Medicare Reimbursement for CPT 22513

CPT 22513 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated national Medicare allowed amount for this code, along with how it can vary by locality and by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$5801.07	$453.58
ALASKA* (AK)	$6273.67	$578.60
ALABAMA (AL)	$5094.93	$415.88
ARKANSAS (AR)	$5004.78	$411.29
ARIZONA (AZ)	$5624.04	$442.33
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$8039.16	$499.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$8216.86	$505.79
OXNARD-THOUSAND OAKS-VENTURA (CA)	$6784.19	$463.46
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$6795.46	$469.39
NAPA (CA)	$7531.53	$483.55
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$8040.94	$500.99
VALLEJO (CA)	$7528.96	$480.98
BAKERSFIELD (CA)	$6310.75	$449.91
CHICO (CA)	$6306.36	$445.52
FRESNO (CA)	$6306.36	$445.52
HANFORD-CORCORAN (CA)	$6306.36	$445.52
MADERA (CA)	$6306.36	$445.52
MERCED (CA)	$6306.36	$445.52
MODESTO (CA)	$6306.36	$445.52
REDDING (CA)	$6306.36	$445.52
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$6323.27	$462.42
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$6678.00	$458.88
SALINAS (CA)	$6654.73	$456.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$8224.15	$513.08
SANTA CRUZ-WATSONVILLE (CA)	$6958.07	$460.87
SANTA ROSA-PETALUMA (CA)	$7031.67	$464.96
STOCKTON (CA)	$6306.36	$445.52
VISALIA (CA)	$6306.36	$445.52
YUBA CITY (CA)	$6306.36	$445.52
EL CENTRO (CA)	$6306.62	$445.78
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$6857.04	$461.45
SAN LUIS OBISPO-PASO ROBLES (CA)	$6541.44	$450.66
SANTA MARIA-SANTA BARBARA (CA)	$6692.15	$456.99
REST OF CALIFORNIA (CA)	$6306.36	$445.52
COLORADO (CO)	$6142.85	$453.13
CONNECTICUT (CT)	$6238.68	$479.44
DC + MD/VA SUBURBS (DC)	$6795.34	$496.00
DELAWARE (DE)	$5731.58	$448.26
FORT LAUDERDALE (FL)	$5914.51	$497.51
MIAMI (FL)	$6105.40	$538.67
REST OF FLORIDA (FL)	$5586.89	$474.70
ATLANTA (GA)	$5899.93	$466.88
REST OF GEORGIA (GA)	$5220.69	$450.74
HAWAII, GUAM (HI)	$6527.98	$447.89
IOWA (IA)	$5304.75	$411.80
IDAHO (ID)	$5336.07	$416.38
EAST ST. LOUIS (IL)	$5416.88	$497.19
SUBURBAN CHICAGO (IL)	$5991.13	$499.27
CHICAGO (IL)	$5898.28	$524.06
REST OF ILLINOIS (IL)	$5354.96	$472.70
INDIANA (IN)	$5375.02	$417.90
KANSAS (KS)	$5250.22	$416.10
KENTUCKY (KY)	$5189.77	$435.85
NEW ORLEANS (LA)	$5485.64	$453.66
REST OF LOUISIANA (LA)	$5170.15	$437.63
METROPOLITAN BOSTON (MA)	$6867.45	$482.56
REST OF MASSACHUSETTS (MA)	$6084.68	$453.78
BALTIMORE/SURR. CNTYS (MD)	$6217.10	$479.25
REST OF MARYLAND (MD)	$5865.19	$453.53
SOUTHERN MAINE (ME)	$5732.51	$433.16
REST OF MAINE (ME)	$5343.88	$424.20
DETROIT (MI)	$5645.69	$485.37
REST OF MICHIGAN (MI)	$5332.20	$449.95
MINNESOTA (MN)	$5922.70	$420.13
METROPOLITAN ST. LOUIS (MO)	$5538.75	$447.95
METROPOLITAN KANSAS CITY (MO)	$5466.37	$445.08
REST OF MISSOURI (MO)	$5045.25	$435.72
MISSISSIPPI (MS)	$5027.46	$423.28
MONTANA** (MT)	$5800.96	$453.48
NORTH CAROLINA (NC)	$5415.84	$426.64
NORTH DAKOTA** (ND)	$5769.92	$422.44
NEBRASKA (NE)	$5347.49	$411.76
NEW HAMPSHIRE (NH)	$6018.66	$451.93
NORTHERN NJ (NJ)	$6697.10	$494.02
REST OF NEW JERSEY (NJ)	$6320.39	$480.93
NEW MEXICO (NM)	$5357.84	$454.20
NEVADA** (NV)	$5797.78	$444.95
MANHATTAN (NY)	$6735.48	$521.71
NYC SUBURBS/LONG ISLAND (NY)	$6897.30	$539.14
POUGHKPSIE/N NYC SUBURBS (NY)	$6344.12	$488.63
QUEENS (NY)	$6837.27	$516.55
REST OF NEW YORK (NY)	$5512.14	$432.03
OHIO (OH)	$5325.85	$443.60
OKLAHOMA (OK)	$5204.40	$429.10
PORTLAND (OR)	$6398.99	$457.94
REST OF OREGON (OR)	$5763.63	$437.53
METROPOLITAN PHILADELPHIA (PA)	$6040.41	$473.68
REST OF PENNSYLVANIA (PA)	$5349.89	$440.89
PUERTO RICO (PR)	$5860.42	$454.11
RHODE ISLAND (RI)	$5981.17	$457.22
SOUTH CAROLINA (SC)	$5377.71	$436.63
SOUTH DAKOTA** (SD)	$5766.25	$418.76
TENNESSEE (TN)	$5279.29	$418.42
BRAZORIA (TX)	$5742.58	$443.22
DALLAS (TX)	$5774.29	$448.19
GALVESTON (TX)	$5756.03	$445.98
HOUSTON (TX)	$5784.77	$474.72
BEAUMONT (TX)	$5305.31	$439.10
FORT WORTH (TX)	$5720.30	$447.68
AUSTIN (TX)	$6112.74	$455.10
REST OF TEXAS (TX)	$5517.16	$442.40
UTAH (UT)	$5467.70	$441.06
VIRGINIA (VA)	$5692.71	$436.13
VIRGIN ISLANDS (VI)	$5860.42	$454.11
VERMONT (VT)	$5720.49	$426.48
SEATTLE (KING CNTY) (WA)	$7046.57	$485.21
REST OF WASHINGTON (WA)	$6081.95	$451.05
WISCONSIN (WI)	$5535.16	$412.27
WEST VIRGINIA (WV)	$5107.48	$460.52
WYOMING** (WY)	$5787.43	$439.95

