Medicare Reimbursement for CPT 22630

CPT 22630 is a physician procedure code reported for professional services under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjustable by locality, and compares non-facility and facility payment settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1510.72	$1510.72
ALASKA* (AK)	$1786.60	$1786.60
ALABAMA (AL)	$1330.49	$1330.49
ARKANSAS (AR)	$1308.61	$1308.61
ARIZONA (AZ)	$1456.45	$1456.45
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1644.24	$1644.24
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1664.56	$1664.56
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1527.75	$1527.75
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1548.42	$1548.42
NAPA (CA)	$1594.48	$1594.48
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1653.19	$1653.19
VALLEJO (CA)	$1581.58	$1581.58
BAKERSFIELD (CA)	$1472.18	$1472.18
CHICO (CA)	$1451.52	$1451.52
FRESNO (CA)	$1451.52	$1451.52
HANFORD-CORCORAN (CA)	$1451.52	$1451.52
MADERA (CA)	$1451.52	$1451.52
MERCED (CA)	$1451.52	$1451.52
MODESTO (CA)	$1451.52	$1451.52
REDDING (CA)	$1451.52	$1451.52
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1535.68	$1535.68
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1500.57	$1500.57
SALINAS (CA)	$1494.86	$1494.86
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1701.14	$1701.14
SANTA CRUZ-WATSONVILLE (CA)	$1517.24	$1517.24
SANTA ROSA-PETALUMA (CA)	$1530.58	$1530.58
STOCKTON (CA)	$1451.52	$1451.52
VISALIA (CA)	$1451.52	$1451.52
YUBA CITY (CA)	$1451.52	$1451.52
EL CENTRO (CA)	$1452.84	$1452.84
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1515.26	$1515.26
SAN LUIS OBISPO-PASO ROBLES (CA)	$1474.23	$1474.23
SANTA MARIA-SANTA BARBARA (CA)	$1496.40	$1496.40
REST OF CALIFORNIA (CA)	$1451.52	$1451.52
COLORADO (CO)	$1495.51	$1495.51
CONNECTICUT (CT)	$1621.04	$1621.04
DC + MD/VA SUBURBS (DC)	$1673.31	$1673.31
DELAWARE (DE)	$1481.40	$1481.40
FORT LAUDERDALE (FL)	$1730.25	$1730.25
MIAMI (FL)	$1934.80	$1934.80
REST OF FLORIDA (FL)	$1619.88	$1619.88
ATLANTA (GA)	$1574.23	$1574.23
REST OF GEORGIA (GA)	$1504.23	$1504.23
HAWAII, GUAM (HI)	$1472.26	$1472.26
IOWA (IA)	$1307.13	$1307.13
IDAHO (ID)	$1329.77	$1329.77
EAST ST. LOUIS (IL)	$1735.36	$1735.36
SUBURBAN CHICAGO (IL)	$1733.21	$1733.21
CHICAGO (IL)	$1859.24	$1859.24
REST OF ILLINOIS (IL)	$1612.96	$1612.96
INDIANA (IN)	$1336.89	$1336.89
KANSAS (KS)	$1329.48	$1329.48
KENTUCKY (KY)	$1429.74	$1429.74
NEW ORLEANS (LA)	$1515.36	$1515.36
REST OF LOUISIANA (LA)	$1438.94	$1438.94
METROPOLITAN BOSTON (MA)	$1613.71	$1613.71
REST OF MASSACHUSETTS (MA)	$1496.79	$1496.79
BALTIMORE/SURR. CNTYS (MD)	$1623.16	$1623.16
REST OF MARYLAND (MD)	$1502.67	$1502.67
SOUTHERN MAINE (ME)	$1408.85	$1408.85
REST OF MAINE (ME)	$1368.99	$1368.99
DETROIT (MI)	$1672.79	$1672.79
REST OF MICHIGAN (MI)	$1498.73	$1498.73
MINNESOTA (MN)	$1340.74	$1340.74
METROPOLITAN ST. LOUIS (MO)	$1485.90	$1485.90
METROPOLITAN KANSAS CITY (MO)	$1472.46	$1472.46
REST OF MISSOURI (MO)	$1431.01	$1431.01
MISSISSIPPI (MS)	$1368.63	$1368.63
MONTANA** (MT)	$1510.20	$1510.20
NORTH CAROLINA (NC)	$1380.33	$1380.33
NORTH DAKOTA** (ND)	$1354.38	$1354.38
NEBRASKA (NE)	$1306.35	$1306.35
NEW HAMPSHIRE (NH)	$1499.47	$1499.47
NORTHERN NJ (NJ)	$1658.44	$1658.44
REST OF NEW JERSEY (NJ)	$1613.61	$1613.61
NEW MEXICO (NM)	$1519.80	$1519.80
NEVADA** (NV)	$1467.30	$1467.30
MANHATTAN (NY)	$1796.55	$1796.55
NYC SUBURBS/LONG ISLAND (NY)	$1882.13	$1882.13
POUGHKPSIE/N NYC SUBURBS (NY)	$1648.54	$1648.54
QUEENS (NY)	$1769.21	$1769.21
REST OF NEW YORK (NY)	$1406.15	$1406.15
OHIO (OH)	$1466.89	$1466.89
OKLAHOMA (OK)	$1395.53	$1395.53
PORTLAND (OR)	$1513.47	$1513.47
REST OF OREGON (OR)	$1430.44	$1430.44
METROPOLITAN PHILADELPHIA (PA)	$1596.12	$1596.12
REST OF PENNSYLVANIA (PA)	$1452.95	$1452.95
PUERTO RICO (PR)	$1512.58	$1512.58
RHODE ISLAND (RI)	$1513.39	$1513.39
SOUTH CAROLINA (SC)	$1431.11	$1431.11
SOUTH DAKOTA** (SD)	$1335.96	$1335.96
TENNESSEE (TN)	$1340.81	$1340.81
BRAZORIA (TX)	$1453.82	$1453.82
DALLAS (TX)	$1477.71	$1477.71
GALVESTON (TX)	$1467.51	$1467.51
HOUSTON (TX)	$1611.74	$1611.74
BEAUMONT (TX)	$1444.51	$1444.51
FORT WORTH (TX)	$1475.85	$1475.85
AUSTIN (TX)	$1512.78	$1512.78
REST OF TEXAS (TX)	$1458.26	$1458.26
UTAH (UT)	$1452.19	$1452.19
VIRGINIA (VA)	$1424.37	$1424.37
VIRGIN ISLANDS (VI)	$1512.58	$1512.58
VERMONT (VT)	$1375.42	$1375.42
SEATTLE (KING CNTY) (WA)	$1618.40	$1618.40
REST OF WASHINGTON (WA)	$1485.16	$1485.16
WISCONSIN (WI)	$1306.41	$1306.41
WEST VIRGINIA (WV)	$1554.98	$1554.98
WYOMING** (WY)	$1442.29	$1442.29

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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 — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Because practice-expense RVUs differ depending on whether the service is furnished in a non-facility (e.g., office) or facility (e.g., hospital) setting, the resulting payment can differ between those settings even for the same code.

RVUs — work 21.54, practice expense 15.81 (non-facility) / 15.81 (facility), malpractice 7.88 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment varies by locality GPCI values, applicable modifiers, multiple-procedure or bilateral payment rules, sequestration, and annual budget-neutrality adjustments.
Always confirm the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the amount differ between non-facility and facility settings?

Because the practice-expense RVU component reflects different overhead costs depending on whether the physician or the facility bears the cost of equipment, supplies, and staff.

Does this amount change by location?

Yes. The GPCI values for work, practice expense, and malpractice vary by Medicare locality, so the same code can have different allowed amounts in different areas.

Why isn't the CPT code description shown here?

CPT code descriptors are copyrighted by the American Medical Association and cannot be republished without a license, so only the code number and derived payment data are shown.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple-procedure reductions can increase or decrease the final paid amount from the base fee schedule rate.

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.