Medicare Reimbursement for CPT 17264

CPT 17264 is a physician procedure code reimbursed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$202.08	$109.22
ALASKA* (AK)	$240.14	$141.25
ALABAMA (AL)	$182.95	$101.71
ARKANSAS (AR)	$180.54	$100.77
ARIZONA (AZ)	$197.10	$107.13
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$258.26	$127.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$263.25	$129.35
OXNARD-THOUSAND OAKS-VENTURA (CA)	$225.33	$115.57
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$226.56	$116.71
NAPA (CA)	$244.67	$122.29
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$258.48	$127.56
VALLEJO (CA)	$244.36	$121.98
BAKERSFIELD (CA)	$213.39	$111.63
CHICO (CA)	$212.80	$111.03
FRESNO (CA)	$212.80	$111.03
HANFORD-CORCORAN (CA)	$212.80	$111.03
MADERA (CA)	$212.80	$111.03
MERCED (CA)	$212.80	$111.03
MODESTO (CA)	$212.80	$111.03
REDDING (CA)	$212.80	$111.03
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$214.88	$113.11
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$222.81	$114.82
SALINAS (CA)	$221.96	$114.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$264.13	$130.23
SANTA CRUZ-WATSONVILLE (CA)	$228.64	$115.82
SANTA ROSA-PETALUMA (CA)	$230.93	$116.90
STOCKTON (CA)	$212.80	$111.03
VISALIA (CA)	$212.80	$111.03
YUBA CITY (CA)	$212.80	$111.03
EL CENTRO (CA)	$212.83	$111.07
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$226.78	$115.72
SAN LUIS OBISPO-PASO ROBLES (CA)	$218.43	$112.67
SANTA MARIA-SANTA BARBARA (CA)	$222.68	$114.41
REST OF CALIFORNIA (CA)	$212.80	$111.03
COLORADO (CO)	$209.84	$111.05
CONNECTICUT (CT)	$214.79	$114.78
DC + MD/VA SUBURBS (DC)	$229.60	$120.21
DELAWARE (DE)	$200.19	$108.45
FORT LAUDERDALE (FL)	$208.91	$114.84
MIAMI (FL)	$217.15	$120.49
REST OF FLORIDA (FL)	$199.51	$110.74
ATLANTA (GA)	$205.64	$111.30
REST OF GEORGIA (GA)	$189.15	$106.33
HAWAII, GUAM (HI)	$217.34	$111.77
IOWA (IA)	$187.12	$102.16
IDAHO (ID)	$188.26	$102.83
EAST ST. LOUIS (IL)	$198.04	$112.61
SUBURBAN CHICAGO (IL)	$210.96	$115.60
CHICAGO (IL)	$211.40	$118.08
REST OF ILLINOIS (IL)	$194.26	$109.48
INDIANA (IN)	$189.26	$103.18
KANSAS (KS)	$186.36	$102.42
KENTUCKY (KY)	$187.00	$104.45
NEW ORLEANS (LA)	$195.21	$107.84
REST OF LOUISIANA (LA)	$186.75	$104.58
METROPOLITAN BOSTON (MA)	$229.43	$118.57
REST OF MASSACHUSETTS (MA)	$208.76	$110.99
BALTIMORE/SURR. CNTYS (MD)	$214.17	$114.54
REST OF MARYLAND (MD)	$203.77	$109.81
SOUTHERN MAINE (ME)	$198.56	$106.54
REST OF MAINE (ME)	$189.20	$103.78
DETROIT (MI)	$201.85	$112.24
REST OF MICHIGAN (MI)	$191.50	$106.73
MINNESOTA (MN)	$201.40	$105.86
METROPOLITAN ST. LOUIS (MO)	$195.80	$107.41
METROPOLITAN KANSAS CITY (MO)	$193.94	$106.75
REST OF MISSOURI (MO)	$183.84	$103.80
MISSISSIPPI (MS)	$182.22	$102.27
MONTANA** (MT)	$202.06	$109.21
NORTH CAROLINA (NC)	$191.01	$104.38
NORTH DAKOTA** (ND)	$198.31	$105.45
NEBRASKA (NE)	$188.05	$102.34
NEW HAMPSHIRE (NH)	$206.65	$109.99
NORTHERN NJ (NJ)	$227.54	$119.83
REST OF NEW JERSEY (NJ)	$217.33	$115.93
NEW MEXICO (NM)	$192.48	$107.34
NEVADA** (NV)	$201.15	$108.20
MANHATTAN (NY)	$231.15	$123.26
NYC SUBURBS/LONG ISLAND (NY)	$236.41	$126.00
POUGHKPSIE/N NYC SUBURBS (NY)	$218.76	$117.09
QUEENS (NY)	$232.86	$123.10
REST OF NEW YORK (NY)	$193.64	$105.43
OHIO (OH)	$190.74	$105.96
OKLAHOMA (OK)	$186.65	$103.73
PORTLAND (OR)	$216.02	$112.86
REST OF OREGON (OR)	$199.67	$107.18
METROPOLITAN PHILADELPHIA (PA)	$209.83	$113.17
REST OF PENNSYLVANIA (PA)	$190.99	$105.75
PUERTO RICO (PR)	$203.42	$109.54
RHODE ISLAND (RI)	$206.94	$111.02
SOUTH CAROLINA (SC)	$191.17	$105.38
SOUTH DAKOTA** (SD)	$197.86	$105.01
TENNESSEE (TN)	$187.22	$102.82
BRAZORIA (TX)	$200.02	$108.00
DALLAS (TX)	$201.23	$108.75
GALVESTON (TX)	$200.59	$108.38
HOUSTON (TX)	$204.06	$111.86
BEAUMONT (TX)	$189.84	$105.34
FORT WORTH (TX)	$200.01	$108.45
AUSTIN (TX)	$209.08	$110.84
REST OF TEXAS (TX)	$194.78	$106.66
UTAH (UT)	$193.57	$106.29
VIRGINIA (VA)	$197.98	$106.71
VIRGIN ISLANDS (VI)	$203.42	$109.54
VERMONT (VT)	$197.63	$105.71
SEATTLE (KING CNTY) (WA)	$233.88	$119.94
REST OF WASHINGTON (WA)	$208.34	$110.56
WISCONSIN (WI)	$192.18	$103.23
WEST VIRGINIA (WV)	$187.66	$106.97
WYOMING** (WY)	$200.43	$107.57

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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 PFS payments are based on three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual national Conversion Factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because facility settings (e.g., hospitals) absorb some overhead costs that otherwise fall to the physician's office.

RVUs — work 1.94, practice expense 3.92 (non-facility) / 1.14 (facility), malpractice 0.19 — × 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 deductible; the patient or secondary payer is responsible for the remainder.
Actual payment varies by locality, applicable modifiers, claims sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the reimbursement amount differ between non-facility and facility settings?

The practice-expense RVU is lower in a facility setting because the facility (such as a hospital) bears certain overhead costs, such as equipment and staff, that the physician practice would otherwise bear in a non-facility setting.

Why does the allowed amount change by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs) for work, practice expense, and malpractice, reflecting regional cost-of-living and labor cost differences, which are applied to the RVUs before calculating the final payment.

Does this amount reflect what the patient or secondary insurer will pay?

No. The figure shown is the full Medicare-allowed amount; Medicare generally pays 80% of this after the deductible is met, with the remaining portion typically billed to the patient or a secondary payer.

Will this amount change during the year?

It can. CMS may apply mid-year adjustments, sequestration, or correct the conversion factor through legislative or budget-neutrality actions, so billed and paid amounts can differ slightly from this estimate.

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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.