Medicare Reimbursement for CPT 22612

CPT 22612 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated PFS allowed amount at the national level and, where available, adjusted for your locality, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1467.64	$1467.64
ALASKA* (AK)	$1782.68	$1782.68
ALABAMA (AL)	$1311.63	$1311.63
ARKANSAS (AR)	$1292.67	$1292.67
ARIZONA (AZ)	$1420.91	$1420.91
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1610.21	$1610.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1630.88	$1630.88
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1493.15	$1493.15
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1512.65	$1512.65
NAPA (CA)	$1559.86	$1559.86
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1617.73	$1617.73
VALLEJO (CA)	$1549.02	$1549.02
BAKERSFIELD (CA)	$1441.85	$1441.85
CHICO (CA)	$1424.17	$1424.17
FRESNO (CA)	$1424.17	$1424.17
HANFORD-CORCORAN (CA)	$1424.17	$1424.17
MADERA (CA)	$1424.17	$1424.17
MERCED (CA)	$1424.17	$1424.17
MODESTO (CA)	$1424.17	$1424.17
REDDING (CA)	$1424.17	$1424.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1495.03	$1495.03
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1470.91	$1470.91
SALINAS (CA)	$1465.16	$1465.16
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1661.62	$1661.62
SANTA CRUZ-WATSONVILLE (CA)	$1484.39	$1484.39
SANTA ROSA-PETALUMA (CA)	$1497.53	$1497.53
STOCKTON (CA)	$1424.17	$1424.17
VISALIA (CA)	$1424.17	$1424.17
YUBA CITY (CA)	$1424.17	$1424.17
EL CENTRO (CA)	$1425.28	$1425.28
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1483.49	$1483.49
SAN LUIS OBISPO-PASO ROBLES (CA)	$1444.83	$1444.83
SANTA MARIA-SANTA BARBARA (CA)	$1466.22	$1466.22
REST OF CALIFORNIA (CA)	$1424.17	$1424.17
COLORADO (CO)	$1459.15	$1459.15
CONNECTICUT (CT)	$1566.38	$1566.38
DC + MD/VA SUBURBS (DC)	$1619.49	$1619.49
DELAWARE (DE)	$1443.37	$1443.37
FORT LAUDERDALE (FL)	$1652.54	$1652.54
MIAMI (FL)	$1825.41	$1825.41
REST OF FLORIDA (FL)	$1557.72	$1557.72
ATLANTA (GA)	$1522.06	$1522.06
REST OF GEORGIA (GA)	$1458.22	$1458.22
HAWAII, GUAM (HI)	$1440.35	$1440.35
IOWA (IA)	$1293.48	$1293.48
IDAHO (ID)	$1312.68	$1312.68
EAST ST. LOUIS (IL)	$1653.42	$1653.42
SUBURBAN CHICAGO (IL)	$1656.67	$1656.67
CHICAGO (IL)	$1761.74	$1761.74
REST OF ILLINOIS (IL)	$1550.34	$1550.34
INDIANA (IN)	$1318.92	$1318.92
KANSAS (KS)	$1311.85	$1311.85
KENTUCKY (KY)	$1395.53	$1395.53
NEW ORLEANS (LA)	$1469.37	$1469.37
REST OF LOUISIANA (LA)	$1403.11	$1403.11
METROPOLITAN BOSTON (MA)	$1567.91	$1567.91
REST OF MASSACHUSETTS (MA)	$1460.47	$1460.47
BALTIMORE/SURR. CNTYS (MD)	$1567.36	$1567.36
REST OF MARYLAND (MD)	$1462.93	$1462.93
SOUTHERN MAINE (ME)	$1381.72	$1381.72
REST OF MAINE (ME)	$1345.63	$1345.63
DETROIT (MI)	$1602.51	$1602.51
REST OF MICHIGAN (MI)	$1454.37	$1454.37
MINNESOTA (MN)	$1325.90	$1325.90
METROPOLITAN ST. LOUIS (MO)	$1445.02	$1445.02
METROPOLITAN KANSAS CITY (MO)	$1433.25	$1433.25
REST OF MISSOURI (MO)	$1395.60	$1395.60
MISSISSIPPI (MS)	$1343.16	$1343.16
MONTANA** (MT)	$1467.19	$1467.19
NORTH CAROLINA (NC)	$1355.63	$1355.63
NORTH DAKOTA** (ND)	$1336.29	$1336.29
NEBRASKA (NE)	$1293.12	$1293.12
NEW HAMPSHIRE (NH)	$1459.69	$1459.69
NORTHERN NJ (NJ)	$1607.79	$1607.79
REST OF NEW JERSEY (NJ)	$1563.92	$1563.92
NEW MEXICO (NM)	$1472.21	$1472.21
NEVADA** (NV)	$1431.19	$1431.19
MANHATTAN (NY)	$1724.06	$1724.06
NYC SUBURBS/LONG ISLAND (NY)	$1796.95	$1796.95
POUGHKPSIE/N NYC SUBURBS (NY)	$1594.18	$1594.18
QUEENS (NY)	$1701.82	$1701.82
REST OF NEW YORK (NY)	$1377.95	$1377.95
OHIO (OH)	$1427.62	$1427.62
OKLAHOMA (OK)	$1366.93	$1366.93
PORTLAND (OR)	$1476.60	$1476.60
REST OF OREGON (OR)	$1400.04	$1400.04
METROPOLITAN PHILADELPHIA (PA)	$1543.79	$1543.79
REST OF PENNSYLVANIA (PA)	$1416.09	$1416.09
PUERTO RICO (PR)	$1469.60	$1469.60
RHODE ISLAND (RI)	$1474.16	$1474.16
SOUTH CAROLINA (SC)	$1397.97	$1397.97
SOUTH DAKOTA** (SD)	$1320.82	$1320.82
TENNESSEE (TN)	$1321.55	$1321.55
BRAZORIA (TX)	$1420.80	$1420.80
DALLAS (TX)	$1441.21	$1441.21
GALVESTON (TX)	$1432.37	$1432.37
HOUSTON (TX)	$1553.54	$1553.54
BEAUMONT (TX)	$1408.71	$1408.71
FORT WORTH (TX)	$1439.28	$1439.28
AUSTIN (TX)	$1471.82	$1471.82
REST OF TEXAS (TX)	$1421.69	$1421.69
UTAH (UT)	$1416.26	$1416.26
VIRGINIA (VA)	$1394.46	$1394.46
VIRGIN ISLANDS (VI)	$1469.60	$1469.60
VERMONT (VT)	$1353.60	$1353.60
SEATTLE (KING CNTY) (WA)	$1574.51	$1574.51
REST OF WASHINGTON (WA)	$1450.21	$1450.21
WISCONSIN (WI)	$1294.45	$1294.45
WEST VIRGINIA (WV)	$1500.02	$1500.02
WYOMING** (WY)	$1410.15	$1410.15

