Medicare Reimbursement for CPT 22802

CPT 22802 is a procedure code reported to Medicare for physician and outpatient billing purposes. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both at the national level and adjusted by locality, with non-facility and facility rates shown separately.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1936.25	$1936.25
ALASKA* (AK)	$2365.94	$2365.94
ALABAMA (AL)	$1734.12	$1734.12
ARKANSAS (AR)	$1709.58	$1709.58
ARIZONA (AZ)	$1875.43	$1875.43
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2111.17	$2111.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2137.72	$2137.72
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1963.29	$1963.29
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1989.53	$1989.53
NAPA (CA)	$2047.22	$2047.22
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2121.17	$2121.17
VALLEJO (CA)	$2032.82	$2032.82
BAKERSFIELD (CA)	$1898.46	$1898.46
CHICO (CA)	$1874.91	$1874.91
FRESNO (CA)	$1874.91	$1874.91
HANFORD-CORCORAN (CA)	$1874.91	$1874.91
MADERA (CA)	$1874.91	$1874.91
MERCED (CA)	$1874.91	$1874.91
MODESTO (CA)	$1874.91	$1874.91
REDDING (CA)	$1874.91	$1874.91
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1969.13	$1969.13
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1934.75	$1934.75
SALINAS (CA)	$1927.14	$1927.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2178.57	$2178.57
SANTA CRUZ-WATSONVILLE (CA)	$1950.09	$1950.09
SANTA ROSA-PETALUMA (CA)	$1967.25	$1967.25
STOCKTON (CA)	$1874.91	$1874.91
VISALIA (CA)	$1874.91	$1874.91
YUBA CITY (CA)	$1874.91	$1874.91
EL CENTRO (CA)	$1876.38	$1876.38
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1949.93	$1949.93
SAN LUIS OBISPO-PASO ROBLES (CA)	$1900.56	$1900.56
SANTA MARIA-SANTA BARBARA (CA)	$1928.18	$1928.18
REST OF CALIFORNIA (CA)	$1874.91	$1874.91
COLORADO (CO)	$1922.61	$1922.61
CONNECTICUT (CT)	$2064.82	$2064.82
DC + MD/VA SUBURBS (DC)	$2132.12	$2132.12
DELAWARE (DE)	$1904.63	$1904.63
FORT LAUDERDALE (FL)	$2181.50	$2181.50
MIAMI (FL)	$2410.12	$2410.12
REST OF FLORIDA (FL)	$2057.85	$2057.85
ATLANTA (GA)	$2008.01	$2008.01
REST OF GEORGIA (GA)	$1928.26	$1928.26
HAWAII, GUAM (HI)	$1894.23	$1894.23
IOWA (IA)	$1708.31	$1708.31
IDAHO (ID)	$1733.63	$1733.63
EAST ST. LOUIS (IL)	$2186.57	$2186.57
SUBURBAN CHICAGO (IL)	$2186.59	$2186.59
CHICAGO (IL)	$2327.19	$2327.19
REST OF ILLINOIS (IL)	$2049.83	$2049.83
INDIANA (IN)	$1741.62	$1741.62
KANSAS (KS)	$1733.19	$1733.19
KENTUCKY (KY)	$1845.05	$1845.05
NEW ORLEANS (LA)	$1941.03	$1941.03
REST OF LOUISIANA (LA)	$1855.30	$1855.30
METROPOLITAN BOSTON (MA)	$2062.52	$2062.52
REST OF MASSACHUSETTS (MA)	$1924.93	$1924.93
BALTIMORE/SURR. CNTYS (MD)	$2066.19	$2066.19
REST OF MARYLAND (MD)	$1929.76	$1929.76
SOUTHERN MAINE (ME)	$1822.42	$1822.42
REST OF MAINE (ME)	$1777.42	$1777.42
DETROIT (MI)	$2117.01	$2117.01
REST OF MICHIGAN (MI)	$1922.27	$1922.27
MINNESOTA (MN)	$1746.62	$1746.62
METROPOLITAN ST. LOUIS (MO)	$1908.20	$1908.20
METROPOLITAN KANSAS CITY (MO)	$1893.10	$1893.10
REST OF MISSOURI (MO)	$1846.29	$1846.29
MISSISSIPPI (MS)	$1776.62	$1776.62
MONTANA** (MT)	$1935.66	$1935.66
NORTH CAROLINA (NC)	$1790.17	$1790.17
NORTH DAKOTA** (ND)	$1761.66	$1761.66
NEBRASKA (NE)	$1707.49	$1707.49
NEW HAMPSHIRE (NH)	$1923.97	$1923.97
NORTHERN NJ (NJ)	$2117.57	$2117.57
REST OF NEW JERSEY (NJ)	$2061.47	$2061.47
NEW MEXICO (NM)	$1945.82	$1945.82
NEVADA** (NV)	$1887.76	$1887.76
MANHATTAN (NY)	$2272.06	$2272.06
NYC SUBURBS/LONG ISLAND (NY)	$2367.82	$2367.82
POUGHKPSIE/N NYC SUBURBS (NY)	$2101.71	$2101.71
QUEENS (NY)	$2241.67	$2241.67
REST OF NEW YORK (NY)	$1819.13	$1819.13
OHIO (OH)	$1886.70	$1886.70
OKLAHOMA (OK)	$1806.87	$1806.87
PORTLAND (OR)	$1943.95	$1943.95
REST OF OREGON (OR)	$1846.57	$1846.57
METROPOLITAN PHILADELPHIA (PA)	$2036.26	$2036.26
REST OF PENNSYLVANIA (PA)	$1871.17	$1871.17
PUERTO RICO (PR)	$1938.40	$1938.40
RHODE ISLAND (RI)	$1944.06	$1944.06
SOUTH CAROLINA (SC)	$1846.82	$1846.82
SOUTH DAKOTA** (SD)	$1741.08	$1741.08
TENNESSEE (TN)	$1745.88	$1745.88
BRAZORIA (TX)	$1874.58	$1874.58
DALLAS (TX)	$1901.54	$1901.54
GALVESTON (TX)	$1889.89	$1889.89
HOUSTON (TX)	$2050.96	$2050.96
BEAUMONT (TX)	$1861.69	$1861.69
FORT WORTH (TX)	$1899.39	$1899.39
AUSTIN (TX)	$1939.43	$1939.43
REST OF TEXAS (TX)	$1877.32	$1877.32
UTAH (UT)	$1870.48	$1870.48
VIRGINIA (VA)	$1839.69	$1839.69
VIRGIN ISLANDS (VI)	$1938.40	$1938.40
VERMONT (VT)	$1785.08	$1785.08
SEATTLE (KING CNTY) (WA)	$2070.17	$2070.17
REST OF WASHINGTON (WA)	$1911.21	$1911.21
WISCONSIN (WI)	$1707.80	$1707.80
WEST VIRGINIA (WV)	$1984.79	$1984.79
WYOMING** (WY)	$1859.83	$1859.83

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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 regional differences in cost of living and practice costs. The adjusted RVUs are summed and multiplied by the annual national Conversion Factor to produce a dollar amount. