Medicare Reimbursement for CPT 22505
CPT 22505 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, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $153.64 | $153.64 |
| ALASKA* (AK) | $176.68 | $176.68 |
| ALABAMA (AL) | $133.99 | $133.99 |
| ARKANSAS (AR) | $131.59 | $131.59 |
| ARIZONA (AZ) | $147.82 | $147.82 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $171.83 | $171.83 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $174.15 | $174.15 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $157.68 | $157.68 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $159.61 | $159.61 |
| NAPA (CA) | $165.90 | $165.90 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $172.71 | $172.71 |
| VALLEJO (CA) | $164.62 | $164.62 |
| BAKERSFIELD (CA) | $151.03 | $151.03 |
| CHICO (CA) | $149.00 | $149.00 |
| FRESNO (CA) | $149.00 | $149.00 |
| HANFORD-CORCORAN (CA) | $149.00 | $149.00 |
| MADERA (CA) | $149.00 | $149.00 |
| MERCED (CA) | $149.00 | $149.00 |
| MODESTO (CA) | $149.00 | $149.00 |
| REDDING (CA) | $149.00 | $149.00 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $157.32 | $157.32 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $154.63 | $154.63 |
| SALINAS (CA) | $154.06 | $154.06 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $177.77 | $177.77 |
| SANTA CRUZ-WATSONVILLE (CA) | $157.19 | $157.19 |
| SANTA ROSA-PETALUMA (CA) | $158.61 | $158.61 |
| STOCKTON (CA) | $149.00 | $149.00 |
| VISALIA (CA) | $149.00 | $149.00 |
| YUBA CITY (CA) | $149.00 | $149.00 |
| EL CENTRO (CA) | $149.13 | $149.13 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $156.63 | $156.63 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $151.87 | $151.87 |
| SANTA MARIA-SANTA BARBARA (CA) | $154.35 | $154.35 |
| REST OF CALIFORNIA (CA) | $149.00 | $149.00 |
| COLORADO (CO) | $152.94 | $152.94 |
| CONNECTICUT (CT) | $165.47 | $165.47 |
| DC + MD/VA SUBURBS (DC) | $171.76 | $171.76 |
| DELAWARE (DE) | $150.52 | $150.52 |
| FORT LAUDERDALE (FL) | $175.56 | $175.56 |
| MIAMI (FL) | $196.22 | $196.22 |
| REST OF FLORIDA (FL) | $163.81 | $163.81 |
| ATLANTA (GA) | $160.13 | $160.13 |
| REST OF GEORGIA (GA) | $151.43 | $151.43 |
| HAWAII, GUAM (HI) | $151.83 | $151.83 |
| IOWA (IA) | $132.26 | $132.26 |
| IDAHO (ID) | $134.57 | $134.57 |
| EAST ST. LOUIS (IL) | $174.72 | $174.72 |
| SUBURBAN CHICAGO (IL) | $175.99 | $175.99 |
| CHICAGO (IL) | $188.14 | $188.14 |
| REST OF ILLINOIS (IL) | $162.50 | $162.50 |
| INDIANA (IN) | $135.38 | $135.38 |
| KANSAS (KS) | $134.31 | $134.31 |
| KENTUCKY (KY) | $144.01 | $144.01 |
| NEW ORLEANS (LA) | $153.25 | $153.25 |
| REST OF LOUISIANA (LA) | $144.87 | $144.87 |
| METROPOLITAN BOSTON (MA) | $166.23 | $166.23 |
| REST OF MASSACHUSETTS (MA) | $152.87 | $152.87 |
| BALTIMORE/SURR. CNTYS (MD) | $165.67 | $165.67 |
| REST OF MARYLAND (MD) | $152.92 | $152.92 |
| SOUTHERN MAINE (ME) | $143.43 | $143.43 |
| REST OF MAINE (ME) | $138.45 | $138.45 |
| DETROIT (MI) | $169.18 | $169.18 |
| REST OF MICHIGAN (MI) | $151.19 | $151.19 |
| MINNESOTA (MN) | $137.24 | $137.24 |
| METROPOLITAN ST. LOUIS (MO) | $150.49 | $150.49 |
| METROPOLITAN KANSAS CITY (MO) | $148.97 | $148.97 |
| REST OF MISSOURI (MO) | $143.75 | $143.75 |
| MISSISSIPPI (MS) | $137.56 | $137.56 |
| MONTANA** (MT) | $153.59 | $153.59 |
| NORTH CAROLINA (NC) | $139.76 | $139.76 |
| NORTH DAKOTA** (ND) | $138.17 | $138.17 |
| NEBRASKA (NE) | $132.30 | $132.30 |
| NEW HAMPSHIRE (NH) | $153.13 | $153.13 |
