Medicare Reimbursement for CPT 22552
CPT 22552 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and adjusted for your locality, broken out by non-facility (office) and facility (hospital/ASC) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $353.05 | $353.05 |
| ALASKA* (AK) | $432.06 | $432.06 |
| ALABAMA (AL) | $313.71 | $313.71 |
| ARKANSAS (AR) | $309.00 | $309.00 |
| ARIZONA (AZ) | $340.74 | $340.74 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $362.00 | $362.00 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $365.49 | $365.49 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $345.48 | $345.48 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $351.18 | $351.18 |
| NAPA (CA) | $354.50 | $354.50 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $364.39 | $364.39 |
| VALLEJO (CA) | $351.07 | $351.07 |
| BAKERSFIELD (CA) | $336.48 | $336.48 |
| CHICO (CA) | $330.93 | $330.93 |
| FRESNO (CA) | $330.93 | $330.93 |
| HANFORD-CORCORAN (CA) | $330.93 | $330.93 |
| MADERA (CA) | $330.93 | $330.93 |
| MERCED (CA) | $330.93 | $330.93 |
| MODESTO (CA) | $330.93 | $330.93 |
| REDDING (CA) | $330.93 | $330.93 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $353.38 | $353.38 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $339.72 | $339.72 |
| SALINAS (CA) | $338.38 | $338.38 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $375.24 | $375.24 |
| SANTA CRUZ-WATSONVILLE (CA) | $340.24 | $340.24 |
| SANTA ROSA-PETALUMA (CA) | $343.08 | $343.08 |
| STOCKTON (CA) | $330.93 | $330.93 |
| VISALIA (CA) | $330.93 | $330.93 |
| YUBA CITY (CA) | $330.93 | $330.93 |
| EL CENTRO (CA) | $331.28 | $331.28 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $341.22 | $341.22 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $333.99 | $333.99 |
| SANTA MARIA-SANTA BARBARA (CA) | $338.24 | $338.24 |
| REST OF CALIFORNIA (CA) | $330.93 | $330.93 |
| COLORADO (CO) | $344.78 | $344.78 |
| CONNECTICUT (CT) | $377.49 | $377.49 |
| DC + MD/VA SUBURBS (DC) | $385.07 | $385.07 |
| DELAWARE (DE) | $346.17 | $346.17 |
| FORT LAUDERDALE (FL) | $410.65 | $410.65 |
| MIAMI (FL) | $463.21 | $463.21 |
| REST OF FLORIDA (FL) | $385.20 | $385.20 |
| ATLANTA (GA) | $368.92 | $368.92 |
| REST OF GEORGIA (GA) | $358.83 | $358.83 |
| HAWAII, GUAM (HI) | $333.26 | $333.26 |
| IOWA (IA) | $304.70 | $304.70 |
| IDAHO (ID) | $310.39 | $310.39 |
| EAST ST. LOUIS (IL) | $418.48 | $418.48 |
| SUBURBAN CHICAGO (IL) | $410.60 | $410.60 |
| CHICAGO (IL) | $445.72 | $445.72 |
| REST OF ILLINOIS (IL) | $386.35 | $386.35 |
| INDIANA (IN) | $311.80 | $311.80 |
| KANSAS (KS) | $311.43 | $311.43 |
| KENTUCKY (KY) | $339.19 | $339.19 |
| NEW ORLEANS (LA) | $358.39 | $358.39 |
| REST OF LOUISIANA (LA) | $341.92 | $341.92 |
| METROPOLITAN BOSTON (MA) | $367.82 | $367.82 |
| REST OF MASSACHUSETTS (MA) | $345.97 | $345.97 |
| BALTIMORE/SURR. CNTYS (MD) | $378.25 | $378.25 |
| REST OF MARYLAND (MD) | $350.27 | $350.27 |
| SOUTHERN MAINE (ME) | $326.52 | $326.52 |
| REST OF MAINE (ME) | $320.84 | $320.84 |
| DETROIT (MI) | $398.67 | $398.67 |
| REST OF MICHIGAN (MI) | $355.91 | $355.91 |
| MINNESOTA (MN) | $305.73 | $305.73 |
| METROPOLITAN ST. LOUIS (MO) | $349.77 | $349.77 |
| METROPOLITAN KANSAS CITY (MO) | $347.09 | $347.09 |
| REST OF MISSOURI (MO) | $341.41 | $341.41 |
| MISSISSIPPI (MS) | $324.85 | $324.85 |
| MONTANA** (MT) | $352.91 | $352.91 |
| NORTH CAROLINA (NC) | $322.96 | $322.96 |
| NORTH DAKOTA** (ND) | $311.38 | $311.38 |
| NEBRASKA (NE) | $303.94 | $303.94 |
| NEW HAMPSHIRE (NH) | $347.20 | $347.20 |
| NORTHERN NJ (NJ) | $382.54 | $382.54 |
