Medicare Reimbursement for CPT 22116

CPT 22116 is a physician procedure code used for billing under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$125.92	$125.92
ALASKA* (AK)	$153.89	$153.89
ALABAMA (AL)	$111.77	$111.77
ARKANSAS (AR)	$110.08	$110.08
ARIZONA (AZ)	$121.49	$121.49
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$128.77	$128.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$129.99	$129.99
OXNARD-THOUSAND OAKS-VENTURA (CA)	$123.02	$123.02
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$125.07	$125.07
NAPA (CA)	$126.15	$126.15
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$129.63	$129.63
VALLEJO (CA)	$124.91	$124.91
BAKERSFIELD (CA)	$119.84	$119.84
CHICO (CA)	$117.83	$117.83
FRESNO (CA)	$117.83	$117.83
HANFORD-CORCORAN (CA)	$117.83	$117.83
MADERA (CA)	$117.83	$117.83
MERCED (CA)	$117.83	$117.83
MODESTO (CA)	$117.83	$117.83
REDDING (CA)	$117.83	$117.83
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$125.95	$125.95
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$120.94	$120.94
SALINAS (CA)	$120.47	$120.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$133.52	$133.52
SANTA CRUZ-WATSONVILLE (CA)	$121.11	$121.11
SANTA ROSA-PETALUMA (CA)	$122.12	$122.12
STOCKTON (CA)	$117.83	$117.83
VISALIA (CA)	$117.83	$117.83
YUBA CITY (CA)	$117.83	$117.83
EL CENTRO (CA)	$117.96	$117.96
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$121.47	$121.47
SAN LUIS OBISPO-PASO ROBLES (CA)	$118.91	$118.91
SANTA MARIA-SANTA BARBARA (CA)	$120.41	$120.41
REST OF CALIFORNIA (CA)	$117.83	$117.83
COLORADO (CO)	$122.87	$122.87
CONNECTICUT (CT)	$134.69	$134.69
DC + MD/VA SUBURBS (DC)	$137.33	$137.33
DELAWARE (DE)	$123.43	$123.43
FORT LAUDERDALE (FL)	$146.76	$146.76
MIAMI (FL)	$165.76	$165.76
REST OF FLORIDA (FL)	$137.59	$137.59
ATLANTA (GA)	$131.65	$131.65
REST OF GEORGIA (GA)	$128.09	$128.09
HAWAII, GUAM (HI)	$118.67	$118.67
IOWA (IA)	$108.49	$108.49
IDAHO (ID)	$110.54	$110.54
EAST ST. LOUIS (IL)	$149.66	$149.66
SUBURBAN CHICAGO (IL)	$146.72	$146.72
CHICAGO (IL)	$159.45	$159.45
REST OF ILLINOIS (IL)	$138.03	$138.03
INDIANA (IN)	$111.04	$111.04
KANSAS (KS)	$110.93	$110.93
KENTUCKY (KY)	$120.98	$120.98
NEW ORLEANS (LA)	$127.90	$127.90
REST OF LOUISIANA (LA)	$121.97	$121.97
METROPOLITAN BOSTON (MA)	$131.08	$131.08
REST OF MASSACHUSETTS (MA)	$123.30	$123.30
BALTIMORE/SURR. CNTYS (MD)	$134.97	$134.97
REST OF MARYLAND (MD)	$124.90	$124.90
SOUTHERN MAINE (ME)	$116.33	$116.33
REST OF MAINE (ME)	$114.32	$114.32
DETROIT (MI)	$142.46	$142.46
REST OF MICHIGAN (MI)	$127.02	$127.02
MINNESOTA (MN)	$108.78	$108.78
METROPOLITAN ST. LOUIS (MO)	$124.77	$124.77
METROPOLITAN KANSAS CITY (MO)	$123.81	$123.81
REST OF MISSOURI (MO)	$121.80	$121.80
MISSISSIPPI (MS)	$115.81	$115.81
MONTANA** (MT)	$125.87	$125.87
NORTH CAROLINA (NC)	$115.08	$115.08
NORTH DAKOTA** (ND)	$110.84	$110.84
NEBRASKA (NE)	$108.20	$108.20
NEW HAMPSHIRE (NH)	$123.78	$123.78
NORTHERN NJ (NJ)	$136.41	$136.41
REST OF NEW JERSEY (NJ)	$133.71	$133.71
NEW MEXICO (NM)	$128.94	$128.94
NEVADA** (NV)	$121.71	$121.71
MANHATTAN (NY)	$149.69	$149.69
NYC SUBURBS/LONG ISLAND (NY)	$157.24	$157.24
POUGHKPSIE/N NYC SUBURBS (NY)	$137.03	$137.03
QUEENS (NY)	$146.53	$146.53
REST OF NEW YORK (NY)	$117.13	$117.13
OHIO (OH)	$123.95	$123.95
OKLAHOMA (OK)	$117.58	$117.58
PORTLAND (OR)	$123.41	$123.41
REST OF OREGON (OR)	$118.28	$118.28
METROPOLITAN PHILADELPHIA (PA)	$133.21	$133.21
REST OF PENNSYLVANIA (PA)	$122.47	$122.47
PUERTO RICO (PR)	$125.82	$125.82
RHODE ISLAND (RI)	$125.44	$125.44
SOUTH CAROLINA (SC)	$120.21	$120.21
SOUTH DAKOTA** (SD)	$109.07	$109.07
TENNESSEE (TN)	$111.89	$111.89
BRAZORIA (TX)	$120.72	$120.72
DALLAS (TX)	$122.90	$122.90
GALVESTON (TX)	$121.98	$121.98
HOUSTON (TX)	$135.89	$135.89
BEAUMONT (TX)	$121.86	$121.86
FORT WORTH (TX)	$122.98	$122.98
AUSTIN (TX)	$124.63	$124.63
REST OF TEXAS (TX)	$122.18	$122.18
UTAH (UT)	$121.83	$121.83
VIRGINIA (VA)	$118.03	$118.03
VIRGIN ISLANDS (VI)	$125.82	$125.82
VERMONT (VT)	$113.13	$113.13
SEATTLE (KING CNTY) (WA)	$130.74	$130.74
REST OF WASHINGTON (WA)	$122.16	$122.16
WISCONSIN (WI)	$107.30	$107.30
WEST VIRGINIA (WV)	$133.58	$133.58
WYOMING** (WY)	$119.32	$119.32

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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 PFS payment is built from three Relative Value Units (RVUs) assigned to each code: physician work, practice expense, and malpractice. 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 the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can have different practice-expense RVUs, which is why the two allowed amounts may differ.

RVUs — work 2.26, practice expense 0.75 (non-facility) / 0.75 (facility), malpractice 0.76 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure 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 patient or secondary insurer is responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Local Medicare Administrative Contractor (MAC) policies and locality-specific GPCIs may cause actual payment to vary from the national figure.
Always verify current rates and coverage rules directly with your MAC before billing or appealing a denial.

Frequently asked

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

The two settings use different practice-expense RVUs because the cost of providing the service (equipment, staff, overhead) differs depending on whether it's performed in an office versus a facility like a hospital.

Does this amount reflect what Medicare will actually pay?

No. The PFS amount shown is the allowed charge before cost-sharing. Medicare generally reimburses 80% of this amount after the deductible, with the remainder owed by the patient or secondary payer.

Why might my locality's payment differ from the national rate?

Geographic Practice Cost Indices (GPCIs) adjust the RVUs based on local wage, rent, and malpractice cost differences, so the same code can have different allowed amounts across localities.

Can 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.

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.