Medicare Reimbursement for CPT 17263

CPT 17263 is a physician procedure code reported to Medicare and other payers; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and (where available) by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$188.38	$102.54
ALASKA* (AK)	$223.54	$132.12
ALABAMA (AL)	$170.45	$95.34
ARKANSAS (AR)	$168.18	$94.44
ARIZONA (AZ)	$183.72	$100.54
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$240.86	$119.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$245.51	$121.73
OXNARD-THOUSAND OAKS-VENTURA (CA)	$210.10	$108.64
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$211.24	$109.70
NAPA (CA)	$228.17	$115.03
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$241.07	$120.03
VALLEJO (CA)	$227.88	$114.74
BAKERSFIELD (CA)	$198.93	$104.85
CHICO (CA)	$198.38	$104.29
FRESNO (CA)	$198.38	$104.29
HANFORD-CORCORAN (CA)	$198.38	$104.29
MADERA (CA)	$198.38	$104.29
MERCED (CA)	$198.38	$104.29
MODESTO (CA)	$198.38	$104.29
REDDING (CA)	$198.38	$104.29
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$200.34	$106.26
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$207.72	$107.89
SALINAS (CA)	$206.94	$107.45
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$246.35	$122.57
SANTA CRUZ-WATSONVILLE (CA)	$213.20	$108.91
SANTA ROSA-PETALUMA (CA)	$215.33	$109.92
STOCKTON (CA)	$198.38	$104.29
VISALIA (CA)	$198.38	$104.29
YUBA CITY (CA)	$198.38	$104.29
EL CENTRO (CA)	$198.41	$104.32
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$211.45	$108.78
SAN LUIS OBISPO-PASO ROBLES (CA)	$203.65	$105.87
SANTA MARIA-SANTA BARBARA (CA)	$207.61	$107.52
REST OF CALIFORNIA (CA)	$198.38	$104.29
COLORADO (CO)	$195.63	$104.29
CONNECTICUT (CT)	$200.28	$107.83
DC + MD/VA SUBURBS (DC)	$214.11	$112.99
DELAWARE (DE)	$186.60	$101.79
FORT LAUDERDALE (FL)	$194.83	$107.88
MIAMI (FL)	$202.60	$113.24
REST OF FLORIDA (FL)	$186.01	$103.95
ATLANTA (GA)	$191.73	$104.52
REST OF GEORGIA (GA)	$176.30	$99.73
HAWAII, GUAM (HI)	$202.64	$105.04
IOWA (IA)	$174.34	$95.79
IDAHO (ID)	$175.41	$96.43
EAST ST. LOUIS (IL)	$184.67	$105.70
SUBURBAN CHICAGO (IL)	$196.75	$108.59
CHICAGO (IL)	$197.20	$110.93
REST OF ILLINOIS (IL)	$181.10	$102.73
INDIANA (IN)	$176.34	$96.77
KANSAS (KS)	$173.63	$96.03
KENTUCKY (KY)	$174.26	$97.95
NEW ORLEANS (LA)	$181.97	$101.19
REST OF LOUISIANA (LA)	$174.03	$98.06
METROPOLITAN BOSTON (MA)	$213.95	$111.46
REST OF MASSACHUSETTS (MA)	$194.61	$104.22
BALTIMORE/SURR. CNTYS (MD)	$199.71	$107.60
REST OF MARYLAND (MD)	$189.96	$103.09
SOUTHERN MAINE (ME)	$185.06	$99.99
REST OF MAINE (ME)	$176.30	$97.33
DETROIT (MI)	$188.22	$105.38
REST OF MICHIGAN (MI)	$178.49	$100.12
MINNESOTA (MN)	$187.70	$99.37
METROPOLITAN ST. LOUIS (MO)	$182.51	$100.79
METROPOLITAN KANSAS CITY (MO)	$180.77	$100.16
REST OF MISSOURI (MO)	$171.31	$97.31
MISSISSIPPI (MS)	$169.77	$95.86
MONTANA** (MT)	$188.37	$102.53
NORTH CAROLINA (NC)	$178.00	$97.91
NORTH DAKOTA** (ND)	$184.81	$98.97
NEBRASKA (NE)	$175.20	$95.97
NEW HAMPSHIRE (NH)	$192.66	$103.30
NORTHERN NJ (NJ)	$212.17	$112.59
REST OF NEW JERSEY (NJ)	$202.63	$108.90
NEW MEXICO (NM)	$179.42	$100.70
NEVADA** (NV)	$187.50	$101.57
MANHATTAN (NY)	$215.59	$115.84
NYC SUBURBS/LONG ISLAND (NY)	$220.53	$118.46
POUGHKPSIE/N NYC SUBURBS (NY)	$203.98	$109.98
QUEENS (NY)	$217.17	$115.71
REST OF NEW YORK (NY)	$180.47	$98.92
OHIO (OH)	$177.76	$99.39
OKLAHOMA (OK)	$173.92	$97.27
PORTLAND (OR)	$201.41	$106.04
REST OF OREGON (OR)	$186.11	$100.61
METROPOLITAN PHILADELPHIA (PA)	$195.64	$106.28
REST OF PENNSYLVANIA (PA)	$178.00	$99.20
PUERTO RICO (PR)	$189.64	$102.85
RHODE ISLAND (RI)	$192.91	$104.24
SOUTH CAROLINA (SC)	$178.16	$98.85
SOUTH DAKOTA** (SD)	$184.39	$98.55
TENNESSEE (TN)	$174.44	$96.41
BRAZORIA (TX)	$186.43	$101.37
DALLAS (TX)	$187.58	$102.08
GALVESTON (TX)	$186.97	$101.73
HOUSTON (TX)	$190.26	$105.02
BEAUMONT (TX)	$176.92	$98.81
FORT WORTH (TX)	$186.43	$101.79
AUSTIN (TX)	$194.92	$104.11
REST OF TEXAS (TX)	$181.55	$100.08
UTAH (UT)	$180.41	$99.72
VIRGINIA (VA)	$184.53	$100.15
VIRGIN ISLANDS (VI)	$189.64	$102.85
VERMONT (VT)	$184.19	$99.20
SEATTLE (KING CNTY) (WA)	$218.10	$112.77
REST OF WASHINGTON (WA)	$194.22	$103.83
WISCONSIN (WI)	$179.07	$96.84
WEST VIRGINIA (WV)	$174.91	$100.32
WYOMING** (WY)	$186.82	$100.98

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 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 Physician Fee Schedule 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, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings, which is why the same code can show two different allowed amounts.

RVUs — work 1.79, practice expense 3.67 (non-facility) / 1.1 (facility), malpractice 0.18 — × 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 patient meets the annual Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules 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 for the same code?

The practice-expense RVU component is lower in facility settings because the facility (e.g., hospital) absorbs certain overhead costs separately, while non-facility settings (e.g., physician office) include more of those costs in the physician's payment.

Why might the amount I see on a remittance differ from this estimate?

Remittance amounts can reflect locality-specific GPCI adjustments, applied modifiers, multiple-procedure reductions, sequestration, or mid-year budget-neutrality corrections not captured in a general estimate.

Does this amount represent what Medicare actually pays?

No. The figure shown is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of that amount after the deductible is met, with the remainder owed by the patient or a secondary payer.

Can I use this page to confirm coverage or medical necessity for CPT 17263?

No. This page addresses payment calculation only. Coverage, documentation, and medical necessity determinations are governed by separate Medicare policies and your MAC's Local Coverage Determinations.

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.