| NORTHERN NJ (NJ) | $169.93 | $169.93 |
| REST OF NEW JERSEY (NJ) | $164.75 | $164.75 |
| NEW MEXICO (NM) | $153.34 | $153.34 |
| NEVADA** (NV) | $149.36 | $149.36 |
| MANHATTAN (NY) | $183.62 | $183.62 |
| NYC SUBURBS/LONG ISLAND (NY) | $192.49 | $192.49 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $168.20 | $168.20 |
| QUEENS (NY) | $181.21 | $181.21 |
| REST OF NEW YORK (NY) | $142.57 | $142.57 |
| OHIO (OH) | $148.04 | $148.04 |
| OKLAHOMA (OK) | $140.69 | $140.69 |
| PORTLAND (OR) | $155.36 | $155.36 |
| REST OF OREGON (OR) | $145.64 | $145.64 |
| METROPOLITAN PHILADELPHIA (PA) | $162.51 | $162.51 |
| REST OF PENNSYLVANIA (PA) | $146.73 | $146.73 |
| PUERTO RICO (PR) | $153.99 | $153.99 |
| RHODE ISLAND (RI) | $154.19 | $154.19 |
| SOUTH CAROLINA (SC) | $144.66 | $144.66 |
| SOUTH DAKOTA** (SD) | $136.35 | $136.35 |
| TENNESSEE (TN) | $135.50 | $135.50 |
| BRAZORIA (TX) | $147.80 | $147.80 |
| DALLAS (TX) | $150.22 | $150.22 |
| GALVESTON (TX) | $149.18 | $149.18 |
| HOUSTON (TX) | $163.46 | $163.46 |
| BEAUMONT (TX) | $145.78 | $145.78 |
| FORT WORTH (TX) | $149.90 | $149.90 |
| AUSTIN (TX) | $154.67 | $154.67 |
| REST OF TEXAS (TX) | $147.71 | $147.71 |
| UTAH (UT) | $146.98 | $146.98 |
| VIRGINIA (VA) | $144.85 | $144.85 |
| VIRGIN ISLANDS (VI) | $153.99 | $153.99 |
| VERMONT (VT) | $140.11 | $140.11 |
| SEATTLE (KING CNTY) (WA) | $167.08 | $167.08 |
| REST OF WASHINGTON (WA) | $151.75 | $151.75 |
| WISCONSIN (WI) | $132.81 | $132.81 |
| WEST VIRGINIA (WV) | $156.12 | $156.12 |
| WYOMING** (WY) | $146.87 | $146.87 |
Look up another code or locality →
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 starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings, which is why the two amounts can vary.
RVUs — work 1.82, practice expense 2 (non-facility) / 2 (facility), malpractice 0.78 — × 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 responsible for the remainder.
- Modifiers, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments can change the actual paid amount.
- Local Medicare Administrative Contractor (MAC) policies and locality-specific GPCIs may cause actual payment to differ from the national figure shown.
- Always confirm current-year rates and coverage rules with your MAC before billing or appealing a denial.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The two settings use different practice-expense RVUs because the resources and overhead a physician incurs differ when a procedure is performed in a facility (e.g., hospital) versus a non-facility setting (e.g., physician office).
Why might my locality's payment differ from the national figure?
Medicare applies locality-specific Geographic Practice Cost Indices (GPCIs) to the work, practice expense, and malpractice RVUs, so allowed amounts vary by geographic area.
Does this amount reflect what the patient will pay?
No. The figure shown is the Medicare-allowed amount. After the deductible is met, Medicare generally pays 80%, leaving the patient or secondary payer responsible for the remaining 20%, subject to any applicable modifiers or adjustments.
Can this amount change during the year?
Yes. Conversion factor updates, budget-neutrality adjustments, sequestration, and mid-year policy changes can all affect the final paid amount, even if the RVUs stay the same.
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.
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