Medicare Reimbursement for CPT 11623

CPT 11623 is a procedure code defined by the American Medical Association; the specific clinical descriptor is not reproduced here due to licensing. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both nationally and adjustable by locality, and separately for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$295.26	$177.69
ALASKA* (AK)	$351.96	$226.74
ALABAMA (AL)	$267.08	$164.21
ARKANSAS (AR)	$263.54	$162.54
ARIZONA (AZ)	$287.81	$173.89
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$371.94	$206.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$378.91	$209.37
OXNARD-THOUSAND OAKS-VENTURA (CA)	$326.32	$187.35
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$328.34	$189.25
NAPA (CA)	$353.07	$198.11
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$372.37	$206.60
VALLEJO (CA)	$352.45	$197.49
BAKERSFIELD (CA)	$309.64	$180.78
CHICO (CA)	$308.51	$179.65
FRESNO (CA)	$308.51	$179.65
HANFORD-CORCORAN (CA)	$308.51	$179.65
MADERA (CA)	$308.51	$179.65
MERCED (CA)	$308.51	$179.65
MODESTO (CA)	$308.51	$179.65
REDDING (CA)	$308.51	$179.65
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$312.63	$183.77
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$322.58	$185.85
SALINAS (CA)	$321.35	$185.08
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$380.67	$211.13
SANTA CRUZ-WATSONVILLE (CA)	$330.49	$187.64
SANTA ROSA-PETALUMA (CA)	$333.76	$189.39
STOCKTON (CA)	$308.51	$179.65
VISALIA (CA)	$308.51	$179.65
YUBA CITY (CA)	$308.51	$179.65
EL CENTRO (CA)	$308.57	$179.71
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$328.03	$187.42
SAN LUIS OBISPO-PASO ROBLES (CA)	$316.31	$182.39
SANTA MARIA-SANTA BARBARA (CA)	$322.32	$185.23
REST OF CALIFORNIA (CA)	$308.51	$179.65
COLORADO (CO)	$305.31	$180.21
CONNECTICUT (CT)	$313.92	$187.29
DC + MD/VA SUBURBS (DC)	$334.45	$195.95
DELAWARE (DE)	$292.31	$176.15
FORT LAUDERDALE (FL)	$307.88	$188.78
MIAMI (FL)	$322.11	$199.72
REST OF FLORIDA (FL)	$293.67	$181.27
ATLANTA (GA)	$301.02	$181.57
REST OF GEORGIA (GA)	$278.11	$173.24
HAWAII, GUAM (HI)	$314.77	$181.09
IOWA (IA)	$272.19	$164.62
IDAHO (ID)	$274.07	$165.90
EAST ST. LOUIS (IL)	$293.62	$185.46
SUBURBAN CHICAGO (IL)	$310.67	$189.92
CHICAGO (IL)	$313.32	$195.16
REST OF ILLINOIS (IL)	$286.63	$179.29
INDIANA (IN)	$275.50	$166.51
KANSAS (KS)	$271.56	$165.27
KENTUCKY (KY)	$274.05	$169.53
NEW ORLEANS (LA)	$286.29	$175.65
REST OF LOUISIANA (LA)	$273.87	$169.82
METROPOLITAN BOSTON (MA)	$333.20	$192.82
REST OF MASSACHUSETTS (MA)	$303.92	$180.12
BALTIMORE/SURR. CNTYS (MD)	$313.13	$186.98
REST OF MARYLAND (MD)	$297.41	$178.43
SOUTHERN MAINE (ME)	$288.95	$172.44
REST OF MAINE (ME)	$275.96	$167.79
DETROIT (MI)	$297.62	$184.17
REST OF MICHIGAN (MI)	$281.12	$173.78
MINNESOTA (MN)	$291.59	$170.61
METROPOLITAN ST. LOUIS (MO)	$286.58	$174.66
METROPOLITAN KANSAS CITY (MO)	$283.91	$173.51
REST OF MISSOURI (MO)	$269.91	$168.56
MISSISSIPPI (MS)	$266.74	$165.51
MONTANA** (MT)	$295.24	$177.67
NORTH CAROLINA (NC)	$278.53	$168.84
NORTH DAKOTA** (ND)	$287.72	$170.15
NEBRASKA (NE)	$273.40	$164.89
NEW HAMPSHIRE (NH)	$301.11	$178.72
NORTHERN NJ (NJ)	$331.52	$195.14
REST OF NEW JERSEY (NJ)	$317.23	$188.84
NEW MEXICO (NM)	$282.76	$174.95
NEVADA** (NV)	$293.33	$175.64
MANHATTAN (NY)	$338.56	$201.94
NYC SUBURBS/LONG ISLAND (NY)	$346.90	$207.10
POUGHKPSIE/N NYC SUBURBS (NY)	$319.71	$190.97
QUEENS (NY)	$340.36	$201.39
REST OF NEW YORK (NY)	$282.43	$170.73
OHIO (OH)	$279.59	$172.24
OKLAHOMA (OK)	$273.03	$168.04
PORTLAND (OR)	$313.77	$183.14
REST OF OREGON (OR)	$290.77	$173.67
METROPOLITAN PHILADELPHIA (PA)	$306.97	$184.58
REST OF PENNSYLVANIA (PA)	$279.69	$171.76
PUERTO RICO (PR)	$297.07	$178.20
RHODE ISLAND (RI)	$301.80	$180.35
SOUTH CAROLINA (SC)	$279.58	$170.94
SOUTH DAKOTA** (SD)	$286.84	$169.27
TENNESSEE (TN)	$272.88	$166.01
BRAZORIA (TX)	$291.65	$175.14
DALLAS (TX)	$293.65	$176.55
GALVESTON (TX)	$292.62	$175.87
HOUSTON (TX)	$299.58	$182.83
BEAUMONT (TX)	$278.04	$171.05
FORT WORTH (TX)	$292.00	$176.07
AUSTIN (TX)	$304.54	$180.15
REST OF TEXAS (TX)	$284.78	$173.21
UTAH (UT)	$283.09	$172.57
VIRGINIA (VA)	$288.45	$172.88
VIRGIN ISLANDS (VI)	$297.07	$178.20
VERMONT (VT)	$287.18	$170.78
SEATTLE (KING CNTY) (WA)	$339.17	$194.91
REST OF WASHINGTON (WA)	$303.16	$179.36
WISCONSIN (WI)	$278.86	$166.23
WEST VIRGINIA (WV)	$276.98	$174.81
WYOMING** (WY)	$291.96	$174.39

