Medicare Reimbursement for CPT Code 17250

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions). It displays the Medicare Physician Fee Schedule (PFS) allowed amount for the national rate and shows how the figure differs between non-facility (e.g., office) and facility (e.g., hospital outpatient) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$90.18	$35.40
ALASKA* (AK)	$101.96	$43.62
ALABAMA (AL)	$80.23	$32.30
ARKANSAS (AR)	$78.97	$31.92
ARIZONA (AZ)	$87.63	$34.55
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$119.70	$42.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$122.17	$43.18
OXNARD-THOUSAND OAKS-VENTURA (CA)	$102.77	$38.02
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$103.15	$38.35
NAPA (CA)	$112.79	$40.60
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$119.78	$42.54
VALLEJO (CA)	$112.68	$40.48
BAKERSFIELD (CA)	$96.44	$36.40
CHICO (CA)	$96.24	$36.20
FRESNO (CA)	$96.24	$36.20
HANFORD-CORCORAN (CA)	$96.24	$36.20
MADERA (CA)	$96.24	$36.20
MERCED (CA)	$96.24	$36.20
MODESTO (CA)	$96.24	$36.20
REDDING (CA)	$96.24	$36.20
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$97.00	$36.96
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$101.34	$37.63
SALINAS (CA)	$100.97	$37.48
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$122.49	$43.50
SANTA CRUZ-WATSONVILLE (CA)	$104.81	$38.25
SANTA ROSA-PETALUMA (CA)	$105.89	$38.62
STOCKTON (CA)	$96.24	$36.20
VISALIA (CA)	$96.24	$36.20
YUBA CITY (CA)	$96.24	$36.20
EL CENTRO (CA)	$96.25	$36.21
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$103.61	$38.10
SAN LUIS OBISPO-PASO ROBLES (CA)	$99.31	$36.92
SANTA MARIA-SANTA BARBARA (CA)	$101.42	$37.55
REST OF CALIFORNIA (CA)	$96.24	$36.20
COLORADO (CO)	$94.44	$36.16
CONNECTICUT (CT)	$96.50	$37.51
DC + MD/VA SUBURBS (DC)	$104.05	$39.53
DELAWARE (DE)	$89.17	$35.05
FORT LAUDERDALE (FL)	$93.00	$37.51
MIAMI (FL)	$96.69	$39.66
REST OF FLORIDA (FL)	$88.21	$35.85
ATLANTA (GA)	$91.85	$36.19
REST OF GEORGIA (GA)	$82.91	$34.05
HAWAII, GUAM (HI)	$98.99	$36.71
IOWA (IA)	$82.70	$32.58
IDAHO (ID)	$83.23	$32.84
EAST ST. LOUIS (IL)	$86.83	$36.44
SUBURBAN CHICAGO (IL)	$94.03	$37.78
CHICAGO (IL)	$93.68	$38.63
REST OF ILLINOIS (IL)	$85.28	$35.27
INDIANA (IN)	$83.76	$32.98
KANSAS (KS)	$82.16	$32.64
KENTUCKY (KY)	$82.05	$33.35
NEW ORLEANS (LA)	$86.28	$34.74
REST OF LOUISIANA (LA)	$81.86	$33.39
METROPOLITAN BOSTON (MA)	$104.46	$39.06
REST OF MASSACHUSETTS (MA)	$93.76	$36.08
BALTIMORE/SURR. CNTYS (MD)	$96.22	$37.44
REST OF MARYLAND (MD)	$91.01	$35.58
SOUTHERN MAINE (ME)	$88.68	$34.39
REST OF MAINE (ME)	$83.58	$33.19
DETROIT (MI)	$89.28	$36.42
REST OF MICHIGAN (MI)	$84.27	$34.25
MINNESOTA (MN)	$90.61	$34.24
METROPOLITAN ST. LOUIS (MO)	$86.76	$34.61
METROPOLITAN KANSAS CITY (MO)	$85.77	$34.33
REST OF MISSOURI (MO)	$80.26	$33.04
MISSISSIPPI (MS)	$79.64	$32.47
MONTANA** (MT)	$90.18	$35.40
NORTH CAROLINA (NC)	$84.55	$33.44
NORTH DAKOTA** (ND)	$88.79	$34.02
NEBRASKA (NE)	$83.22	$32.66
NEW HAMPSHIRE (NH)	$92.82	$35.80
NORTHERN NJ (NJ)	$102.81	$39.27
REST OF NEW JERSEY (NJ)	$97.64	$37.82
NEW MEXICO (NM)	$84.72	$34.49
NEVADA** (NV)	$89.86	$35.03
MANHATTAN (NY)	$104.18	$40.53
NYC SUBURBS/LONG ISLAND (NY)	$106.74	$41.61
POUGHKPSIE/N NYC SUBURBS (NY)	$98.20	$38.22
QUEENS (NY)	$105.27	$40.53
REST OF NEW YORK (NY)	$85.91	$33.88
OHIO (OH)	$83.98	$33.97
OKLAHOMA (OK)	$82.01	$33.10
PORTLAND (OR)	$97.78	$36.92
REST OF OREGON (OR)	$89.20	$34.64
METROPOLITAN PHILADELPHIA (PA)	$93.86	$36.84
REST OF PENNSYLVANIA (PA)	$84.19	$33.91
PUERTO RICO (PR)	$90.93	$35.55
RHODE ISLAND (RI)	$92.60	$36.01
SOUTH CAROLINA (SC)	$84.40	$33.79
SOUTH DAKOTA** (SD)	$88.63	$33.85
TENNESSEE (TN)	$82.60	$32.80
BRAZORIA (TX)	$89.16	$34.87
DALLAS (TX)	$89.71	$35.15
GALVESTON (TX)	$89.41	$35.02
HOUSTON (TX)	$90.69	$36.30
BEAUMONT (TX)	$83.58	$33.74
FORT WORTH (TX)	$89.03	$35.02
AUSTIN (TX)	$94.09	$36.14
REST OF TEXAS (TX)	$86.31	$34.33
UTAH (UT)	$85.66	$34.16
VIRGINIA (VA)	$88.28	$34.43
VIRGIN ISLANDS (VI)	$90.93	$35.55
VERMONT (VT)	$88.31	$34.08
SEATTLE (KING CNTY) (WA)	$106.80	$39.59
REST OF WASHINGTON (WA)	$93.62	$35.94
WISCONSIN (WI)	$85.56	$33.09
WEST VIRGINIA (WV)	$81.83	$34.22
WYOMING** (WY)	$89.57	$34.80

