Medicare Reimbursement for CPT 22226

This page covers a CPT procedure code (descriptor not shown here due to AMA licensing restrictions). It shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$319.65	$319.65
ALASKA* (AK)	$395.64	$395.64
ALABAMA (AL)	$286.08	$286.08
ARKANSAS (AR)	$282.05	$282.05
ARIZONA (AZ)	$309.18	$309.18
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$330.93	$330.93
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$334.30	$334.30
OXNARD-THOUSAND OAKS-VENTURA (CA)	$314.72	$314.72
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$319.74	$319.74
NAPA (CA)	$323.60	$323.60
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$332.93	$332.93
VALLEJO (CA)	$320.72	$320.72
BAKERSFIELD (CA)	$306.58	$306.58
CHICO (CA)	$301.90	$301.90
FRESNO (CA)	$301.90	$301.90
HANFORD-CORCORAN (CA)	$301.90	$301.90
MADERA (CA)	$301.90	$301.90
MERCED (CA)	$301.90	$301.90
MODESTO (CA)	$301.90	$301.90
REDDING (CA)	$301.90	$301.90
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$320.73	$320.73
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$309.95	$309.95
SALINAS (CA)	$308.71	$308.71
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$342.47	$342.47
SANTA CRUZ-WATSONVILLE (CA)	$310.35	$310.35
SANTA ROSA-PETALUMA (CA)	$312.96	$312.96
STOCKTON (CA)	$301.90	$301.90
VISALIA (CA)	$301.90	$301.90
YUBA CITY (CA)	$301.90	$301.90
EL CENTRO (CA)	$302.19	$302.19
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$311.25	$311.25
SAN LUIS OBISPO-PASO ROBLES (CA)	$304.67	$304.67
SANTA MARIA-SANTA BARBARA (CA)	$308.57	$308.57
REST OF CALIFORNIA (CA)	$301.90	$301.90
COLORADO (CO)	$313.26	$313.26
CONNECTICUT (CT)	$340.88	$340.88
DC + MD/VA SUBURBS (DC)	$348.37	$348.37
DELAWARE (DE)	$313.92	$313.92
FORT LAUDERDALE (FL)	$367.98	$367.98
MIAMI (FL)	$412.17	$412.17
REST OF FLORIDA (FL)	$346.38	$346.38
ATLANTA (GA)	$333.08	$333.08
REST OF GEORGIA (GA)	$323.97	$323.97
HAWAII, GUAM (HI)	$303.73	$303.73
IOWA (IA)	$278.72	$278.72
IDAHO (ID)	$283.51	$283.51
EAST ST. LOUIS (IL)	$374.10	$374.10
SUBURBAN CHICAGO (IL)	$368.14	$368.14
CHICAGO (IL)	$397.47	$397.47
REST OF ILLINOIS (IL)	$347.13	$347.13
INDIANA (IN)	$284.72	$284.72
KANSAS (KS)	$284.30	$284.30
KENTUCKY (KY)	$307.49	$307.49
NEW ORLEANS (LA)	$323.84	$323.84
REST OF LOUISIANA (LA)	$309.76	$309.76
METROPOLITAN BOSTON (MA)	$333.74	$333.74
REST OF MASSACHUSETTS (MA)	$314.27	$314.27
BALTIMORE/SURR. CNTYS (MD)	$341.43	$341.43
REST OF MARYLAND (MD)	$317.56	$317.56
SOUTHERN MAINE (ME)	$297.37	$297.37
REST OF MAINE (ME)	$292.27	$292.27
DETROIT (MI)	$357.72	$357.72
REST OF MICHIGAN (MI)	$321.62	$321.62
MINNESOTA (MN)	$280.13	$280.13
METROPOLITAN ST. LOUIS (MO)	$316.67	$316.67
METROPOLITAN KANSAS CITY (MO)	$314.36	$314.36
REST OF MISSOURI (MO)	$309.22	$309.22
MISSISSIPPI (MS)	$295.34	$295.34
MONTANA** (MT)	$319.53	$319.53
NORTH CAROLINA (NC)	$294.11	$294.11
NORTH DAKOTA** (ND)	$284.73	$284.73
NEBRASKA (NE)	$278.12	$278.12
NEW HAMPSHIRE (NH)	$314.94	$314.94
NORTHERN NJ (NJ)	$346.33	$346.33
REST OF NEW JERSEY (NJ)	$339.14	$339.14
NEW MEXICO (NM)	$326.11	$326.11
NEVADA** (NV)	$309.89	$309.89
MANHATTAN (NY)	$377.11	$377.11
NYC SUBURBS/LONG ISLAND (NY)	$394.78	$394.78
POUGHKPSIE/N NYC SUBURBS (NY)	$346.95	$346.95
QUEENS (NY)	$369.93	$369.93
REST OF NEW YORK (NY)	$298.96	$298.96
OHIO (OH)	$314.51	$314.51
OKLAHOMA (OK)	$299.64	$299.64
PORTLAND (OR)	$314.90	$314.90
REST OF OREGON (OR)	$301.93	$301.93
METROPOLITAN PHILADELPHIA (PA)	$337.17	$337.17
REST OF PENNSYLVANIA (PA)	$311.13	$311.13
PUERTO RICO (PR)	$319.47	$319.47
RHODE ISLAND (RI)	$319.16	$319.16
SOUTH CAROLINA (SC)	$305.93	$305.93
SOUTH DAKOTA** (SD)	$280.61	$280.61
TENNESSEE (TN)	$286.56	$286.56
BRAZORIA (TX)	$307.70	$307.70
DALLAS (TX)	$312.81	$312.81
GALVESTON (TX)	$310.66	$310.66
HOUSTON (TX)	$342.87	$342.87
BEAUMONT (TX)	$309.67	$309.67
FORT WORTH (TX)	$312.93	$312.93
AUSTIN (TX)	$317.08	$317.08
REST OF TEXAS (TX)	$310.66	$310.66
UTAH (UT)	$309.78	$309.78
VIRGINIA (VA)	$301.27	$301.27
VIRGIN ISLANDS (VI)	$319.47	$319.47
VERMONT (VT)	$289.96	$289.96
SEATTLE (KING CNTY) (WA)	$333.34	$333.34
REST OF WASHINGTON (WA)	$311.57	$311.57
WISCONSIN (WI)	$276.26	$276.26
WEST VIRGINIA (WV)	$336.54	$336.54
WYOMING** (WY)	$304.36	$304.36

