Medicare Reimbursement for CPT 22212

CPT 22212 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out by non-facility and facility settings. Because the CPT descriptor is proprietary to the AMA, it is not reproduced here — please consult your CPT codebook or encoder for the official description.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1455.95	$1455.95
ALASKA* (AK)	$1739.15	$1739.15
ALABAMA (AL)	$1293.98	$1293.98
ARKANSAS (AR)	$1274.21	$1274.21
ARIZONA (AZ)	$1408.08	$1408.08
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1628.93	$1628.93
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1651.19	$1651.19
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1497.26	$1497.26
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1515.39	$1515.39
NAPA (CA)	$1573.06	$1573.06
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1636.13	$1636.13
VALLEJO (CA)	$1562.68	$1562.68
BAKERSFIELD (CA)	$1439.94	$1439.94
CHICO (CA)	$1423.12	$1423.12
FRESNO (CA)	$1423.12	$1423.12
HANFORD-CORCORAN (CA)	$1423.12	$1423.12
MADERA (CA)	$1423.12	$1423.12
MERCED (CA)	$1423.12	$1423.12
MODESTO (CA)	$1423.12	$1423.12
REDDING (CA)	$1423.12	$1423.12
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1490.93	$1490.93
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1473.66	$1473.66
SALINAS (CA)	$1468.00	$1468.00
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1680.62	$1680.62
SANTA CRUZ-WATSONVILLE (CA)	$1492.55	$1492.55
SANTA ROSA-PETALUMA (CA)	$1505.99	$1505.99
STOCKTON (CA)	$1423.12	$1423.12
VISALIA (CA)	$1423.12	$1423.12
YUBA CITY (CA)	$1423.12	$1423.12
EL CENTRO (CA)	$1424.17	$1424.17
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1489.32	$1489.32
SAN LUIS OBISPO-PASO ROBLES (CA)	$1447.22	$1447.22
SANTA MARIA-SANTA BARBARA (CA)	$1469.87	$1469.87
REST OF CALIFORNIA (CA)	$1423.12	$1423.12
COLORADO (CO)	$1453.64	$1453.64
CONNECTICUT (CT)	$1557.25	$1557.25
DC + MD/VA SUBURBS (DC)	$1616.56	$1616.56
DELAWARE (DE)	$1431.25	$1431.25
FORT LAUDERDALE (FL)	$1634.33	$1634.33
MIAMI (FL)	$1802.71	$1802.71
REST OF FLORIDA (FL)	$1537.80	$1537.80
ATLANTA (GA)	$1509.53	$1509.53
REST OF GEORGIA (GA)	$1436.07	$1436.07
HAWAII, GUAM (HI)	$1443.58	$1443.58
IOWA (IA)	$1280.61	$1280.61
IDAHO (ID)	$1299.51	$1299.51
EAST ST. LOUIS (IL)	$1625.83	$1625.83
SUBURBAN CHICAGO (IL)	$1639.34	$1639.34
CHICAGO (IL)	$1737.76	$1737.76
REST OF ILLINOIS (IL)	$1526.41	$1526.41
INDIANA (IN)	$1306.19	$1306.19
KANSAS (KS)	$1297.11	$1297.11
KENTUCKY (KY)	$1375.73	$1375.73
NEW ORLEANS (LA)	$1451.68	$1451.68
REST OF LOUISIANA (LA)	$1382.60	$1382.60
METROPOLITAN BOSTON (MA)	$1569.41	$1569.41
REST OF MASSACHUSETTS (MA)	$1453.60	$1453.60
BALTIMORE/SURR. CNTYS (MD)	$1557.99	$1557.99
REST OF MARYLAND (MD)	$1452.14	$1452.14
SOUTHERN MAINE (ME)	$1372.76	$1372.76
REST OF MAINE (ME)	$1331.06	$1331.06
DETROIT (MI)	$1581.60	$1581.60
REST OF MICHIGAN (MI)	$1434.50	$1434.50
MINNESOTA (MN)	$1323.12	$1323.12
METROPOLITAN ST. LOUIS (MO)	$1429.47	$1429.47
METROPOLITAN KANSAS CITY (MO)	$1416.89	$1416.89
REST OF MISSOURI (MO)	$1373.09	$1373.09
MISSISSIPPI (MS)	$1322.77	$1322.77
MONTANA** (MT)	$1455.52	$1455.52
NORTH CAROLINA (NC)	$1341.95	$1341.95
NORTH DAKOTA** (ND)	$1330.16	$1330.16
NEBRASKA (NE)	$1281.07	$1281.07
NEW HAMPSHIRE (NH)	$1452.45	$1452.45
NORTHERN NJ (NJ)	$1603.09	$1603.09
REST OF NEW JERSEY (NJ)	$1555.40	$1555.40
NEW MEXICO (NM)	$1451.99	$1451.99
NEVADA** (NV)	$1421.14	$1421.14
MANHATTAN (NY)	$1714.59	$1714.59
NYC SUBURBS/LONG ISLAND (NY)	$1787.11	$1787.11
POUGHKPSIE/N NYC SUBURBS (NY)	$1584.43	$1584.43
QUEENS (NY)	$1695.31	$1695.31
REST OF NEW YORK (NY)	$1365.03	$1365.03
OHIO (OH)	$1408.88	$1408.88
OKLAHOMA (OK)	$1348.75	$1348.75
PORTLAND (OR)	$1474.89	$1474.89
REST OF OREGON (OR)	$1390.81	$1390.81
METROPOLITAN PHILADELPHIA (PA)	$1532.10	$1532.10
REST OF PENNSYLVANIA (PA)	$1398.34	$1398.34
PUERTO RICO (PR)	$1458.93	$1458.93
RHODE ISLAND (RI)	$1464.56	$1464.56
SOUTH CAROLINA (SC)	$1381.59	$1381.59
SOUTH DAKOTA** (SD)	$1315.34	$1315.34
TENNESSEE (TN)	$1306.90	$1306.90
BRAZORIA (TX)	$1409.78	$1409.78
DALLAS (TX)	$1429.79	$1429.79
GALVESTON (TX)	$1421.07	$1421.07
HOUSTON (TX)	$1537.11	$1537.11
BEAUMONT (TX)	$1390.47	$1390.47
FORT WORTH (TX)	$1426.93	$1426.93
AUSTIN (TX)	$1465.68	$1465.68
REST OF TEXAS (TX)	$1406.82	$1406.82
UTAH (UT)	$1400.72	$1400.72
VIRGINIA (VA)	$1384.16	$1384.16
VIRGIN ISLANDS (VI)	$1458.93	$1458.93
VERMONT (VT)	$1345.73	$1345.73
SEATTLE (KING CNTY) (WA)	$1578.60	$1578.60
REST OF WASHINGTON (WA)	$1443.93	$1443.93
WISCONSIN (WI)	$1285.87	$1285.87
WEST VIRGINIA (WV)	$1473.79	$1473.79
WYOMING** (WY)	$1400.89	$1400.89

