Medicare Reimbursement for CPT 22207

This page covers the Medicare Physician Fee Schedule (PFS) estimated allowed amount for CPT code 22207, a procedure code defined by the American Medical Association. It shows the national estimate for 2026 as well as how the amount can vary by locality, and compares non-facility and facility payment settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2214.48	$2214.48
ALASKA* (AK)	$2690.34	$2690.34
ALABAMA (AL)	$1974.16	$1974.16
ARKANSAS (AR)	$1945.07	$1945.07
ARIZONA (AZ)	$2141.60	$2141.60
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2386.58	$2386.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2415.23	$2415.23
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2229.50	$2229.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2260.65	$2260.65
NAPA (CA)	$2318.40	$2318.40
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2398.99	$2398.99
VALLEJO (CA)	$2300.51	$2300.51
BAKERSFIELD (CA)	$2157.31	$2157.31
CHICO (CA)	$2128.27	$2128.27
FRESNO (CA)	$2128.27	$2128.27
HANFORD-CORCORAN (CA)	$2128.27	$2128.27
MADERA (CA)	$2128.27	$2128.27
MERCED (CA)	$2128.27	$2128.27
MODESTO (CA)	$2128.27	$2128.27
REDDING (CA)	$2128.27	$2128.27
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2245.19	$2245.19
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2194.85	$2194.85
SALINAS (CA)	$2186.26	$2186.26
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2465.98	$2465.98
SANTA CRUZ-WATSONVILLE (CA)	$2210.99	$2210.99
SANTA ROSA-PETALUMA (CA)	$2230.26	$2230.26
STOCKTON (CA)	$2128.27	$2128.27
VISALIA (CA)	$2128.27	$2128.27
YUBA CITY (CA)	$2128.27	$2128.27
EL CENTRO (CA)	$2130.10	$2130.10
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2211.49	$2211.49
SAN LUIS OBISPO-PASO ROBLES (CA)	$2156.44	$2156.44
SANTA MARIA-SANTA BARBARA (CA)	$2187.26	$2187.26
REST OF CALIFORNIA (CA)	$2128.27	$2128.27
COLORADO (CO)	$2190.78	$2190.78
CONNECTICUT (CT)	$2365.47	$2365.47
DC + MD/VA SUBURBS (DC)	$2436.82	$2436.82
DELAWARE (DE)	$2175.72	$2175.72
FORT LAUDERDALE (FL)	$2517.97	$2517.97
MIAMI (FL)	$2799.53	$2799.53
REST OF FLORIDA (FL)	$2369.29	$2369.29
ATLANTA (GA)	$2301.92	$2301.92
REST OF GEORGIA (GA)	$2213.83	$2213.83
HAWAII, GUAM (HI)	$2150.52	$2150.52
IOWA (IA)	$1938.67	$1938.67
IDAHO (ID)	$1969.69	$1969.69
EAST ST. LOUIS (IL)	$2532.26	$2532.26
SUBURBAN CHICAGO (IL)	$2522.36	$2522.36
CHICAGO (IL)	$2698.88	$2698.88
REST OF ILLINOIS (IL)	$2363.03	$2363.03
INDIANA (IN)	$1979.02	$1979.02
KANSAS (KS)	$1970.52	$1970.52
KENTUCKY (KY)	$2110.74	$2110.74
NEW ORLEANS (LA)	$2225.48	$2225.48
REST OF LOUISIANA (LA)	$2123.82	$2123.82
METROPOLITAN BOSTON (MA)	$2350.36	$2350.36
REST OF MASSACHUSETTS (MA)	$2194.20	$2194.20
BALTIMORE/SURR. CNTYS (MD)	$2367.93	$2367.93
REST OF MARYLAND (MD)	$2204.35	$2204.35
SOUTHERN MAINE (ME)	$2073.87	$2073.87
REST OF MAINE (ME)	$2024.08	$2024.08
DETROIT (MI)	$2441.99	$2441.99
REST OF MICHIGAN (MI)	$2204.59	$2204.59
MINNESOTA (MN)	$1976.46	$1976.46
METROPOLITAN ST. LOUIS (MO)	$2183.77	$2183.77
METROPOLITAN KANSAS CITY (MO)	$2166.13	$2166.13
REST OF MISSOURI (MO)	$2114.60	$2114.60
MISSISSIPPI (MS)	$2028.15	$2028.15
MONTANA** (MT)	$2213.75	$2213.75
NORTH CAROLINA (NC)	$2038.80	$2038.80
NORTH DAKOTA** (ND)	$1997.63	$1997.63
NEBRASKA (NE)	$1936.97	$1936.97
NEW HAMPSHIRE (NH)	$2195.70	$2195.70
NORTHERN NJ (NJ)	$2419.35	$2419.35
REST OF NEW JERSEY (NJ)	$2357.93	$2357.93
NEW MEXICO (NM)	$2233.49	$2233.49
NEVADA** (NV)	$2154.17	$2154.17
MANHATTAN (NY)	$2610.96	$2610.96
NYC SUBURBS/LONG ISLAND (NY)	$2727.58	$2727.58
POUGHKPSIE/N NYC SUBURBS (NY)	$2407.12	$2407.12
QUEENS (NY)	$2571.49	$2571.49
REST OF NEW YORK (NY)	$2073.30	$2073.30
OHIO (OH)	$2160.42	$2160.42
OKLAHOMA (OK)	$2062.98	$2062.98
PORTLAND (OR)	$2212.84	$2212.84
REST OF OREGON (OR)	$2103.43	$2103.43
METROPOLITAN PHILADELPHIA (PA)	$2333.29	$2333.29
REST OF PENNSYLVANIA (PA)	$2140.69	$2140.69
PUERTO RICO (PR)	$2216.21	$2216.21
RHODE ISLAND (RI)	$2219.36	$2219.36
SOUTH CAROLINA (SC)	$2109.94	$2109.94
SOUTH DAKOTA** (SD)	$1972.07	$1972.07
TENNESSEE (TN)	$1985.85	$1985.85
BRAZORIA (TX)	$2137.82	$2137.82
DALLAS (TX)	$2170.77	$2170.77
GALVESTON (TX)	$2156.66	$2156.66
HOUSTON (TX)	$2356.72	$2356.72
BEAUMONT (TX)	$2129.61	$2129.61
FORT WORTH (TX)	$2168.97	$2168.97
AUSTIN (TX)	$2213.24	$2213.24
REST OF TEXAS (TX)	$2145.66	$2145.66
UTAH (UT)	$2137.94	$2137.94
VIRGINIA (VA)	$2096.01	$2096.01
VIRGIN ISLANDS (VI)	$2216.21	$2216.21
VERMONT (VT)	$2027.58	$2027.58
SEATTLE (KING CNTY) (WA)	$2356.08	$2356.08
REST OF WASHINGTON (WA)	$2177.47	$2177.47
WISCONSIN (WI)	$1934.34	$1934.34
WEST VIRGINIA (WV)	$2286.02	$2286.02
WYOMING** (WY)	$2119.56	$2119.56

