Medicare Reimbursement for CPT 17261

CPT 17261 is a procedure code used in Medicare billing; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for your 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)	$144.29	$74.48
ALASKA* (AK)	$168.90	$94.56
ALABAMA (AL)	$129.99	$68.90
ARKANSAS (AR)	$128.17	$68.21
ARIZONA (AZ)	$140.60	$72.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$186.98	$88.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$190.68	$90.02
OXNARD-THOUSAND OAKS-VENTURA (CA)	$162.19	$79.68
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$162.97	$80.39
NAPA (CA)	$176.79	$84.79
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$187.12	$88.69
VALLEJO (CA)	$176.60	$84.59
BAKERSFIELD (CA)	$153.13	$76.62
CHICO (CA)	$152.76	$76.25
FRESNO (CA)	$152.76	$76.25
HANFORD-CORCORAN (CA)	$152.76	$76.25
MADERA (CA)	$152.76	$76.25
MERCED (CA)	$152.76	$76.25
MODESTO (CA)	$152.76	$76.25
REDDING (CA)	$152.76	$76.25
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$154.07	$77.56
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$160.25	$79.06
SALINAS (CA)	$159.65	$78.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$191.24	$90.58
SANTA CRUZ-WATSONVILLE (CA)	$164.88	$80.07
SANTA ROSA-PETALUMA (CA)	$166.55	$80.82
STOCKTON (CA)	$152.76	$76.25
VISALIA (CA)	$152.76	$76.25
YUBA CITY (CA)	$152.76	$76.25
EL CENTRO (CA)	$152.78	$76.27
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$163.35	$79.86
SAN LUIS OBISPO-PASO ROBLES (CA)	$157.08	$77.57
SANTA MARIA-SANTA BARBARA (CA)	$160.23	$78.84
REST OF CALIFORNIA (CA)	$152.76	$76.25
COLORADO (CO)	$150.33	$76.05
CONNECTICUT (CT)	$153.67	$78.49
DC + MD/VA SUBURBS (DC)	$164.79	$82.55
DELAWARE (DE)	$142.88	$73.91
FORT LAUDERDALE (FL)	$148.84	$78.12
MIAMI (FL)	$154.54	$81.87
REST OF FLORIDA (FL)	$141.88	$75.15
ATLANTA (GA)	$146.83	$75.90
REST OF GEORGIA (GA)	$134.20	$71.93
HAWAII, GUAM (HI)	$156.38	$77.01
IOWA (IA)	$133.33	$69.46
IDAHO (ID)	$134.14	$69.91
EAST ST. LOUIS (IL)	$140.31	$76.09
SUBURBAN CHICAGO (IL)	$150.38	$78.69
CHICAGO (IL)	$150.26	$80.11
REST OF ILLINOIS (IL)	$137.80	$74.07
INDIANA (IN)	$134.89	$70.18
KANSAS (KS)	$132.65	$69.55
KENTUCKY (KY)	$132.79	$70.73
NEW ORLEANS (LA)	$138.91	$73.22
REST OF LOUISIANA (LA)	$132.56	$70.78
METROPOLITAN BOSTON (MA)	$164.98	$81.63
REST OF MASSACHUSETTS (MA)	$149.44	$75.93
BALTIMORE/SURR. CNTYS (MD)	$153.22	$78.31
REST OF MARYLAND (MD)	$145.57	$74.92
SOUTHERN MAINE (ME)	$141.91	$72.73
REST OF MAINE (ME)	$134.73	$70.51
DETROIT (MI)	$143.52	$76.16
REST OF MICHIGAN (MI)	$136.06	$72.33
MINNESOTA (MN)	$144.39	$72.55
METROPOLITAN ST. LOUIS (MO)	$139.47	$73.02
METROPOLITAN KANSAS CITY (MO)	$138.07	$72.52
REST OF MISSOURI (MO)	$130.31	$70.14
MISSISSIPPI (MS)	$129.27	$69.17
MONTANA** (MT)	$144.28	$74.48
NORTH CAROLINA (NC)	$136.11	$70.98
NORTH DAKOTA** (ND)	$141.91	$72.10
NEBRASKA (NE)	$134.06	$69.62
NEW HAMPSHIRE (NH)	$147.91	$75.24
NORTHERN NJ (NJ)	$163.15	$82.18
REST OF NEW JERSEY (NJ)	$155.52	$79.29
NEW MEXICO (NM)	$136.75	$72.74
NEVADA** (NV)	$143.72	$73.85
MANHATTAN (NY)	$165.47	$84.35
NYC SUBURBS/LONG ISLAND (NY)	$169.27	$86.27
POUGHKPSIE/N NYC SUBURBS (NY)	$156.47	$80.03
QUEENS (NY)	$166.90	$84.39
REST OF NEW YORK (NY)	$138.07	$71.76
OHIO (OH)	$135.58	$71.84
OKLAHOMA (OK)	$132.64	$70.30
PORTLAND (OR)	$155.06	$77.50
REST OF OREGON (OR)	$142.70	$73.17
METROPOLITAN PHILADELPHIA (PA)	$149.90	$77.23
REST OF PENNSYLVANIA (PA)	$135.83	$71.74
PUERTO RICO (PR)	$145.34	$74.76
RHODE ISLAND (RI)	$147.93	$75.82
SOUTH CAROLINA (SC)	$136.05	$71.55
SOUTH DAKOTA** (SD)	$141.63	$71.82
TENNESSEE (TN)	$133.29	$69.83
BRAZORIA (TX)	$142.82	$73.64
DALLAS (TX)	$143.68	$74.15
GALVESTON (TX)	$143.22	$73.90
HOUSTON (TX)	$145.41	$76.09
BEAUMONT (TX)	$134.96	$71.43
FORT WORTH (TX)	$142.73	$73.89
AUSTIN (TX)	$149.75	$75.89
REST OF TEXAS (TX)	$138.78	$72.53
UTAH (UT)	$137.85	$72.23
VIRGINIA (VA)	$141.40	$72.78
VIRGIN ISLANDS (VI)	$145.34	$74.76
VERMONT (VT)	$141.31	$72.20
SEATTLE (KING CNTY) (WA)	$168.37	$82.71
REST OF WASHINGTON (WA)	$149.18	$75.67
WISCONSIN (WI)	$137.30	$70.42
WEST VIRGINIA (WV)	$132.85	$72.19
WYOMING** (WY)	$143.25	$73.44

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 7 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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to your Medicare locality, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility rates differ because the practice-expense RVU is lower in facility settings, where the facility itself bears more of the overhead and equipment cost.

RVUs — work 1.19, practice expense 3.01 (non-facility) / 0.92 (facility), malpractice 0.12 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual payment depends on claim-specific factors.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Rates vary by Medicare Administrative Contractor (MAC) locality — always confirm current rates with your MAC before billing or appealing a denial.

Frequently asked

Why is the facility rate lower than the non-facility rate for this code?

In facility settings, the facility (not the billing physician) absorbs most of the overhead, equipment, and supply costs, so the practice-expense RVU — and therefore the total payment to the physician — is lower.

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

No. The national amount is a baseline; actual payment is adjusted using Geographic Practice Cost Indices (GPCIs) specific to your Medicare locality, which can raise or lower the final amount.

Does this amount reflect what Medicare will actually pay?

It reflects the Medicare-allowed amount before the standard 20% patient coinsurance and deductible are applied, and before any claim-specific adjustments like modifiers or sequestration.

Where can I find the official CPT descriptor for this code?

CPT code descriptors are copyrighted by the American Medical Association (AMA); consult your CPT codebook, AMA resources, or your practice management software for the full description.

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.