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CPT 11303

National PFS baseline · Q2 2026

11303 · Historical

GPCIs 1.000 · Participating · Before sequestration

Find the locality-adjusted allowed amount

Nationally priced under PFS, using the RVU formula.

The national PFS baseline was $147.30 for CPT 11303 in the office (non-facility) setting and $57.78 in a facility under the Q2 2026 Physician Fee Schedule, effective April 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Calculation evidence

Physician relative value file (Q2 2026) · rvu26b-updated-05-01-2026.zip (PPRRVU2026_Apr_nonQPP.csv row 1,195)

Compact facts

Why are the facility and non-facility amounts different?

Only the practice-expense RVU changes with the setting. For 11303 it's 3.06 RVUs in the office versus 0.38 in a facility—the whole $89.52 gap between $147.30 and $57.78. In an office the practice bears the overhead, so Medicare pays more; in a hospital or ASC the facility bills its own fee, so the professional payment is lower. See facility vs non-facility.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).

What could change this amount? Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Service location and setting · Participation and payment shares

Facility/non-facility Applies Multiple-procedure reduction Context required
Other payment indicators (8)

Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Compare payment localities

The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.

Maine: $137.48–$144.78 across 2 localities ME Wisconsin: $140.00 WI Vermont: $144.13 VT New Hampshire: $150.95 NH Montana: $147.29 MT North Dakota: $144.72 ND Minnesota: $147.21 MN Michigan: $138.97–$146.70 across 2 localities MI New York: $140.90–$172.94 across 5 localities NY Massachusetts: $152.49–$168.32 across 2 localities MA Rhode Island: $150.98 RI Washington: $152.21–$171.74 across 2 localities WA Idaho: $136.83 ID Wyoming: $146.17 WY South Dakota: $144.41 SD Iowa: $135.99 IA Illinois: $140.85–$153.72 across 4 localities IL Indiana: $137.61 IN Ohio: $138.44 OH Pennsylvania: $138.68–$153.06 across 2 localities PA New Jersey: $158.75–$166.51 across 2 localities NJ Connecticut: $156.89 CT Oregon: $145.60–$158.18 across 2 localities OR Nevada: $146.68 NV Utah: $140.72 UT Colorado: $153.38 CO Nebraska: $136.73 NE Missouri: $133.08–$142.40 across 3 localities MO Kentucky: $135.58 KY West Virginia: $135.78 WV Virginia: $144.28 VA Maryland: $148.58–$156.44 across 2 localities MD Delaware: $145.84 DE California: $155.79–$194.94 across 29 localities CA Arizona: $143.50 AZ New Mexico: $139.69 NM Kansas: $135.33 KS Oklahoma: $135.39 OK Arkansas: $130.78 AR Tennessee: $135.99 TN North Carolina: $138.88 NC South Carolina: $138.88 SC District of Columbia: $168.18 DC Texas: $137.79–$152.81 across 8 localities TX Louisiana: $135.36–$141.86 across 2 localities LA Mississippi: $131.96 MS Alabama: $132.64 AL Georgia: $137.09–$149.93 across 2 localities GA Florida: $144.98–$158.13 across 3 localities FL Alaska: $172.37 AK Hawaii: $159.47 HI
$131–$138 $138–$145 $145–$152 $152–$159 $159–$165 $165–$172

