Medicare Reimbursement for CPT 22315

CPT 22315 is a procedure code valued under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount for this code at the national level and adjusted for a specific locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1005.03	$755.86
ALASKA* (AK)	$1170.01	$904.65
ALABAMA (AL)	$894.36	$676.33
ARKANSAS (AR)	$880.57	$666.54
ARIZONA (AZ)	$974.50	$733.05
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1229.79	$878.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1251.26	$891.96
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1089.81	$795.29
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1098.16	$803.39
NAPA (CA)	$1171.93	$843.53
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1232.68	$881.34
VALLEJO (CA)	$1167.78	$839.37
BAKERSFIELD (CA)	$1034.84	$761.75
CHICO (CA)	$1027.99	$754.90
FRESNO (CA)	$1027.99	$754.90
HANFORD-CORCORAN (CA)	$1027.99	$754.90
MADERA (CA)	$1027.99	$754.90
MERCED (CA)	$1027.99	$754.90
MODESTO (CA)	$1027.99	$754.90
REDDING (CA)	$1027.99	$754.90
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1055.21	$782.12
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1073.83	$784.05
SALINAS (CA)	$1069.82	$781.04
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1263.06	$903.75
SANTA CRUZ-WATSONVILLE (CA)	$1099.62	$796.88
SANTA ROSA-PETALUMA (CA)	$1110.26	$804.28
STOCKTON (CA)	$1027.99	$754.90
VISALIA (CA)	$1027.99	$754.90
YUBA CITY (CA)	$1027.99	$754.90
EL CENTRO (CA)	$1028.41	$755.32
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1091.87	$793.86
SAN LUIS OBISPO-PASO ROBLES (CA)	$1053.40	$769.59
SANTA MARIA-SANTA BARBARA (CA)	$1072.97	$782.44
REST OF CALIFORNIA (CA)	$1027.99	$754.90
COLORADO (CO)	$1028.22	$763.10
CONNECTICUT (CT)	$1074.93	$806.58
DC + MD/VA SUBURBS (DC)	$1137.58	$844.05
DELAWARE (DE)	$991.02	$744.84
FORT LAUDERDALE (FL)	$1081.26	$828.85
MIAMI (FL)	$1158.98	$899.59
REST OF FLORIDA (FL)	$1021.71	$783.50
ATLANTA (GA)	$1032.53	$779.37
REST OF GEORGIA (GA)	$957.51	$735.25
HAWAII, GUAM (HI)	$1050.26	$766.96
IOWA (IA)	$903.65	$675.66
IDAHO (ID)	$913.05	$683.82
EAST ST. LOUIS (IL)	$1043.79	$814.55
SUBURBAN CHICAGO (IL)	$1088.79	$832.89
CHICAGO (IL)	$1120.16	$869.74
REST OF ILLINOIS (IL)	$1001.39	$773.90
INDIANA (IN)	$918.29	$687.31
KANSAS (KS)	$906.23	$680.98
KENTUCKY (KY)	$932.24	$710.72
NEW ORLEANS (LA)	$981.71	$747.24
REST OF LOUISIANA (LA)	$933.52	$713.00
METROPOLITAN BOSTON (MA)	$1123.83	$826.32
REST OF MASSACHUSETTS (MA)	$1024.40	$762.02
BALTIMORE/SURR. CNTYS (MD)	$1073.54	$806.18
REST OF MARYLAND (MD)	$1008.46	$756.30
SOUTHERN MAINE (ME)	$968.41	$721.48
REST OF MAINE (ME)	$925.70	$696.46
DETROIT (MI)	$1042.55	$802.10
REST OF MICHIGAN (MI)	$964.57	$737.08
MINNESOTA (MN)	$962.44	$706.05
METROPOLITAN ST. LOUIS (MO)	$976.84	$739.63
METROPOLITAN KANSAS CITY (MO)	$967.04	$733.07
REST OF MISSOURI (MO)	$921.29	$706.50
MISSISSIPPI (MS)	$900.76	$686.22
MONTANA** (MT)	$1004.86	$755.69
NORTH CAROLINA (NC)	$934.82	$702.34
NORTH DAKOTA** (ND)	$954.64	$705.47
NEBRASKA (NE)	$906.77	$676.78
NEW HAMPSHIRE (NH)	$1018.65	$759.27
NORTHERN NJ (NJ)	$1126.09	$837.05
REST OF NEW JERSEY (NJ)	$1080.80	$808.70
NEW MEXICO (NM)	$973.04	$744.55
NEVADA** (NV)	$991.46	$742.04
MANHATTAN (NY)	$1171.55	$882.01
NYC SUBURBS/LONG ISLAND (NY)	$1210.49	$914.23
POUGHKPSIE/N NYC SUBURBS (NY)	$1093.80	$820.96
QUEENS (NY)	$1171.15	$876.63
REST OF NEW YORK (NY)	$950.29	$713.58
OHIO (OH)	$954.31	$726.81
OKLAHOMA (OK)	$922.89	$700.38
PORTLAND (OR)	$1054.17	$777.34
REST OF OREGON (OR)	$977.47	$729.30
METROPOLITAN PHILADELPHIA (PA)	$1051.56	$792.17
REST OF PENNSYLVANIA (PA)	$951.92	$723.18
PUERTO RICO (PR)	$1010.26	$758.35
RHODE ISLAND (RI)	$1021.63	$764.23
SOUTH CAROLINA (SC)	$947.40	$717.17
SOUTH DAKOTA** (SD)	$948.70	$699.53
TENNESSEE (TN)	$911.98	$685.49
BRAZORIA (TX)	$983.69	$736.76
DALLAS (TX)	$993.59	$745.41
GALVESTON (TX)	$988.94	$741.51
HOUSTON (TX)	$1035.43	$788.00
BEAUMONT (TX)	$945.83	$719.09
FORT WORTH (TX)	$988.78	$743.10
AUSTIN (TX)	$1030.29	$766.67
REST OF TEXAS (TX)	$966.67	$730.21
UTAH (UT)	$960.93	$726.71
VIRGINIA (VA)	$970.05	$725.11
VIRGIN ISLANDS (VI)	$1010.26	$758.35
VERMONT (VT)	$957.21	$710.54
SEATTLE (KING CNTY) (WA)	$1140.10	$834.37
REST OF WASHINGTON (WA)	$1020.35	$757.98
WISCONSIN (WI)	$921.51	$682.80
WEST VIRGINIA (WV)	$964.20	$747.67
WYOMING** (WY)	$982.98	$733.80