| REST OF NEW JERSEY (NJ) | $374.87 | $374.87 |
| NEW MEXICO (NM) | $361.24 | $361.24 |
| NEVADA** (NV) | $341.40 | $341.40 |
| MANHATTAN (NY) | $419.23 | $419.23 |
| NYC SUBURBS/LONG ISLAND (NY) | $440.16 | $440.16 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $384.07 | $384.07 |
| QUEENS (NY) | $410.55 | $410.55 |
| REST OF NEW YORK (NY) | $328.66 | $328.66 |
| OHIO (OH) | $347.42 | $347.42 |
| OKLAHOMA (OK) | $329.79 | $329.79 |
| PORTLAND (OR) | $346.38 | $346.38 |
| REST OF OREGON (OR) | $331.93 | $331.93 |
| METROPOLITAN PHILADELPHIA (PA) | $373.31 | $373.31 |
| REST OF PENNSYLVANIA (PA) | $343.36 | $343.36 |
| PUERTO RICO (PR) | $352.78 | $352.78 |
| RHODE ISLAND (RI) | $351.84 | $351.84 |
| SOUTH CAROLINA (SC) | $337.12 | $337.12 |
| SOUTH DAKOTA** (SD) | $306.47 | $306.47 |
| TENNESSEE (TN) | $314.10 | $314.10 |
| BRAZORIA (TX) | $338.67 | $338.67 |
| DALLAS (TX) | $344.71 | $344.71 |
| GALVESTON (TX) | $342.18 | $342.18 |
| HOUSTON (TX) | $380.62 | $380.62 |
| BEAUMONT (TX) | $341.66 | $341.66 |
| FORT WORTH (TX) | $344.91 | $344.91 |
| AUSTIN (TX) | $349.60 | $349.60 |
| REST OF TEXAS (TX) | $342.62 | $342.62 |
| UTAH (UT) | $341.62 | $341.62 |
| VIRGINIA (VA) | $331.22 | $331.22 |
| VIRGIN ISLANDS (VI) | $352.78 | $352.78 |
| VERMONT (VT) | $317.69 | $317.69 |
| SEATTLE (KING CNTY) (WA) | $366.95 | $366.95 |
| REST OF WASHINGTON (WA) | $342.81 | $342.81 |
| WISCONSIN (WI) | $301.52 | $301.52 |
| WEST VIRGINIA (WV) | $373.96 | $373.96 |
| WYOMING** (WY) | $334.81 | $334.81 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 5 units per patient per day — Date of Service Edit: Clinical. 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) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is multiplied by a locality-specific Geographic Practice Cost Index (GPCI) to reflect regional cost differences, the adjusted RVUs are summed, and the total is multiplied by the annual national 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, which is why the two settings can show different allowed amounts.
RVUs — work 6.34, practice expense 2.13 (non-facility) / 2.13 (facility), malpractice 2.1 — × 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 Part B deductible; the patient or secondary payer is generally responsible for the remainder.
- Actual payment can vary due to modifiers, place-of-service rules, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
- Always confirm the specific allowed amount and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.
Frequently asked
Why does the facility amount differ from the non-facility amount for this code?
The two amounts use different practice-expense RVUs because overhead costs are allocated differently depending on whether the service is performed in a physician office versus a facility like a hospital or ambulatory surgical center.
Does this amount reflect what Medicare will actually pay?
No. It's an estimate based on standard PFS inputs. Final payment can be affected by the patient's specific locality, applicable modifiers, deductible status, and other claim-specific factors.
Why does the amount change from year to year?
The conversion factor, RVUs, and GPCIs are updated annually by CMS, which can raise or lower the calculated amount even if the code itself hasn't changed.
Where can I verify the exact amount for my location?
Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules, and the CMS Physician Fee Schedule Look-Up Tool can also be used to confirm current rates.
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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