Medicare Reimbursement for CPT 22206

CPT 22206 is a surgical procedure code reported to Medicare for reimbursement purposes. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for the code at the national level and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2285.29	$2285.29
ALASKA* (AK)	$2753.99	$2753.99
ALABAMA (AL)	$2026.82	$2026.82
ARKANSAS (AR)	$1995.56	$1995.56
ARIZONA (AZ)	$2206.58	$2206.58
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2445.08	$2445.08
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2473.51	$2473.51
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2290.14	$2290.14
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2323.03	$2323.03
NAPA (CA)	$2377.79	$2377.79
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2458.74	$2458.74
VALLEJO (CA)	$2358.10	$2358.10
BAKERSFIELD (CA)	$2215.76	$2215.76
CHICO (CA)	$2184.01	$2184.01
FRESNO (CA)	$2184.01	$2184.01
HANFORD-CORCORAN (CA)	$2184.01	$2184.01
MADERA (CA)	$2184.01	$2184.01
MERCED (CA)	$2184.01	$2184.01
MODESTO (CA)	$2184.01	$2184.01
REDDING (CA)	$2184.01	$2184.01
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2312.60	$2312.60
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2252.09	$2252.09
SALINAS (CA)	$2243.34	$2243.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2529.37	$2529.37
SANTA CRUZ-WATSONVILLE (CA)	$2268.90	$2268.90
SANTA ROSA-PETALUMA (CA)	$2288.55	$2288.55
STOCKTON (CA)	$2184.01	$2184.01
VISALIA (CA)	$2184.01	$2184.01
YUBA CITY (CA)	$2184.01	$2184.01
EL CENTRO (CA)	$2186.02	$2186.02
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2269.43	$2269.43
SAN LUIS OBISPO-PASO ROBLES (CA)	$2212.94	$2212.94
SANTA MARIA-SANTA BARBARA (CA)	$2244.42	$2244.42
REST OF CALIFORNIA (CA)	$2184.01	$2184.01
COLORADO (CO)	$2254.87	$2254.87
CONNECTICUT (CT)	$2445.68	$2445.68
DC + MD/VA SUBURBS (DC)	$2515.82	$2515.82
DELAWARE (DE)	$2242.69	$2242.69
FORT LAUDERDALE (FL)	$2618.70	$2618.70
MIAMI (FL)	$2927.24	$2927.24
REST OF FLORIDA (FL)	$2457.80	$2457.80
ATLANTA (GA)	$2380.45	$2380.45
REST OF GEORGIA (GA)	$2289.79	$2289.79
HAWAII, GUAM (HI)	$2208.29	$2208.29
IOWA (IA)	$1985.82	$1985.82
IDAHO (ID)	$2019.72	$2019.72
EAST ST. LOUIS (IL)	$2638.91	$2638.91
SUBURBAN CHICAGO (IL)	$2622.13	$2622.13
CHICAGO (IL)	$2817.48	$2817.48
REST OF ILLINOIS (IL)	$2452.99	$2452.99
INDIANA (IN)	$2029.65	$2029.65
KANSAS (KS)	$2021.41	$2021.41
KENTUCKY (KY)	$2176.47	$2176.47
NEW ORLEANS (LA)	$2300.25	$2300.25
REST OF LOUISIANA (LA)	$2191.05	$2191.05
METROPOLITAN BOSTON (MA)	$2421.23	$2421.23
REST OF MASSACHUSETTS (MA)	$2258.75	$2258.75
BALTIMORE/SURR. CNTYS (MD)	$2449.00	$2449.00
REST OF MARYLAND (MD)	$2272.52	$2272.52
SOUTHERN MAINE (ME)	$2130.97	$2130.97
REST OF MAINE (ME)	$2079.59	$2079.59
DETROIT (MI)	$2537.39	$2537.39
REST OF MICHIGAN (MI)	$2278.60	$2278.60
MINNESOTA (MN)	$2021.92	$2021.92
METROPOLITAN ST. LOUIS (MO)	$2253.80	$2253.80
METROPOLITAN KANSAS CITY (MO)	$2235.01	$2235.01
REST OF MISSOURI (MO)	$2182.01	$2182.01
MISSISSIPPI (MS)	$2086.91	$2086.91
MONTANA** (MT)	$2284.49	$2284.49
NORTH CAROLINA (NC)	$2095.16	$2095.16
NORTH DAKOTA** (ND)	$2046.61	$2046.61
NEBRASKA (NE)	$1983.56	$1983.56
NEW HAMPSHIRE (NH)	$2262.64	$2262.64
NORTHERN NJ (NJ)	$2496.52	$2496.52
REST OF NEW JERSEY (NJ)	$2434.58	$2434.58
NEW MEXICO (NM)	$2310.22	$2310.22
NEVADA** (NV)	$2218.86	$2218.86
MANHATTAN (NY)	$2707.22	$2707.22
NYC SUBURBS/LONG ISLAND (NY)	$2834.27	$2834.27
POUGHKPSIE/N NYC SUBURBS (NY)	$2488.06	$2488.06
QUEENS (NY)	$2662.81	$2662.81
REST OF NEW YORK (NY)	$2132.32	$2132.32
OHIO (OH)	$2229.98	$2229.98
OKLAHOMA (OK)	$2123.71	$2123.71
PORTLAND (OR)	$2276.47	$2276.47
REST OF OREGON (OR)	$2163.26	$2163.26
METROPOLITAN PHILADELPHIA (PA)	$2412.21	$2412.21
REST OF PENNSYLVANIA (PA)	$2208.03	$2208.03
PUERTO RICO (PR)	$2286.66	$2286.66
RHODE ISLAND (RI)	$2287.10	$2287.10
SOUTH CAROLINA (SC)	$2173.89	$2173.89
SOUTH DAKOTA** (SD)	$2018.49	$2018.49
TENNESSEE (TN)	$2038.04	$2038.04
BRAZORIA (TX)	$2200.52	$2200.52
DALLAS (TX)	$2236.44	$2236.44
GALVESTON (TX)	$2221.16	$2221.16
HOUSTON (TX)	$2441.35	$2441.35
BEAUMONT (TX)	$2196.22	$2196.22
FORT WORTH (TX)	$2234.94	$2234.94
AUSTIN (TX)	$2280.92	$2280.92
REST OF TEXAS (TX)	$2212.01	$2212.01
UTAH (UT)	$2203.94	$2203.94
VIRGINIA (VA)	$2155.72	$2155.72
VIRGIN ISLANDS (VI)	$2286.66	$2286.66
VERMONT (VT)	$2080.07	$2080.07
SEATTLE (KING CNTY) (WA)	$2425.00	$2425.00
REST OF WASHINGTON (WA)	$2240.65	$2240.65
WISCONSIN (WI)	$1978.98	$1978.98
WEST VIRGINIA (WV)	$2370.35	$2370.35
WYOMING** (WY)	$2180.82	$2180.82

