Medicare Reimbursement for CPT 22554
CPT 22554 is a procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and, where available, adjusted for local cost differences, broken out by non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $1216.13 | $1216.13 |
| ALASKA* (AK) | $1446.06 | $1446.06 |
| ALABAMA (AL) | $1076.17 | $1076.17 |
| ARKANSAS (AR) | $1059.14 | $1059.14 |
| ARIZONA (AZ) | $1174.36 | $1174.36 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1342.10 | $1342.10 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1359.58 | $1359.58 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1240.25 | $1240.25 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1256.15 | $1256.15 |
| NAPA (CA) | $1298.74 | $1298.74 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1348.70 | $1348.70 |
| VALLEJO (CA) | $1289.24 | $1289.24 |
| BAKERSFIELD (CA) | $1194.00 | $1194.00 |
| CHICO (CA) | $1178.68 | $1178.68 |
| FRESNO (CA) | $1178.68 | $1178.68 |
| HANFORD-CORCORAN (CA) | $1178.68 | $1178.68 |
| MADERA (CA) | $1178.68 | $1178.68 |
| MERCED (CA) | $1178.68 | $1178.68 |
| MODESTO (CA) | $1178.68 | $1178.68 |
| REDDING (CA) | $1178.68 | $1178.68 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $1240.78 | $1240.78 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1219.51 | $1219.51 |
| SALINAS (CA) | $1214.84 | $1214.84 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1386.55 | $1386.55 |
| SANTA CRUZ-WATSONVILLE (CA) | $1234.05 | $1234.05 |
| SANTA ROSA-PETALUMA (CA) | $1245.03 | $1245.03 |
| STOCKTON (CA) | $1178.68 | $1178.68 |
| VISALIA (CA) | $1178.68 | $1178.68 |
| YUBA CITY (CA) | $1178.68 | $1178.68 |
| EL CENTRO (CA) | $1179.65 | $1179.65 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1231.93 | $1231.93 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $1197.86 | $1197.86 |
| SANTA MARIA-SANTA BARBARA (CA) | $1216.24 | $1216.24 |
| REST OF CALIFORNIA (CA) | $1178.68 | $1178.68 |
| COLORADO (CO) | $1209.08 | $1209.08 |
| CONNECTICUT (CT) | $1302.74 | $1302.74 |
| DC + MD/VA SUBURBS (DC) | $1348.54 | $1348.54 |
| DELAWARE (DE) | $1194.06 | $1194.06 |
| FORT LAUDERDALE (FL) | $1378.72 | $1378.72 |
| MIAMI (FL) | $1531.13 | $1531.13 |
| REST OF FLORIDA (FL) | $1294.12 | $1294.12 |
| ATLANTA (GA) | $1264.00 | $1264.00 |
| REST OF GEORGIA (GA) | $1205.23 | $1205.23 |
| HAWAII, GUAM (HI) | $1195.52 | $1195.52 |
| IOWA (IA) | $1061.21 | $1061.21 |
| IDAHO (ID) | $1078.19 | $1078.19 |
| EAST ST. LOUIS (IL) | $1377.23 | $1377.23 |
| SUBURBAN CHICAGO (IL) | $1382.01 | $1382.01 |
| CHICAGO (IL) | $1473.70 | $1473.70 |
| REST OF ILLINOIS (IL) | $1286.59 | $1286.59 |
| INDIANA (IN) | $1083.83 | $1083.83 |
| KANSAS (KS) | $1077.07 | $1077.07 |
| KENTUCKY (KY) | $1150.14 | $1150.14 |
| NEW ORLEANS (LA) | $1216.21 | $1216.21 |
| REST OF LOUISIANA (LA) | $1156.70 | $1156.70 |
| METROPOLITAN BOSTON (MA) | $1304.91 | $1304.91 |
| REST OF MASSACHUSETTS (MA) | $1209.58 | $1209.58 |
| BALTIMORE/SURR. CNTYS (MD) | $1303.89 | $1303.89 |
| REST OF MARYLAND (MD) | $1211.33 | $1211.33 |
| SOUTHERN MAINE (ME) | $1140.51 | $1140.51 |
| REST OF MAINE (ME) | $1107.10 | $1107.10 |
| DETROIT (MI) | $1333.64 | $1333.64 |
| REST OF MICHIGAN (MI) | $1202.37 | $1202.37 |
| MINNESOTA (MN) | $1092.44 | $1092.44 |
| METROPOLITAN ST. LOUIS (MO) | $1195.11 | $1195.11 |
| METROPOLITAN KANSAS CITY (MO) | $1184.46 | $1184.46 |
| REST OF MISSOURI (MO) | $1149.55 | $1149.55 |
| MISSISSIPPI (MS) | $1103.50 | $1103.50 |
| MONTANA** (MT) | $1215.74 | $1215.74 |
| NORTH CAROLINA (NC) | $1116.20 | $1116.20 |
| NORTH DAKOTA** (ND) | $1100.86 | $1100.86 |
| NEBRASKA (NE) | $1061.09 | $1061.09 |
| NEW HAMPSHIRE (NH) | $1210.15 | $1210.15 |
| NORTHERN NJ (NJ) | $1336.97 | $1336.97 |