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 4 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 amount is built from three relative value units (RVUs) — physician work, practice expense, and malpractice — that reflect the resources typically needed to furnish a service. Each RVU component is adjusted by geographic practice cost indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs often differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings because overhead costs differ, which is why the two amounts can diverge. The conversion factor is updated annually and applied uniformly nationwide, while GPCIs vary allowed amounts by locality.

RVUs — work 5.88, practice expense 1.93 (non-facility) / 1.93 (facility), malpractice 1.76 — × 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 deductible; the patient or secondary insurer is responsible for the rest.
Modifiers, place-of-service codes, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts shown are based on national or locality-level inputs and may not match your specific Medicare Administrative Contractor (MAC) determination.
Always verify current rates and coverage policy with your MAC before billing or appealing a claim.

Frequently asked

Why is the non-facility amount different from the facility amount?

The two settings use different practice-expense RVUs because overhead costs (equipment, staff, supplies) differ when a service is furnished in a physician office versus a hospital or facility setting.

Why does the allowed amount change by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to each RVU component to reflect regional differences in wages, rents, and malpractice costs, so the same code can have different allowed amounts in different areas.

Does this amount reflect what the patient actually pays?

No. The figure shown is the Medicare-allowed amount. Patients generally owe 20% coinsurance after the deductible, and secondary insurance or supplemental coverage may affect the final out-of-pocket cost.

Will this amount stay the same next year?

No. The conversion factor, RVUs, and GPCIs are reviewed and can change annually, and budget-neutrality adjustments may also shift allowed amounts 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.