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

The Medicare PFS amount for a code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted using the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Because practice expense costs differ depending on whether a service is performed in a non-facility setting (e.g., physician office) versus a facility setting (e.g., hospital), the practice-expense RVU — and therefore the total allowed amount — differs between these two settings. The work and malpractice RVUs generally stay the same across settings, while the practice-expense RVU is usually lower in the facility setting since overhead costs are borne by the facility rather than the billing physician.

RVUs — work 8.43, practice expense 163.68 (non-facility) / 3.58 (facility), malpractice 1.57 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment; actual reimbursement may differ.
Medicare typically pays 80% of the allowed amount after the patient's annual deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the amount actually paid.
Locality-specific GPCI values mean the amount paid in your area may differ from the national figure shown here.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The practice-expense RVU is lower in the facility setting because the facility, not the billing physician, incurs most of the overhead and equipment costs for the service.

Will I be paid exactly the national amount shown?

No. The national figure is a baseline calculated with national GPCI inputs; actual payment is recalculated using the GPCI values for your specific Medicare locality and may be higher or lower.

Does this amount reflect what Medicare actually pays out?

It reflects the Medicare-allowed amount. Medicare generally reimburses 80% of that amount after the deductible is satisfied, with the remaining portion owed by the patient or a secondary payer.

Can modifiers change this estimate?

Yes. Modifiers indicating bilateral procedures, reduced services, multiple procedures, or other circumstances can increase or decrease the final allowed amount relative to the base rate shown here.

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.