Highest-paying locality

$194.94

CA flag San Jose-Sunnyvale-Santa Clara (San Benito County), Ca, CA

Lowest-paying locality

$130.78

AR flag Arkansas, AR

11303 non-facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $172.37 Locality 02102-01 Washington, DC flag Washington, DC $168.18 Locality 12202-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $166.51 Locality 12402-01 Honolulu, HI flag Honolulu, HI $159.47 Locality 01212-01 Hartford, CT flag Hartford, CT $156.89 Locality 13102-00 Denver, CO flag Denver, CO $153.38 Locality 04112-01 Providence, RI flag Providence, RI $150.98 Locality 14412-01
Show 24 more metros
Minneapolis, MN flag Minneapolis, MN $147.21 Locality 06202-00 Las Vegas, NV flag Las Vegas, NV $146.68 Locality 01312-00 Tampa, FL flag Tampa, FL $144.98 Locality 09102-99 Portland, ME flag Portland, ME $144.78 Locality 14112-03 Richmond, VA flag Richmond, VA $144.28 Locality 11302-00 Phoenix, AZ flag Phoenix, AZ $143.50 Locality 03102-00 San Antonio, TX flag San Antonio, TX $141.66 Locality 04412-99 Buffalo, NY flag Buffalo, NY $140.90 Locality 13282-99 Salt Lake City, UT flag Salt Lake City, UT $140.72 Locality 03502-09 Milwaukee, WI flag Milwaukee, WI $140.00 Locality 06302-00 Albuquerque, NM flag Albuquerque, NM $139.69 Locality 04212-05 Charlotte, NC flag Charlotte, NC $138.88 Locality 11502-00 Charleston, SC flag Charleston, SC $138.88 Locality 11202-01 Pittsburgh, PA flag Pittsburgh, PA $138.68 Locality 12502-99 Columbus, OH flag Columbus, OH $138.44 Locality 15202-00 Indianapolis, IN flag Indianapolis, IN $137.61 Locality 08102-00 Boise, ID flag Boise, ID $136.83 Locality 02202-00 Omaha, NE flag Omaha, NE $136.73 Locality 05402-00 Des Moines, IA flag Des Moines, IA $135.99 Locality 05102-00 Nashville, TN flag Nashville, TN $135.99 Locality 10312-35 Louisville, KY flag Louisville, KY $135.58 Locality 15102-00 Oklahoma City, OK flag Oklahoma City, OK $135.39 Locality 04312-00 Wichita, KS flag Wichita, KS $135.33 Locality 05202-00 Birmingham, AL flag Birmingham, AL $132.64 Locality 10112-00
Maine: $55.13–$56.07 across 2 localities ME Wisconsin: $54.25 WI Vermont: $55.51 VT New Hampshire: $57.76 NH Montana: $57.77 MT North Dakota: $55.20 ND Minnesota: $55.09 MN Michigan: $57.24–$60.32 across 2 localities MI New York: $55.86–$66.51 across 5 localities NY Massachusetts: $58.23–$61.44 across 2 localities MA Rhode Island: $58.51 RI Washington: $57.95–$61.91 across 2 localities WA Idaho: $54.48 ID Wyoming: $56.65 WY South Dakota: $54.90 SD Iowa: $54.09 IA Illinois: $59.12–$63.76 across 4 localities IL Indiana: $54.63 IN Ohio: $56.71 OH Pennsylvania: $56.50–$59.88 across 2 localities PA New Jersey: $61.00–$62.68 across 2 localities NJ Connecticut: $60.49 CT Oregon: $56.44–$58.73 across 2 localities OR Nevada: $57.07 NV Utah: $56.58 UT Colorado: $58.13 CO Nebraska: $54.11 NE Missouri: $55.92–$57.18 across 3 localities MO Kentucky: $56.01 KY West Virginia: $57.99 WV Virginia: $56.29 VA Maryland: $57.99–$60.39 across 2 localities MD Delaware: $57.40 DE California: $57.68–$65.86 across 29 localities CA Arizona: $56.76 AZ New Mexico: $57.60 NM Kansas: $54.41 KS Oklahoma: $55.46 OK Arkansas: $53.89 AR Tennessee: $54.62 TN North Carolina: $55.37 NC South Carolina: $56.17 SC District of Columbia: $62.73 DC Texas: $56.33–$59.65 across 8 localities TX Louisiana: $56.14–$57.63 across 2 localities LA Mississippi: $54.89 MS Alabama: $54.31 AL Georgia: $57.25–$58.98 across 2 localities GA Florida: $59.41–$64.94 across 3 localities FL Alaska: $77.03 AK Hawaii: $57.69 HI
$54–$58 $58–$62 $62–$65 $65–$69 $69–$73 $73–$77