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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 procedure code is based on three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed. The adjusted RVUs are summed and then multiplied by the annual Medicare Conversion Factor to produce the allowed amount. Non-facility and facility settings generally differ because the practice-expense RVU reflects whether the physician's office bears the overhead costs (non-facility) or whether that overhead is instead billed separately by a hospital or ASC (facility). For this code, the practice-expense RVU is the same in both settings, so the non-facility and facility allowed amounts are identical.

RVUs — work 20.47, practice expense 16.78 (non-facility) / 16.78 (facility), malpractice 6.34 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient's Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Always verify the final allowed amount and any applicable edits with your Medicare Administrative Contractor (MAC).

Frequently asked

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

When the practice-expense RVU is identical in both settings, the calculated allowed amount comes out the same regardless of place of service.

Does this amount reflect what my practice will actually be paid?

No — it's a PFS-based estimate. Final payment depends on your specific locality GPCIs, any modifiers applied, claim-level adjustments, and current sequestration or other mandated reductions.

Why isn't the CPT code description shown?

CPT code descriptors are copyrighted by the American Medical Association and cannot be reproduced here. Refer to your CPT codebook or practice management system for the official language.

How often do these amounts change?

The Conversion Factor and RVUs are updated annually by CMS, and GPCIs can also be revised periodically, so allowed amounts should be re-checked each 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.