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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 amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility payments differ mainly because the practice-expense RVU is higher when the physician's practice bears the overhead costs (non-facility) versus when a facility (like a hospital) bears them (facility). The result is a national estimate that can shift based on where the service is furnished.

RVUs — work 3.03, practice expense 5.43 (non-facility) / 1.91 (facility), malpractice 0.38 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual Medicare payment may differ.
Medicare typically pays 80% of the allowed amount after the patient meets their annual deductible; the patient or secondary insurer is responsible for the remainder.
Amounts vary by locality due to GPCI adjustments and are not the same in every state or region.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always confirm the exact allowed amount with your Medicare Administrative Contractor (MAC) or current fee schedule lookup tool before billing or appealing a denial.

Frequently asked

Why is the facility amount lower than the non-facility amount?

The facility amount excludes most practice-expense overhead because those costs are assumed to be borne by the facility (e.g., hospital) rather than the physician's own practice, resulting in a lower practice-expense RVU and thus a lower total payment.

Does this amount reflect what my locality will actually pay?

No — the figures shown include a national baseline; actual reimbursement depends on the GPCI adjustments specific to your Medicare locality, which can raise or lower the amount from the national average.

Can I use this number to predict my exact Medicare check?

Not precisely. This is a PFS-based estimate before considering the patient's deductible, any applicable modifiers, secondary payer coordination, or sequestration reductions that may apply to your specific claim.

Where can I find the official 2026 conversion factor and RVUs used here?

The Centers for Medicare & Medicaid Services (CMS) publishes the annual Physician Fee Schedule Final Rule, which includes the conversion factor and RVU values used to calculate these estimates.

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.