Medicare Reimbursement for CPT 22556

This page covers CPT code 22556, a procedure code defined by the American Medical Association. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount nationally and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1598.90	$1598.90
ALASKA* (AK)	$1920.33	$1920.33
ALABAMA (AL)	$1420.00	$1420.00
ARKANSAS (AR)	$1398.27	$1398.27
ARIZONA (AZ)	$1545.17	$1545.17
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1747.44	$1747.44
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1769.48	$1769.48
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1622.09	$1622.09
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1643.64	$1643.64
NAPA (CA)	$1693.66	$1693.66
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1756.20	$1756.20
VALLEJO (CA)	$1681.05	$1681.05
BAKERSFIELD (CA)	$1565.05	$1565.05
CHICO (CA)	$1544.64	$1544.64
FRESNO (CA)	$1544.64	$1544.64
HANFORD-CORCORAN (CA)	$1544.64	$1544.64
MADERA (CA)	$1544.64	$1544.64
MERCED (CA)	$1544.64	$1544.64
MODESTO (CA)	$1544.64	$1544.64
REDDING (CA)	$1544.64	$1544.64
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1627.08	$1627.08
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1595.91	$1595.91
SALINAS (CA)	$1589.74	$1589.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1805.28	$1805.28
SANTA CRUZ-WATSONVILLE (CA)	$1611.78	$1611.78
SANTA ROSA-PETALUMA (CA)	$1626.00	$1626.00
STOCKTON (CA)	$1544.64	$1544.64
VISALIA (CA)	$1544.64	$1544.64
YUBA CITY (CA)	$1544.64	$1544.64
EL CENTRO (CA)	$1545.93	$1545.93
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1610.35	$1610.35
SAN LUIS OBISPO-PASO ROBLES (CA)	$1567.74	$1567.74
SANTA MARIA-SANTA BARBARA (CA)	$1591.09	$1591.09
REST OF CALIFORNIA (CA)	$1544.64	$1544.64
COLORADO (CO)	$1586.53	$1586.53
CONNECTICUT (CT)	$1710.42	$1710.42
DC + MD/VA SUBURBS (DC)	$1767.03	$1767.03
DELAWARE (DE)	$1570.47	$1570.47
FORT LAUDERDALE (FL)	$1813.96	$1813.96
MIAMI (FL)	$2014.67	$2014.67
REST OF FLORIDA (FL)	$1704.80	$1704.80
ATLANTA (GA)	$1661.67	$1661.67
REST OF GEORGIA (GA)	$1590.34	$1590.34
HAWAII, GUAM (HI)	$1564.07	$1564.07
IOWA (IA)	$1397.96	$1397.96
IDAHO (ID)	$1420.22	$1420.22
EAST ST. LOUIS (IL)	$1817.06	$1817.06
SUBURBAN CHICAGO (IL)	$1817.84	$1817.84
CHICAGO (IL)	$1940.71	$1940.71
REST OF ILLINOIS (IL)	$1697.16	$1697.16
INDIANA (IN)	$1427.33	$1427.33
KANSAS (KS)	$1419.61	$1419.61
KENTUCKY (KY)	$1517.40	$1517.40
NEW ORLEANS (LA)	$1602.24	$1602.24
REST OF LOUISIANA (LA)	$1526.32	$1526.32
METROPOLITAN BOSTON (MA)	$1707.74	$1707.74
REST OF MASSACHUSETTS (MA)	$1587.96	$1587.96
BALTIMORE/SURR. CNTYS (MD)	$1712.01	$1712.01
REST OF MARYLAND (MD)	$1592.27	$1592.27
SOUTHERN MAINE (ME)	$1499.04	$1499.04
REST OF MAINE (ME)	$1458.59	$1458.59
DETROIT (MI)	$1756.76	$1756.76
REST OF MICHIGAN (MI)	$1585.39	$1585.39
MINNESOTA (MN)	$1433.18	$1433.18
METROPOLITAN ST. LOUIS (MO)	$1573.64	$1573.64
METROPOLITAN KANSAS CITY (MO)	$1560.22	$1560.22
REST OF MISSOURI (MO)	$1518.09	$1518.09
MISSISSIPPI (MS)	$1457.03	$1457.03
MONTANA** (MT)	$1598.39	$1598.39
NORTH CAROLINA (NC)	$1469.95	$1469.95
NORTH DAKOTA** (ND)	$1445.93	$1445.93
NEBRASKA (NE)	$1397.37	$1397.37
NEW HAMPSHIRE (NH)	$1588.73	$1588.73
NORTHERN NJ (NJ)	$1753.02	$1753.02