Highest-paying locality

$77.03

AK flag Alaska , AK

Lowest-paying locality

$53.89

AR flag Arkansas, AR

11303 facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $77.03 Locality 02102-01 Washington, DC flag Washington, DC $62.73 Locality 12202-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $62.68 Locality 12402-01 Hartford, CT flag Hartford, CT $60.49 Locality 13102-00 Tampa, FL flag Tampa, FL $59.41 Locality 09102-99 Providence, RI flag Providence, RI $58.51 Locality 14412-01 Denver, CO flag Denver, CO $58.13 Locality 04112-01
Show 24 more metros
Honolulu, HI flag Honolulu, HI $57.69 Locality 01212-01 Albuquerque, NM flag Albuquerque, NM $57.60 Locality 04212-05 Las Vegas, NV flag Las Vegas, NV $57.07 Locality 01312-00 Phoenix, AZ flag Phoenix, AZ $56.76 Locality 03102-00 San Antonio, TX flag San Antonio, TX $56.72 Locality 04412-99 Columbus, OH flag Columbus, OH $56.71 Locality 15202-00 Salt Lake City, UT flag Salt Lake City, UT $56.58 Locality 03502-09 Pittsburgh, PA flag Pittsburgh, PA $56.50 Locality 12502-99 Richmond, VA flag Richmond, VA $56.29 Locality 11302-00 Charleston, SC flag Charleston, SC $56.17 Locality 11202-01 Portland, ME flag Portland, ME $56.07 Locality 14112-03 Louisville, KY flag Louisville, KY $56.01 Locality 15102-00 Buffalo, NY flag Buffalo, NY $55.86 Locality 13282-99 Oklahoma City, OK flag Oklahoma City, OK $55.46 Locality 04312-00 Charlotte, NC flag Charlotte, NC $55.37 Locality 11502-00 Minneapolis, MN flag Minneapolis, MN $55.09 Locality 06202-00 Indianapolis, IN flag Indianapolis, IN $54.63 Locality 08102-00 Nashville, TN flag Nashville, TN $54.62 Locality 10312-35 Boise, ID flag Boise, ID $54.48 Locality 02202-00 Wichita, KS flag Wichita, KS $54.41 Locality 05202-00 Birmingham, AL flag Birmingham, AL $54.31 Locality 10112-00 Milwaukee, WI flag Milwaukee, WI $54.25 Locality 06302-00 Omaha, NE flag Omaha, NE $54.11 Locality 05402-00 Des Moines, IA flag Des Moines, IA $54.09 Locality 05102-00

Look up your exact locality →

Q2 2026 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

How this amount is computed Copy link

CPT 11303 has a work RVU of 1.22, a non-facility practice expense RVU of 3.06, a facility practice expense RVU of 0.38 and a malpractice RVU of 0.13—for total non-facility RVUs of 4.41 and total facility RVUs of 1.73 in the Q2 2026 release.

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Release Q2 2026
Component RVU
Work RVU 1.22
Practice expense RVU (non-facility) 3.06
Practice expense RVU (facility) 0.38
Malpractice RVU 0.13

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead—higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

Payment review for 11303 Copy link

Four published payment rules can change what 11303 allows on a claim: the office/facility differential, the same-day global package, the standard multiple-procedure reduction and documentation-restricted assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

What to reconcile

  • Check the place-of-service code before attributing the gap to the payer: office and facility pricing differ by $89.52 nationally at GPCI 1.000, before any locality adjustment.
  • Check the visit date: this code carries no follow-up window, so a related visit the day after the procedure is separately payable and should not have bundled.
  • Rank the claim’s procedure lines before calling this one short-paid: ranked below a higher-valued procedure on the same date it prices at $73.65 rather than $147.30 nationally at GPCI 1.000, which is the rule working rather than a payer error.
  • Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Nearby payment lines

National Q2 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Why compare Office Facility
11302 Same payment rules, less physician work $131.60 $48.43
11305 Same payment rules, less physician work $101.20 $32.73
11301 Same payment rules, less physician work $116.24 $41.75
Check an actual payment Model this code in a contract

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Payment rules

Global period: what 11303's fee already covers Copy link

000 Same day only

The fee covers pre-operative and post-operative work on the day of the procedure only—there is no follow-up window afterward. A visit the next day is separately payable.

Modifiers that report work outside 11303's global period
Modifier Reports
-25 A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

Billing policy Copy link

What 11303's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.

Policy Value What it means
Assistant at surgery 0 Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity.
Co-surgeons 0 Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure.
Team surgery 0 Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure.
Multiple procedures 2 Standard reduction applies. The same standard ranking-and-reduction rule as indicator 1 applies to this procedure when billed with others on the same date.
Professional/technical split 0 No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service.

Modifier amounts: -26/TC, -80/81/82, -AS, -62, -66 Copy link

National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

Modifier What it means Amount
-26/TC Professional/technical split Not payable
-80/81/82 Assistant surgeon (physician) (16%) $23.57 If documented
-AS Assistant at surgery (PA, NP, or CNS) (13.6%) $20.03 If documented
-62 Co-surgeons, each Not payable
-66 Team surgery Not payable

These apply standard MPFS percentages—assistant surgeon 16%, co-surgeon 62.5%, bilateral 150%—to the national non-facility amount above, and require both the RVU inputs and the applicable payment rule as evidence. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted—an unpaid claim without that documentation is not an underpayment.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 11303.

See every current NCCI pair for 11303 →

Allowed amount, program payment, and patient share Copy link

These figures use the same national baseline, with different participation and payment assumptions.

Computed from the Q2 2026 CMS release

Medicare allowed amount

What Medicare recognizes as the full price for 11303 in the office (non-facility) setting. Every figure below derives from it.

$147.30
Medicare's share

80% of the allowed amount, before the ~2% sequestration cut.

$117.84
Patient coinsurance

The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.

