Medicare Reimbursement for CPT 22511

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code (CPT descriptors are proprietary to the AMA and not reproduced here). It shows the 2026 national estimate as well as how the amount can vary by locality, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1773.92	$361.40
ALASKA* (AK)	$1974.74	$470.40
ALABAMA (AL)	$1570.99	$335.03
ARKANSAS (AR)	$1545.18	$331.82
ARIZONA (AZ)	$1722.30	$353.56
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2390.80	$399.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2441.36	$404.50
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2040.02	$370.42
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2046.09	$375.07
NAPA (CA)	$2248.18	$386.48
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2392.01	$400.36
VALLEJO (CA)	$2246.43	$384.72
BAKERSFIELD (CA)	$1908.42	$360.30
CHICO (CA)	$1905.34	$357.21
FRESNO (CA)	$1905.34	$357.21
HANFORD-CORCORAN (CA)	$1905.34	$357.21
MADERA (CA)	$1905.34	$357.21
MERCED (CA)	$1905.34	$357.21
MODESTO (CA)	$1905.34	$357.21
REDDING (CA)	$1905.34	$357.21
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1916.91	$368.78
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2010.33	$367.57
SALINAS (CA)	$2003.14	$366.03
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2446.33	$409.47
SANTA CRUZ-WATSONVILLE (CA)	$2084.72	$368.50
SANTA ROSA-PETALUMA (CA)	$2106.36	$371.78
STOCKTON (CA)	$1905.34	$357.21
VISALIA (CA)	$1905.34	$357.21
YUBA CITY (CA)	$1905.34	$357.21
EL CENTRO (CA)	$1905.52	$357.39
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2058.59	$369.21
SAN LUIS OBISPO-PASO ROBLES (CA)	$1969.81	$360.95
SANTA MARIA-SANTA BARBARA (CA)	$2012.92	$365.92
REST OF CALIFORNIA (CA)	$1905.34	$357.21
COLORADO (CO)	$1864.92	$361.99
CONNECTICUT (CT)	$1901.65	$380.37
DC + MD/VA SUBURBS (DC)	$2057.74	$393.79
DELAWARE (DE)	$1753.51	$357.94
FORT LAUDERDALE (FL)	$1822.29	$391.40
MIAMI (FL)	$1890.04	$419.60
REST OF FLORIDA (FL)	$1725.93	$375.55
ATLANTA (GA)	$1805.81	$370.69
REST OF GEORGIA (GA)	$1618.85	$358.88
HAWAII, GUAM (HI)	$1964.29	$358.25
IOWA (IA)	$1624.93	$332.47
IDAHO (ID)	$1635.14	$335.62
EAST ST. LOUIS (IL)	$1690.21	$390.69
SUBURBAN CHICAGO (IL)	$1843.67	$393.00
CHICAGO (IL)	$1829.37	$409.79
REST OF ILLINOIS (IL)	$1663.60	$373.96
INDIANA (IN)	$1646.10	$336.69
KANSAS (KS)	$1612.26	$335.33
KENTUCKY (KY)	$1604.45	$348.72
NEW ORLEANS (LA)	$1690.32	$361.13
REST OF LOUISIANA (LA)	$1599.99	$349.91
METROPOLITAN BOSTON (MA)	$2070.66	$384.11
REST OF MASSACHUSETTS (MA)	$1849.95	$362.57
BALTIMORE/SURR. CNTYS (MD)	$1895.67	$380.03
REST OF MARYLAND (MD)	$1791.37	$361.90
SOUTHERN MAINE (ME)	$1747.24	$347.43
REST OF MAINE (ME)	$1640.46	$340.94
DETROIT (MI)	$1745.96	$382.88
REST OF MICHIGAN (MI)	$1648.09	$358.45
MINNESOTA (MN)	$1792.24	$338.76
METROPOLITAN ST. LOUIS (MO)	$1702.02	$357.30
METROPOLITAN KANSAS CITY (MO)	$1681.64	$355.28
REST OF MISSOURI (MO)	$1566.08	$348.48
MISSISSIPPI (MS)	$1556.18	$340.00
MONTANA** (MT)	$1773.85	$361.33
NORTH CAROLINA (NC)	$1660.56	$342.68
NORTH DAKOTA** (ND)	$1752.69	$340.17
NEBRASKA (NE)	$1636.24	$332.48
NEW HAMPSHIRE (NH)	$1830.93	$360.49
NORTHERN NJ (NJ)	$2031.30	$392.77
