
RHODE ISLAND (RI)	$166.45	$84.33
SOUTH CAROLINA (SC)	$153.07	$79.62
SOUTH DAKOTA** (SD)	$159.45	$79.95
TENNESSEE (TN)	$150.01	$77.75
BRAZORIA (TX)	$160.71	$81.93
DALLAS (TX)	$161.66	$82.49
GALVESTON (TX)	$161.15	$82.21
HOUSTON (TX)	$163.53	$84.59
BEAUMONT (TX)	$151.83	$79.49
FORT WORTH (TX)	$160.59	$82.20
AUSTIN (TX)	$168.49	$84.39
REST OF TEXAS (TX)	$156.13	$80.69
UTAH (UT)	$155.09	$80.37
VIRGINIA (VA)	$159.13	$80.98
VIRGIN ISLANDS (VI)	$163.51	$83.14
VERMONT (VT)	$159.05	$80.35
SEATTLE (KING CNTY) (WA)	$189.47	$91.94
REST OF WASHINGTON (WA)	$167.87	$84.17
WISCONSIN (WI)	$154.57	$78.41
WEST VIRGINIA (WV)	$149.37	$80.29
WYOMING** (WY)	$161.20	$81.71

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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 pricing starts with three Relative Value Units (RVUs) assigned to the 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, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility amounts differ mainly because the practice-expense RVU is higher in non-facility settings, where the billing provider absorbs more overhead costs, versus facility settings where the facility bears those costs separately.

RVUs — work 1.34, practice expense 3.39 (non-facility) / 1.01 (facility), malpractice 0.13 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement can vary.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Rates differ by locality due to GPCI adjustments — confirm the specific locality used for this calculation.
Always verify final allowed amounts and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount for the same code?

In facility settings, the facility (e.g., hospital) bears most of the overhead costs and bills separately, so the practice-expense RVU assigned to the physician's service is lower, resulting in a lower professional-fee allowed amount.

Does this amount reflect what Medicare actually pays?

No. The allowed amount shown is the basis for payment. Medicare generally pays 80% of this amount after the deductible is met, with the remaining 20% owed by the patient or secondary insurance, unless modifiers or other adjustments apply.

Why might my locality's amount differ from the national amount?

Medicare adjusts RVUs using locality-specific Geographic Practice Cost Indices (GPCIs) to account for regional differences in wages, rent, and malpractice costs, so the allowed amount can vary by geographic area.

Why can't you show the CPT code description here?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page refers to the code generically rather than reproducing the official descriptor.

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.