| REST OF NEW JERSEY (NJ) | $1299.02 | $1299.02 |
| NEW MEXICO (NM) | $1218.12 | $1218.12 |
| NEVADA** (NV) | $1184.16 | $1184.16 |
| MANHATTAN (NY) | $1438.96 | $1438.96 |
| NYC SUBURBS/LONG ISLAND (NY) | $1503.59 | $1503.59 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1325.17 | $1325.17 |
| QUEENS (NY) | $1419.93 | $1419.93 |
| REST OF NEW YORK (NY) | $1136.20 | $1136.20 |
| OHIO (OH) | $1178.89 | $1178.89 |
| OKLAHOMA (OK) | $1125.14 | $1125.14 |
| PORTLAND (OR) | $1225.16 | $1225.16 |
| REST OF OREGON (OR) | $1156.71 | $1156.71 |
| METROPOLITAN PHILADELPHIA (PA) | $1282.23 | $1282.23 |
| REST OF PENNSYLVANIA (PA) | $1168.89 | $1168.89 |
| PUERTO RICO (PR) | $1218.12 | $1218.12 |
| RHODE ISLAND (RI) | $1220.83 | $1220.83 |
| SOUTH CAROLINA (SC) | $1153.13 | $1153.13 |
| SOUTH DAKOTA** (SD) | $1087.27 | $1087.27 |
| TENNESSEE (TN) | $1085.70 | $1085.70 |
| BRAZORIA (TX) | $1174.03 | $1174.03 |
| DALLAS (TX) | $1191.97 | $1191.97 |
| GALVESTON (TX) | $1184.24 | $1184.24 |
| HOUSTON (TX) | $1290.58 | $1290.58 |
| BEAUMONT (TX) | $1162.22 | $1162.22 |
| FORT WORTH (TX) | $1190.04 | $1190.04 |
| AUSTIN (TX) | $1221.02 | $1221.02 |
| REST OF TEXAS (TX) | $1174.56 | $1174.56 |
| UTAH (UT) | $1169.58 | $1169.58 |
| VIRGINIA (VA) | $1151.49 | $1151.49 |
| VIRGIN ISLANDS (VI) | $1218.12 | $1218.12 |
| VERMONT (VT) | $1115.80 | $1115.80 |
| SEATTLE (KING CNTY) (WA) | $1310.64 | $1310.64 |
| REST OF WASHINGTON (WA) | $1200.87 | $1200.87 |
| WISCONSIN (WI) | $1063.11 | $1063.11 |
| WEST VIRGINIA (WV) | $1241.35 | $1241.35 |
| WYOMING** (WY) | $1165.67 | $1165.67 |
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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) that reflect local cost-of-living and practice-cost differences. These adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar figure set by CMS) to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs, since overhead costs differ when a facility bears some of the expense. The resulting total represents the full Medicare-allowed amount before patient cost-sharing is applied.
RVUs — work 17.25, practice expense 13.35 (non-facility) / 13.35 (facility), malpractice 5.81 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only, based on national RVUs and the current conversion factor — actual payment depends on your specific locality's GPCIs.
- Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary insurer is responsible for the remainder.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
- Always verify the exact allowed amount and any applicable adjustments with your local Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The two settings often use different practice-expense RVUs because overhead costs (equipment, staff, supplies) are allocated differently depending on whether the service is performed in a physician's office versus a hospital or ambulatory surgical center.
Does this amount reflect what Medicare will actually pay?
No. It reflects the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible is met, and local adjustments, modifiers, and policy changes can further affect the final payment.
Why might my MAC's payment differ from this estimate?
Payments are adjusted using locality-specific GPCIs, which vary by region, and may also reflect sequestration, claim-specific modifiers, or mid-year/annual rule changes not reflected in a static estimate.
Can this figure be used to predict a denial or underpayment?
No. This page provides a general fee estimate for reference only; it does not account for coverage determinations, medical necessity edits, or payer-specific billing rules that can lead to a denial.
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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