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 4 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 the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is billed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because facility settings assume the facility itself absorbs certain overhead costs, which typically lowers the facility rate relative to non-facility.

RVUs — work 0.49, practice expense 2.14 (non-facility) / 0.5 (facility), malpractice 0.07 — × 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 approved amount after the patient's Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment varies by locality GPCI values, applicable modifiers, claim-level adjustments, and sequestration.
Annual updates to RVUs and the conversion factor, as well as budget-neutrality adjustments, can change this amount each year.
Always verify the current, locality-specific rate with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the non-facility amount higher than the facility amount for this code?

Non-facility rates include a higher practice-expense RVU because the billing provider is assumed to cover overhead like staff, supplies, and equipment. In a facility setting, the facility bills separately for those overhead costs, so the physician's PE RVU — and therefore the payment — is lower.

Does this amount reflect what my specific locality will pay?

No. The national amount is a baseline. Actual payment is calculated using your locality's specific GPCI values, which this page can also display, since costs vary by region.

How does this number help with a denial or appeal?

It gives you a reference estimate of the Medicare-allowed amount so you can compare it to what was billed or denied, but it does not replace the explanation of benefits (EOB) or remittance advice from your MAC, which reflects the actual adjudicated amount.

Will modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the final paid amount relative to the base PFS rate shown here.

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.