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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 pricing for this code starts with three Relative Value Units (RVUs) — work, practice expense, and malpractice — that reflect the physician effort, overhead costs, and liability risk associated with the service. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, accounting for 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 estimated allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs, which is why the two amounts can differ for some codes, though for this code they are currently equal.

RVUs — work 35.76, practice expense 19.61 (non-facility) / 19.61 (facility), malpractice 10.93 — × 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 annual Part B deductible is met; the patient or secondary insurer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts vary by Medicare locality due to differing GPCIs; the national figure is a reference point, not a locality-specific payment.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the amount shown here differ from what my MAC actually paid?

The figure shown is a national PFS estimate based on standard RVUs, GPCIs, and the conversion factor. Actual payment can differ due to locality-specific GPCIs, applied modifiers, secondary procedure adjustments, sequestration, and other claim-specific factors.

Why are the non-facility and facility amounts the same for this code?

When the practice-expense RVU is identical in both settings, as is the case here, the total RVUs and resulting allowed amount are the same regardless of place of service.

Does this amount represent what the patient will owe?

No. This is the Medicare-allowed amount before cost-sharing. After the Part B deductible is met, Medicare generally pays 80%, leaving the patient or supplemental insurance responsible for the remaining 20%, subject to any applicable modifiers or adjustments.

Will this amount change next year?

Yes. The conversion factor and RVUs are updated annually, and budget-neutrality adjustments or policy changes can shift the allowed amount from year to year.

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.