Medicare Reimbursement for CPT 22101

CPT 22101 is a surgical procedure code billed under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted for locality, and compares non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$867.76	$867.76
ALASKA* (AK)	$1022.19	$1022.19
ALABAMA (AL)	$768.98	$768.98
ARKANSAS (AR)	$756.85	$756.85
ARIZONA (AZ)	$839.09	$839.09
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$997.06	$997.06
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1011.82	$1011.82
OXNARD-THOUSAND OAKS-VENTURA (CA)	$906.09	$906.09
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$915.87	$915.87
NAPA (CA)	$958.92	$958.92
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1000.95	$1000.95
VALLEJO (CA)	$953.30	$953.30
BAKERSFIELD (CA)	$867.49	$867.49
CHICO (CA)	$858.41	$858.41
FRESNO (CA)	$858.41	$858.41
HANFORD-CORCORAN (CA)	$858.41	$858.41
MADERA (CA)	$858.41	$858.41
MERCED (CA)	$858.41	$858.41
MODESTO (CA)	$858.41	$858.41
REDDING (CA)	$858.41	$858.41
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$895.08	$895.08
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$891.55	$891.55
SALINAS (CA)	$888.18	$888.18
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1027.75	$1027.75
SANTA CRUZ-WATSONVILLE (CA)	$906.55	$906.55
SANTA ROSA-PETALUMA (CA)	$914.90	$914.90
STOCKTON (CA)	$858.41	$858.41
VISALIA (CA)	$858.41	$858.41
YUBA CITY (CA)	$858.41	$858.41
EL CENTRO (CA)	$858.98	$858.98
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$903.03	$903.03
SAN LUIS OBISPO-PASO ROBLES (CA)	$875.28	$875.28
SANTA MARIA-SANTA BARBARA (CA)	$889.85	$889.85
REST OF CALIFORNIA (CA)	$858.41	$858.41
COLORADO (CO)	$872.11	$872.11
CONNECTICUT (CT)	$929.25	$929.25
DC + MD/VA SUBURBS (DC)	$970.04	$970.04
DELAWARE (DE)	$853.28	$853.28
FORT LAUDERDALE (FL)	$965.43	$965.43
MIAMI (FL)	$1059.02	$1059.02
REST OF FLORIDA (FL)	$908.11	$908.11
ATLANTA (GA)	$898.14	$898.14
REST OF GEORGIA (GA)	$847.37	$847.37
HAWAII, GUAM (HI)	$873.29	$873.29
IOWA (IA)	$765.31	$765.31
IDAHO (ID)	$775.98	$775.98
EAST ST. LOUIS (IL)	$952.53	$952.53
SUBURBAN CHICAGO (IL)	$969.32	$969.32
CHICAGO (IL)	$1020.60	$1020.60
REST OF ILLINOIS (IL)	$898.11	$898.11
INDIANA (IN)	$780.22	$780.22
KANSAS (KS)	$773.25	$773.25
KENTUCKY (KY)	$814.45	$814.45
NEW ORLEANS (LA)	$860.18	$860.18
REST OF LOUISIANA (LA)	$817.81	$817.81
METROPOLITAN BOSTON (MA)	$946.08	$946.08
REST OF MASSACHUSETTS (MA)	$871.07	$871.07
BALTIMORE/SURR. CNTYS (MD)	$929.33	$929.33
REST OF MARYLAND (MD)	$866.68	$866.68
SOUTHERN MAINE (ME)	$821.95	$821.95
REST OF MAINE (ME)	$793.05	$793.05
DETROIT (MI)	$932.61	$932.61
REST OF MICHIGAN (MI)	$848.39	$848.39
MINNESOTA (MN)	$798.48	$798.48
METROPOLITAN ST. LOUIS (MO)	$849.15	$849.15
METROPOLITAN KANSAS CITY (MO)	$841.18	$841.18
REST OF MISSOURI (MO)	$810.62	$810.62
MISSISSIPPI (MS)	$783.30	$783.30
MONTANA** (MT)	$867.53	$867.53
NORTH CAROLINA (NC)	$800.10	$800.10
NORTH DAKOTA** (ND)	$799.70	$799.70
NEBRASKA (NE)	$766.28	$766.28
NEW HAMPSHIRE (NH)	$869.53	$869.53
NORTHERN NJ (NJ)	$961.07	$961.07
REST OF NEW JERSEY (NJ)	$929.40	$929.40
NEW MEXICO (NM)	$858.21	$858.21
NEVADA** (NV)	$849.02	$849.02
MANHATTAN (NY)	$1021.56	$1021.56
NYC SUBURBS/LONG ISLAND (NY)	$1063.20	$1063.20
POUGHKPSIE/N NYC SUBURBS (NY)	$945.33	$945.33
QUEENS (NY)	$1012.91	$1012.91
REST OF NEW YORK (NY)	$814.11	$814.11
OHIO (OH)	$834.53	$834.53
OKLAHOMA (OK)	$800.21	$800.21
PORTLAND (OR)	$887.76	$887.76
REST OF OREGON (OR)	$832.16	$832.16
METROPOLITAN PHILADELPHIA (PA)	$912.45	$912.45
REST OF PENNSYLVANIA (PA)	$829.27	$829.27
PUERTO RICO (PR)	$870.35	$870.35
RHODE ISLAND (RI)	$875.19	$875.19
SOUTH CAROLINA (SC)	$820.74	$820.74
SOUTH DAKOTA** (SD)	$791.68	$791.68
TENNESSEE (TN)	$779.00	$779.00
BRAZORIA (TX)	$841.90	$841.90
DALLAS (TX)	$853.16	$853.16
GALVESTON (TX)	$848.19	$848.19
HOUSTON (TX)	$910.97	$910.97
BEAUMONT (TX)	$824.30	$824.30
FORT WORTH (TX)	$850.73	$850.73
AUSTIN (TX)	$878.18	$878.18
REST OF TEXAS (TX)	$836.63	$836.63
UTAH (UT)	$832.52	$832.52
VIRGINIA (VA)	$827.40	$827.40
VIRGIN ISLANDS (VI)	$870.35	$870.35
VERMONT (VT)	$807.24	$807.24
SEATTLE (KING CNTY) (WA)	$953.92	$953.92
REST OF WASHINGTON (WA)	$865.86	$865.86
WISCONSIN (WI)	$771.99	$771.99
WEST VIRGINIA (WV)	$865.72	$865.72
WYOMING** (WY)	$837.97	$837.97

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. 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) — work, practice expense, and malpractice — that reflect the physician effort, overhead costs, and liability risk associated with a code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, since costs vary across the country. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar figure set by CMS) to produce the allowed amount. Non-facility and facility rates can differ because the practice-expense RVU changes depending on whether the service is performed in a physician office (non-facility) or a hospital/ASC setting (facility), reflecting different overhead assumptions.

RVUs — work 10.8, practice expense 11.75 (non-facility) / 11.75 (facility), malpractice 3.43 — × 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 insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean actual payment varies by where the service is furnished.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the facility amount differ from the non-facility amount?

The practice-expense RVU is typically lower in the facility setting because the facility (hospital or ASC) bears some of the overhead costs, whereas in a non-facility setting the physician's practice absorbs those costs.

Does this amount reflect what Medicare will actually pay?

No. It reflects the PFS allowed amount before the standard 80/20 split, deductible, modifiers, sequestration, and any local adjustments are applied.

Why is the CPT descriptor not shown on this page?

CPT code descriptors are copyrighted by the American Medical Association and cannot be republished without a license, so this page refers to the code generically.

Why do amounts change year to year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, which can raise or lower the PFS amount for a given code.

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.