Medicare Reimbursement for CPT 11922
CPT 11922 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $66.13 | $24.38 |
| ALASKA* (AK) | $76.03 | $31.57 |
| ALABAMA (AL) | $59.05 | $22.51 |
| ARKANSAS (AR) | $58.15 | $22.29 |
| ARIZONA (AZ) | $64.28 | $23.82 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $85.57 | $26.70 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $87.25 | $27.04 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $74.21 | $24.86 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $74.57 | $25.18 |
| NAPA (CA) | $80.91 | $25.88 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $85.66 | $26.79 |
| VALLEJO (CA) | $80.78 | $25.75 |
| BAKERSFIELD (CA) | $69.95 | $24.19 |
| CHICO (CA) | $69.72 | $23.96 |
| FRESNO (CA) | $69.72 | $23.96 |
| HANFORD-CORCORAN (CA) | $69.72 | $23.96 |
| MADERA (CA) | $69.72 | $23.96 |
| MERCED (CA) | $69.72 | $23.96 |
| MODESTO (CA) | $69.72 | $23.96 |
| REDDING (CA) | $69.72 | $23.96 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $70.58 | $24.82 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $73.20 | $24.65 |
| SALINAS (CA) | $72.93 | $24.54 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $87.62 | $27.42 |
| SANTA CRUZ-WATSONVILLE (CA) | $75.43 | $24.70 |
| SANTA ROSA-PETALUMA (CA) | $76.19 | $24.92 |
| STOCKTON (CA) | $69.72 | $23.96 |
| VISALIA (CA) | $69.72 | $23.96 |
| YUBA CITY (CA) | $69.72 | $23.96 |
| EL CENTRO (CA) | $69.73 | $23.97 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $74.69 | $24.75 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $71.76 | $24.20 |
| SANTA MARIA-SANTA BARBARA (CA) | $73.22 | $24.53 |
| REST OF CALIFORNIA (CA) | $69.72 | $23.96 |
| COLORADO (CO) | $68.78 | $24.35 |
| CONNECTICUT (CT) | $70.67 | $25.70 |
| DC + MD/VA SUBURBS (DC) | $75.74 | $26.56 |
| DELAWARE (DE) | $65.37 | $24.12 |
| FORT LAUDERDALE (FL) | $68.91 | $26.62 |
| MIAMI (FL) | $72.16 | $28.70 |
| REST OF FLORIDA (FL) | $65.39 | $25.48 |
| ATLANTA (GA) | $67.48 | $25.06 |
| REST OF GEORGIA (GA) | $61.52 | $24.28 |
| HAWAII, GUAM (HI) | $71.51 | $24.04 |
| IOWA (IA) | $60.49 | $22.29 |
| IDAHO (ID) | $60.93 | $22.52 |
| EAST ST. LOUIS (IL) | $65.05 | $26.64 |
| SUBURBAN CHICAGO (IL) | $69.59 | $26.71 |
| CHICAGO (IL) | $69.94 | $27.98 |
| REST OF ILLINOIS (IL) | $63.51 | $25.39 |
| INDIANA (IN) | $61.30 | $22.59 |
| KANSAS (KS) | $60.26 | $22.51 |
| KENTUCKY (KY) | $60.64 | $23.53 |
| NEW ORLEANS (LA) | $63.70 | $24.41 |
| REST OF LOUISIANA (LA) | $60.57 | $23.62 |
| METROPOLITAN BOSTON (MA) | $75.70 | $25.85 |
| REST OF MASSACHUSETTS (MA) | $68.36 | $24.40 |
| BALTIMORE/SURR. CNTYS (MD) | $70.49 | $25.69 |
| REST OF MARYLAND (MD) | $66.64 | $24.39 |
| SOUTHERN MAINE (ME) | $64.72 | $23.35 |
| REST OF MAINE (ME) | $61.33 | $22.92 |
| DETROIT (MI) | $66.31 | $26.02 |
| REST OF MICHIGAN (MI) | $62.35 | $24.23 |
| MINNESOTA (MN) | $65.63 | $22.67 |
| METROPOLITAN ST. LOUIS (MO) | $63.86 | $24.12 |
| METROPOLITAN KANSAS CITY (MO) | $63.18 | $23.97 |
| REST OF MISSOURI (MO) | $59.52 | $23.53 |
| MISSISSIPPI (MS) | $58.84 | $22.90 |
| MONTANA** (MT) | $66.13 | $24.38 |
| NORTH CAROLINA (NC) | $61.99 | $23.04 |
| NORTH DAKOTA** (ND) | $64.55 | $22.80 |
| NEBRASKA (NE) | $60.82 | $22.28 |
| NEW HAMPSHIRE (NH) | $67.74 | $24.28 |
| NORTHERN NJ (NJ) | $74.91 | $26.48 |