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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 — that are each adjusted by the Geographic Practice Cost Indices (GPCIs) for the locality where the service is billed. These geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility amounts differ primarily because the practice-expense RVU is higher in non-facility settings (where the physician's practice absorbs more overhead) and lower in facility settings (where the facility bills separately for overhead costs). The result is an estimate of the total allowed charge before any patient cost-sharing is applied.

RVUs — work 9.86, practice expense 17.69 (non-facility) / 10.23 (facility), malpractice 2.54 — × 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 payer is responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual updates to RVUs, GPCIs, and the conversion factor, as well as budget-neutrality adjustments, can shift amounts from year to year.
Always verify the final allowed amount and payment with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

In facility settings, the facility (e.g., hospital) bills separately for overhead and equipment costs, so the practice-expense RVU used to calculate the physician's payment is lower than when the service is performed in a non-facility setting like an office.

Why might the amount I see on CareNiva differ from what I'm actually paid?

Actual payment depends on the specific locality's GPCIs, any applicable modifiers, multiple-procedure payment reductions, sequestration, and the patient's deductible status — all of which can cause variance from the estimates shown here.

Does this amount represent what the patient owes?

No. The figures shown are the total Medicare-allowed amount. Medicare generally pays 80% of this after the deductible is met, with the patient or a secondary payer typically responsible for the remaining 20%.

Will this amount change next year?

Yes, it can. RVUs, GPCIs, and the conversion factor are updated annually by CMS, and budget-neutrality adjustments can also affect the final allowed amount.

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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.