Medicare Reimbursement for CPT 22551

CPT 22551 is a physician procedure code reported to Medicare for payment purposes; the specific clinical descriptor is licensed by the AMA and is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted by locality, with non-facility and facility rate comparisons where applicable.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1604.91	$1604.91
ALASKA* (AK)	$1921.99	$1921.99
ALABAMA (AL)	$1421.04	$1421.04
ARKANSAS (AR)	$1398.76	$1398.76
ARIZONA (AZ)	$1549.30	$1549.30
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1735.32	$1735.32
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1756.32	$1756.32
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1617.75	$1617.75
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1640.14	$1640.14
NAPA (CA)	$1684.69	$1684.69
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1744.68	$1744.68
VALLEJO (CA)	$1671.21	$1671.21
BAKERSFIELD (CA)	$1562.25	$1562.25
CHICO (CA)	$1540.53	$1540.53
FRESNO (CA)	$1540.53	$1540.53
HANFORD-CORCORAN (CA)	$1540.53	$1540.53
MADERA (CA)	$1540.53	$1540.53
MERCED (CA)	$1540.53	$1540.53
MODESTO (CA)	$1540.53	$1540.53
REDDING (CA)	$1540.53	$1540.53
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1628.59	$1628.59
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1590.53	$1590.53
SALINAS (CA)	$1584.40	$1584.40
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1794.58	$1794.58
SANTA CRUZ-WATSONVILLE (CA)	$1605.12	$1605.12
SANTA ROSA-PETALUMA (CA)	$1619.14	$1619.14
STOCKTON (CA)	$1540.53	$1540.53
VISALIA (CA)	$1540.53	$1540.53
YUBA CITY (CA)	$1540.53	$1540.53
EL CENTRO (CA)	$1541.91	$1541.91
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1604.30	$1604.30
SAN LUIS OBISPO-PASO ROBLES (CA)	$1562.69	$1562.69
SANTA MARIA-SANTA BARBARA (CA)	$1585.56	$1585.56
REST OF CALIFORNIA (CA)	$1540.53	$1540.53
COLORADO (CO)	$1587.40	$1587.40
CONNECTICUT (CT)	$1718.68	$1718.68
DC + MD/VA SUBURBS (DC)	$1771.72	$1771.72
DELAWARE (DE)	$1575.00	$1575.00
FORT LAUDERDALE (FL)	$1833.99	$1833.99
MIAMI (FL)	$2046.86	$2046.86
REST OF FLORIDA (FL)	$1720.67	$1720.67
ATLANTA (GA)	$1670.92	$1670.92
REST OF GEORGIA (GA)	$1602.10	$1602.10
HAWAII, GUAM (HI)	$1559.65	$1559.65
IOWA (IA)	$1395.15	$1395.15
IDAHO (ID)	$1418.64	$1418.64
EAST ST. LOUIS (IL)	$1842.76	$1842.76
SUBURBAN CHICAGO (IL)	$1837.00	$1837.00
CHICAGO (IL)	$1969.60	$1969.60
REST OF ILLINOIS (IL)	$1715.03	$1715.03
INDIANA (IN)	$1425.83	$1425.83
KANSAS (KS)	$1418.93	$1418.93
KENTUCKY (KY)	$1524.31	$1524.31
NEW ORLEANS (LA)	$1611.94	$1611.94
REST OF LOUISIANA (LA)	$1534.09	$1534.09
METROPOLITAN BOSTON (MA)	$1708.01	$1708.01
REST OF MASSACHUSETTS (MA)	$1589.39	$1589.39
BALTIMORE/SURR. CNTYS (MD)	$1720.79	$1720.79
REST OF MARYLAND (MD)	$1596.67	$1596.67
SOUTHERN MAINE (ME)	$1498.72	$1498.72
REST OF MAINE (ME)	$1459.65	$1459.65
DETROIT (MI)	$1775.68	$1775.68
REST OF MICHIGAN (MI)	$1595.58	$1595.58
MINNESOTA (MN)	$1426.10	$1426.10
METROPOLITAN ST. LOUIS (MO)	$1580.73	$1580.73
METROPOLITAN KANSAS CITY (MO)	$1567.15	$1567.15
REST OF MISSOURI (MO)	$1526.64	$1526.64
MISSISSIPPI (MS)	$1461.44	$1461.44
MONTANA** (MT)	$1604.36	$1604.36
NORTH CAROLINA (NC)	$1471.03	$1471.03
NORTH DAKOTA** (ND)	$1441.43	$1441.43
NEBRASKA (NE)	$1394.04	$1394.04