| REST OF NEW JERSEY (NJ) | $71.40 | $25.81 |
| NEW MEXICO (NM) | $62.73 | $24.45 |
| NEVADA** (NV) | $65.73 | $23.94 |
| MANHATTAN (NY) | $76.41 | $27.89 |
| NYC SUBURBS/LONG ISLAND (NY) | $78.41 | $28.77 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $71.92 | $26.20 |
| QUEENS (NY) | $76.97 | $27.62 |
| REST OF NEW YORK (NY) | $62.97 | $23.31 |
| OHIO (OH) | $62.03 | $23.91 |
| OKLAHOMA (OK) | $60.46 | $23.18 |
| PORTLAND (OR) | $70.97 | $24.59 |
| REST OF OREGON (OR) | $65.15 | $23.57 |
| METROPOLITAN PHILADELPHIA (PA) | $68.88 | $25.42 |
| REST OF PENNSYLVANIA (PA) | $62.10 | $23.77 |
| PUERTO RICO (PR) | $66.62 | $24.41 |
| RHODE ISLAND (RI) | $67.71 | $24.59 |
| SOUTH CAROLINA (SC) | $62.13 | $23.55 |
| SOUTH DAKOTA** (SD) | $64.36 | $22.61 |
| TENNESSEE (TN) | $60.58 | $22.63 |
| BRAZORIA (TX) | $65.25 | $23.87 |
| DALLAS (TX) | $65.71 | $24.12 |
| GALVESTON (TX) | $65.47 | $24.01 |
| HOUSTON (TX) | $66.93 | $25.48 |
| BEAUMONT (TX) | $61.68 | $23.68 |
| FORT WORTH (TX) | $65.27 | $24.10 |
| AUSTIN (TX) | $68.61 | $24.44 |
| REST OF TEXAS (TX) | $63.46 | $23.83 |
| UTAH (UT) | $63.02 | $23.77 |
| VIRGINIA (VA) | $64.54 | $23.50 |
| VIRGIN ISLANDS (VI) | $66.62 | $24.41 |
| VERMONT (VT) | $64.34 | $23.01 |
| SEATTLE (KING CNTY) (WA) | $77.21 | $25.98 |
| REST OF WASHINGTON (WA) | $68.22 | $24.25 |
| WISCONSIN (WI) | $62.29 | $22.30 |
| WEST VIRGINIA (WV) | $61.07 | $24.79 |
| WYOMING** (WY) | $65.44 | $23.69 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 1 unit 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 the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Conversion Factor to produce a dollar amount. Non-facility and facility settings use different practice-expense RVUs because the resources a physician's office must supply differ from those already covered by a facility, which is why the same code can price differently depending on place of service.
RVUs — work 0.48, practice expense 1.42 (non-facility) / 0.17 (facility), malpractice 0.08 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only, not a guarantee of payment.
- Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
- Always verify current rates and locality-specific figures with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why does the facility amount differ from the non-facility amount?
Facility rates use a lower practice-expense RVU because the facility (not the physician's office) supplies certain overhead resources like equipment and supplies, so the physician's payment reflects only professional services.
Why does the reimbursement amount vary by locality?
Each locality has its own Geographic Practice Cost Indices (GPCIs) that adjust the work, practice expense, and malpractice RVUs to reflect regional differences in wages and costs, which changes the final calculated amount.
Is this the amount Medicare will actually pay?
No. This figure is the Medicare-allowed amount before patient responsibility, deductible status, modifiers, and other adjustments are applied, so actual payment may differ.
Where can I confirm the exact rate for my area?
Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules and can confirm the exact allowed amount for a given code and place of service.
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.
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