REST OF NEW JERSEY (NJ)	$1924.88	$382.41
NEW MEXICO (NM)	$1656.66	$361.37
NEVADA** (NV)	$1769.45	$355.52
MANHATTAN (NY)	$2053.05	$411.69
NYC SUBURBS/LONG ISLAND (NY)	$2103.21	$423.72
POUGHKPSIE/N NYC SUBURBS (NY)	$1934.61	$387.90
QUEENS (NY)	$2077.89	$408.28
REST OF NEW YORK (NY)	$1688.34	$346.44
OHIO (OH)	$1643.76	$354.13
OKLAHOMA (OK)	$1605.52	$344.14
PORTLAND (OR)	$1935.02	$365.71
REST OF OREGON (OR)	$1757.31	$350.44
METROPOLITAN PHILADELPHIA (PA)	$1846.59	$376.15
REST OF PENNSYLVANIA (PA)	$1649.01	$352.31
PUERTO RICO (PR)	$1789.88	$361.82
RHODE ISLAND (RI)	$1824.08	$364.94
SOUTH CAROLINA (SC)	$1654.61	$349.44
SOUTH DAKOTA** (SD)	$1750.19	$337.67
TENNESSEE (TN)	$1620.93	$336.95
BRAZORIA (TX)	$1754.48	$354.66
DALLAS (TX)	$1765.00	$358.12
GALVESTON (TX)	$1759.19	$356.55
HOUSTON (TX)	$1778.77	$376.14
BEAUMONT (TX)	$1636.44	$351.04
FORT WORTH (TX)	$1750.47	$357.72
AUSTIN (TX)	$1857.29	$362.84
REST OF TEXAS (TX)	$1693.99	$353.50
UTAH (UT)	$1680.31	$352.54
VIRGINIA (VA)	$1737.93	$349.41
VIRGIN ISLANDS (VI)	$1789.88	$361.82
VERMONT (VT)	$1741.27	$342.87
SEATTLE (KING CNTY) (WA)	$2119.68	$386.51
REST OF WASHINGTON (WA)	$1847.95	$360.56
WISCONSIN (WI)	$1686.22	$333.02
WEST VIRGINIA (WV)	$1592.91	$365.42
WYOMING** (WY)	$1764.63	$352.11

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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 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 to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice expense RVUs differ between non-facility and facility settings because overhead costs (equipment, supplies, staff) are treated differently depending on where the service is performed. The national amounts shown represent an average across localities, while the locality-specific amount applies the actual GPCI values for that area.

RVUs — work 7.15, practice expense 44.89 (non-facility) / 2.6 (facility), malpractice 1.07 — × 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, bilateral billing, and other claim-specific factors can change the actual paid amount.
Annual budget-neutrality adjustments and sequestration (if applicable) may further affect final reimbursement.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The facility amount uses a lower practice expense RVU because Medicare assumes the facility (e.g., hospital) absorbs certain overhead costs separately, while the non-facility amount assumes the billing provider bears those costs directly, such as in a private office.

Why might the amount differ from what my MAC pays?

Local GPCI values vary by locality, and modifiers, place of service, or policy-specific adjustments can change the final paid amount from the national estimate shown here.

Does this amount reflect what the patient will owe?

No. This figure is the Medicare-allowed amount before cost-sharing; the patient's out-of-pocket responsibility depends on deductible status, coinsurance, and any secondary coverage.

Will this amount change next year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can shift fee schedule amounts from year to year.

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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.