REST OF NEW JERSEY (NJ)	$1705.46	$1705.46
NEW MEXICO (NM)	$1606.08	$1606.08
NEVADA** (NV)	$1556.43	$1556.43
MANHATTAN (NY)	$1888.29	$1888.29
NYC SUBURBS/LONG ISLAND (NY)	$1972.58	$1972.58
POUGHKPSIE/N NYC SUBURBS (NY)	$1740.20	$1740.20
QUEENS (NY)	$1861.95	$1861.95
REST OF NEW YORK (NY)	$1495.56	$1495.56
OHIO (OH)	$1554.23	$1554.23
OKLAHOMA (OK)	$1484.01	$1484.01
PORTLAND (OR)	$1605.46	$1605.46
REST OF OREGON (OR)	$1520.27	$1520.27
METROPOLITAN PHILADELPHIA (PA)	$1685.10	$1685.10
REST OF PENNSYLVANIA (PA)	$1540.70	$1540.70
PUERTO RICO (PR)	$1600.95	$1600.95
RHODE ISLAND (RI)	$1604.09	$1604.09
SOUTH CAROLINA (SC)	$1519.45	$1519.45
SOUTH DAKOTA** (SD)	$1427.91	$1427.91
TENNESSEE (TN)	$1430.79	$1430.79
BRAZORIA (TX)	$1543.85	$1543.85
DALLAS (TX)	$1567.42	$1567.42
GALVESTON (TX)	$1557.28	$1557.28
HOUSTON (TX)	$1698.40	$1698.40
BEAUMONT (TX)	$1532.28	$1532.28
FORT WORTH (TX)	$1565.40	$1565.40
AUSTIN (TX)	$1602.30	$1602.30
REST OF TEXAS (TX)	$1546.53	$1546.53
UTAH (UT)	$1540.41	$1540.41
VIRGINIA (VA)	$1514.06	$1514.06
VIRGIN ISLANDS (VI)	$1600.95	$1600.95
VERMONT (VT)	$1466.31	$1466.31
SEATTLE (KING CNTY) (WA)	$1713.91	$1713.91
REST OF WASHINGTON (WA)	$1576.27	$1576.27
WISCONSIN (WI)	$1398.14	$1398.14
WEST VIRGINIA (WV)	$1639.53	$1639.53
WYOMING** (WY)	$1531.95	$1531.95

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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

The Medicare PFS amount is built from three Relative Value Units (RVUs) assigned to a 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 regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility rates can differ because the practice-expense RVU is typically higher in non-facility (e.g., office) settings, where the provider bears more overhead costs, versus facility settings where a hospital or ASC absorbs part of that overhead. For this code, work and malpractice RVUs stay constant across settings, while practice-expense RVU is the component most likely to vary.

RVUs — work 24.08, practice expense 16.08 (non-facility) / 16.08 (facility), malpractice 7.71 — × 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 approved amount after the annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary based on locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

Facility and non-facility rates can differ because the practice-expense RVU component accounts for overhead costs, which are allocated differently depending on where the service is performed.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-approved amount before the standard 80/20 cost-sharing split and before any modifier, sequestration, or locality-specific adjustments are applied.

Why do locality-specific amounts differ from the national amount?

Locality amounts apply Geographic Practice Cost Indices (GPCIs) to adjust for regional differences in wages and operating costs, which can raise or lower the amount relative to the national average.

Will this fee schedule amount change next year?

Yes, CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can shift the final allowed amount even if RVUs stay the same.

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.