Medicare Reimbursement for CPT 11423

CPT 11423 is a 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 adjusted for locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$208.76	$143.62
ALASKA* (AK)	$246.89	$177.53
ALABAMA (AL)	$188.27	$131.28
ARKANSAS (AR)	$185.68	$129.74
ARIZONA (AZ)	$203.35	$140.23
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$264.31	$172.48
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$269.31	$175.39
OXNARD-THOUSAND OAKS-VENTURA (CA)	$231.37	$154.38
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$232.74	$155.69
NAPA (CA)	$250.72	$164.87
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$264.62	$172.79
VALLEJO (CA)	$250.27	$164.43
BAKERSFIELD (CA)	$219.23	$147.85
CHICO (CA)	$218.44	$147.06
FRESNO (CA)	$218.44	$147.06
HANFORD-CORCORAN (CA)	$218.44	$147.06
MADERA (CA)	$218.44	$147.06
MERCED (CA)	$218.44	$147.06
MODESTO (CA)	$218.44	$147.06
REDDING (CA)	$218.44	$147.06
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$221.37	$149.98
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$228.60	$152.85
SALINAS (CA)	$227.74	$152.25
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$270.57	$176.65
SANTA CRUZ-WATSONVILLE (CA)	$234.49	$155.36
SANTA ROSA-PETALUMA (CA)	$236.82	$156.84
STOCKTON (CA)	$218.44	$147.06
VISALIA (CA)	$218.44	$147.06
YUBA CITY (CA)	$218.44	$147.06
EL CENTRO (CA)	$218.49	$147.10
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$232.63	$154.73
SAN LUIS OBISPO-PASO ROBLES (CA)	$224.14	$149.96
SANTA MARIA-SANTA BARBARA (CA)	$228.46	$152.52
REST OF CALIFORNIA (CA)	$218.44	$147.06
COLORADO (CO)	$216.07	$146.77
CONNECTICUT (CT)	$222.20	$152.06
DC + MD/VA SUBURBS (DC)	$237.00	$160.28
DELAWARE (DE)	$206.59	$142.24
FORT LAUDERDALE (FL)	$217.77	$151.79
MIAMI (FL)	$227.98	$160.18
REST OF FLORIDA (FL)	$207.46	$145.19
ATLANTA (GA)	$212.89	$146.72
REST OF GEORGIA (GA)	$196.17	$138.07
HAWAII, GUAM (HI)	$223.13	$149.07
IOWA (IA)	$192.05	$132.45
IDAHO (ID)	$193.39	$133.47
EAST ST. LOUIS (IL)	$207.29	$147.37
SUBURBAN CHICAGO (IL)	$219.77	$152.88
CHICAGO (IL)	$221.57	$156.11
REST OF ILLINOIS (IL)	$202.30	$142.83
INDIANA (IN)	$194.44	$134.06
KANSAS (KS)	$191.55	$132.67
KENTUCKY (KY)	$193.27	$135.37
NEW ORLEANS (LA)	$202.16	$140.87
REST OF LOUISIANA (LA)	$193.13	$135.49
METROPOLITAN BOSTON (MA)	$236.24	$158.47
REST OF MASSACHUSETTS (MA)	$215.03	$146.44
BALTIMORE/SURR. CNTYS (MD)	$221.65	$151.76
REST OF MARYLAND (MD)	$210.28	$144.37
SOUTHERN MAINE (ME)	$204.23	$139.69
REST OF MAINE (ME)	$194.74	$134.82
DETROIT (MI)	$210.30	$147.45
REST OF MICHIGAN (MI)	$198.38	$138.92
MINNESOTA (MN)	$206.25	$139.23
METROPOLITAN ST. LOUIS (MO)	$202.41	$140.40
METROPOLITAN KANSAS CITY (MO)	$200.46	$139.30
REST OF MISSOURI (MO)	$190.22	$134.08
MISSISSIPPI (MS)	$187.97	$131.89
MONTANA** (MT)	$208.74	$143.61
NORTH CAROLINA (NC)	$196.62	$135.85
NORTH DAKOTA** (ND)	$203.40	$138.27
NEBRASKA (NE)	$192.94	$132.82
NEW HAMPSHIRE (NH)	$213.07	$145.26
NORTHERN NJ (NJ)	$234.81	$159.26
REST OF NEW JERSEY (NJ)	$224.52	$153.39
NEW MEXICO (NM)	$199.56	$139.84
NEVADA** (NV)	$207.38	$142.19
MANHATTAN (NY)	$239.82	$164.14
NYC SUBURBS/LONG ISLAND (NY)	$245.84	$168.40
POUGHKPSIE/N NYC SUBURBS (NY)	$226.27	$154.95
QUEENS (NY)	$241.17	$164.19
REST OF NEW YORK (NY)	$199.45	$137.57
OHIO (OH)	$197.29	$137.83
OKLAHOMA (OK)	$192.56	$134.39
PORTLAND (OR)	$222.24	$149.88
REST OF OREGON (OR)	$205.55	$140.68
METROPOLITAN PHILADELPHIA (PA)	$217.14	$149.34
REST OF PENNSYLVANIA (PA)	$197.39	$137.60
PUERTO RICO (PR)	$210.08	$144.23
RHODE ISLAND (RI)	$213.43	$146.15
SOUTH CAROLINA (SC)	$197.33	$137.14
SOUTH DAKOTA** (SD)	$202.77	$137.64
TENNESSEE (TN)	$192.51	$133.31
BRAZORIA (TX)	$206.12	$141.57
DALLAS (TX)	$207.55	$142.68
GALVESTON (TX)	$206.81	$142.14
HOUSTON (TX)	$211.76	$147.08
BEAUMONT (TX)	$196.18	$136.91
FORT WORTH (TX)	$206.34	$142.12
AUSTIN (TX)	$215.55	$146.64
REST OF TEXAS (TX)	$201.12	$139.31
UTAH (UT)	$199.88	$138.66
VIRGINIA (VA)	$203.85	$139.83
VIRGIN ISLANDS (VI)	$210.08	$144.23
VERMONT (VT)	$202.97	$138.49
SEATTLE (KING CNTY) (WA)	$240.56	$160.65
REST OF WASHINGTON (WA)	$214.50	$145.92
WISCONSIN (WI)	$196.95	$134.55
WEST VIRGINIA (WV)	$195.27	$138.67
WYOMING** (WY)	$206.41	$141.28

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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 payment is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is furnished, since costs vary by region. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar figure set each year) to produce the allowed amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher when the provider bears the overhead (e.g., in an office) versus when the service is performed in a facility that separately bills its own overhead.

RVUs — work 2.01, practice expense 3.97 (non-facility) / 2.02 (facility), malpractice 0.27 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments to the conversion factor.
Always verify the final allowed amount and payment with your Medicare Administrative Contractor (MAC), as local pricing files may differ from these estimates.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The facility rate uses a lower practice-expense RVU because the facility (e.g., hospital) — not the billing physician — incurs and bills separately for the overhead costs of the encounter.

Does this amount reflect what Medicare will actually pay?

No. It reflects the PFS-allowed amount before the standard 80/20 split, deductible status, modifiers, and any sequestration or local adjustments are applied.

Why does the fee change year to year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and these updates — along with statutory budget-neutrality requirements — can raise or lower the allowed amount from one year to the next.

Can I use this figure to bill a specific locality?

Use the locality-adjusted figure shown on this page as a reference estimate, but confirm the exact amount with your MAC's published fee schedule, since GPCI values are locality-specific.

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.