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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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the 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. Non-facility and facility rates can differ because the practice-expense RVU often changes depending on whether the service is performed in a physician's office versus a hospital or facility setting, reflecting different overhead assumptions. For this code, the practice-expense RVU is the same in both settings, so the computed non-facility and facility national amounts are equal; locality-adjusted amounts may still vary.

RVUs — work 22.94, practice expense 14.38 (non-facility) / 14.38 (facility), malpractice 6.62 — × 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 patient meets the annual Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, assistant-at-surgery rules, and other claim-specific factors can change the actual paid amount.
Annual conversion factor updates, legislative adjustments, and budget-neutrality changes can shift amounts year to year.
Sequestration and other federal payment adjustments may reduce the amount actually disbursed.
Always verify final payment policy and locality-specific rates with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The amounts can match when the practice-expense RVU used in the PFS formula is identical for both settings, meaning Medicare assumes similar overhead costs whether the service is performed in an office or a facility.

Does the amount shown include the patient's coinsurance?

No. The figure represents the total Medicare-approved amount before the standard 80/20 split; Medicare generally pays 80% after the deductible is met, with the patient or secondary insurance covering the rest.

Will my actual payment match the national amount shown?

Not necessarily. Actual payment depends on your specific locality's GPCIs, any applicable modifiers, sequestration, and other claim-level adjustments, so amounts can vary from the national figure.

Where do the RVU and GPCI values come from?

They are sourced from CMS's published Physician Fee Schedule files for the relevant year and are applied using CMS's standard formula to produce the estimated allowed amount shown on this page.

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.