NEW HAMPSHIRE (NH)	$1591.64	$1591.64
NORTHERN NJ (NJ)	$1757.39	$1757.39
REST OF NEW JERSEY (NJ)	$1711.60	$1711.60
NEW MEXICO (NM)	$1617.46	$1617.46
NEVADA** (NV)	$1559.47	$1559.47
MANHATTAN (NY)	$1901.80	$1901.80
NYC SUBURBS/LONG ISLAND (NY)	$1990.30	$1990.30
POUGHKPSIE/N NYC SUBURBS (NY)	$1748.31	$1748.31
QUEENS (NY)	$1872.48	$1872.48
REST OF NEW YORK (NY)	$1497.40	$1497.40
OHIO (OH)	$1562.28	$1562.28
OKLAHOMA (OK)	$1488.39	$1488.39
PORTLAND (OR)	$1604.69	$1604.69
REST OF OREGON (OR)	$1521.11	$1521.11
METROPOLITAN PHILADELPHIA (PA)	$1693.82	$1693.82
REST OF PENNSYLVANIA (PA)	$1547.52	$1547.52
PUERTO RICO (PR)	$1606.45	$1606.45
RHODE ISLAND (RI)	$1607.67	$1607.67
SOUTH CAROLINA (SC)	$1524.46	$1524.46
SOUTH DAKOTA** (SD)	$1422.16	$1422.16
TENNESSEE (TN)	$1430.59	$1430.59
BRAZORIA (TX)	$1546.24	$1546.24
DALLAS (TX)	$1571.10	$1571.10
GALVESTON (TX)	$1560.48	$1560.48
HOUSTON (TX)	$1711.30	$1711.30
BEAUMONT (TX)	$1538.99	$1538.99
FORT WORTH (TX)	$1569.52	$1569.52
AUSTIN (TX)	$1605.06	$1605.06
REST OF TEXAS (TX)	$1551.93	$1551.93
UTAH (UT)	$1545.92	$1545.92
VIRGINIA (VA)	$1515.24	$1515.24
VIRGIN ISLANDS (VI)	$1606.45	$1606.45
VERMONT (VT)	$1463.80	$1463.80
SEATTLE (KING CNTY) (WA)	$1712.25	$1712.25
REST OF WASHINGTON (WA)	$1577.04	$1577.04
WISCONSIN (WI)	$1392.81	$1392.81
WEST VIRGINIA (WV)	$1656.02	$1656.02
WYOMING** (WY)	$1533.36	$1533.36

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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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished. These geographically adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which can cause the two amounts to diverge; for this code they currently align. The resulting figure represents the full Medicare-allowed amount before patient cost-sharing is applied.

RVUs — work 24.38, practice expense 15.43 (non-facility) / 15.43 (facility), malpractice 8.24 — × 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's annual deductible is met; the patient or secondary payer is responsible for the rest.
Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the final rate can differ meaningfully from the national average.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the amount shown differ from what my MAC actually paid?

Differences can arise from modifiers, the specific locality GPCI used, sequestration cuts, secondary payer adjustments, or mid-year budget-neutrality changes that aren't reflected in a generic estimate.

Why are the non-facility and facility amounts the same for this code?

When the practice-expense RVU is identical in both settings, as shown here, the calculated non-facility and facility amounts will match.

Does this amount include the patient's coinsurance?

No. The figure represents the total Medicare-allowed amount; Medicare generally pays 80% after the deductible, leaving the remainder as patient or secondary-payer responsibility.

Can I use this number to predict reimbursement in my specific locality?

Only as a starting point. The GPCI-adjusted locality rate on this page is closer to what you'd expect locally, but your MAC's published fee schedule is the authoritative source.

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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.