$29.46
Limiting charge

The ceiling a non-participating provider can bill a patient on an unassigned claim—109.25% of the allowed amount.

$160.93

National Q2 2026 figures at GPCI 1.000. Adjust for your locality and sequestration, or expand the explanations below for each figure in full.

Is $147.30 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($117.84) and the patient owes 20% coinsurance ($29.46). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 11303?

$139.94 in the office (non-facility) setting—95% of the $147.30 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 11303?

$160.93 in the office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $147.30 amount above. The non-participating amount is 95% of the fee schedule rate ($139.94), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

Common payment questions Copy link

Why would a Medicare claim for 11303 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

History

Rate history by release Copy link

National non-facility amount for 11303 across quarterly releases. +25.4% increase since Q1 2013 · high $160.51 in Q1 2021

$161 $134 $108 $81 $55 Q1 2013 · $117.50 Q2 2014 · $154.75 (+31.7%) Q3 2014 · $154.75 (0.0%) Q4 2014 · $154.75 (0.0%) Q1 2015 · $156.96 (+1.4%) Q2 2015 · $156.96 (0.0%) Q3 2015 · $156.96 (0.0%) Q4 2015 · $157.75 (+0.5%) Q1 2016 · $157.54 (-0.1%) Q2 2016 · $157.54 (0.0%) Q3 2016 · $157.54 (0.0%) Q4 2016 · $157.54 (0.0%) Q1 2017 · $159.70 (+1.4%) Q2 2017 · $159.70 (0.0%) Q3 2017 · $159.70 (0.0%) Q4 2017 · $159.70 (0.0%) Q1 2018 · $160.20 (+0.3%) Q2 2018 · $160.20 (0.0%) Q3 2018 · $160.20 (0.0%) Q4 2018 · $160.20 (0.0%) Q1 2019 · $158.21 (-1.2%) Q2 2019 · $158.21 (0.0%) Q3 2019 · $158.21 (0.0%) Q4 2019 · $158.21 (0.0%) Q1 2020 · $158.43 (+0.1%) Q2 2020 · $158.43 (0.0%) Q3 2020 · $158.43 (0.0%) Q4 2020 · $158.43 (0.0%) Q1 2021 · $160.51 (+1.3%) Q2 2021 · $160.51 (0.0%) Q3 2021 · $160.51 (0.0%) Q4 2021 · $160.51 (0.0%) Q1 2022 · $157.80 (-1.7%) Q2 2022 · $157.80 (0.0%) Q3 2022 · $157.80 (0.0%) Q4 2022 · $157.80 (0.0%) Q1 2023 · $155.20 (-1.6%) Q2 2023 · $155.20 (0.0%) Q3 2023 · $155.20 (0.0%) Q4 2023 · $155.20 (0.0%) Q1 2024 · $149.31 (-3.8%) Q1 2024 · $151.79 (+1.7%) Q2 2024 · $151.79 (0.0%) Q3 2024 · $151.79 (0.0%) Q4 2024 · $151.79 (0.0%) Q1 2025 · $146.21 (-3.7%) Q2 2025 · $146.21 (0.0%) Q3 2025 · $146.21 (0.0%) Q4 2025 · $146.21 (0.0%) Q1 2026 · $147.30 (+0.7%) Q2 2026 · $147.30 (0.0%) Q3 2026 · $147.30 (0.0%) Q4 2026 · $147.30 (0.0%) Q1 2013 Q3 2016 Q2 2019 Q4 2021 Q2 2024 Q4 2026
Non-facility Facility
Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 A $147.30 (0.0% no change ) $57.78 (0.0% no change )

This price has been unchanged since Q1 2026, when it increased 0.7%.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 11303 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Beyond Medicare

Contracted rate: % of Medicare Copy link

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 11303 pays at that rate—$147.30 is 100%.

We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →

See how to find your contract's actual percentage.

Usage & related

How often 11303 is billed Copy link

Across Original Medicare in CY2024, 11303 ranked #2,131 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries
13,152
Office + facility patients combined
Services
16,029
Times it was billed
Allowed
$2.0M
Total Medicare allowed dollars
Compare: ↑ #2,129 more popular · 69420 ↓ #2,133 less popular · 73222

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q2 2026 fee schedule above.

Did this answer your question about CPT 11303?

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q2 2026 release (effective April 2026). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q2 2026) · rvu26b-updated-05-01-2026.zip (PPRRVU2026_Apr_nonQPP.csv row 1,195)

Conversion factor $33.4009 read from the same file, row 11, column 26.

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 11303 National PFS baseline: Office (non-facility) $147.30; Facility $57.78 (Q2 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/11303/2026/B