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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) — 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 regional differences in cost of living and practice costs. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates differ because the practice-expense RVU is typically lower in facility settings, where the facility itself bears more of the overhead cost. For this code, non-facility and facility PE RVUs are the same, so the national amounts match.

RVUs — work 36.25, practice expense 20.14 (non-facility) / 20.14 (facility), malpractice 12.03 — × 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 their Part B deductible; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-level adjustments, and sequestration reductions.
Annual updates to RVUs, GPCIs, and the conversion factor — including budget-neutrality adjustments — can change this amount year to year.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount for some codes?

The practice-expense RVU is usually lower in facility settings because overhead costs like equipment and staff are borne by the facility rather than the billing provider. For this code, the practice-expense RVU is the same in both settings, so the national amounts are equal.

Why does the Medicare amount differ by locality?

Each RVU component is adjusted using locality-specific GPCIs before being multiplied by the conversion factor, so areas with higher practice costs or malpractice premiums typically see higher allowed amounts.

Does this figure represent what the provider will actually be paid?

No. It represents the Medicare-allowed amount before the standard 80/20 cost-sharing split, deductible application, modifiers, and any sequestration or other claim-specific adjustments.

Why isn't the CPT code description shown here?

CPT code descriptors are copyrighted by the American Medical Association, so this page refers to the code generically rather than reproducing the official descriptor.

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.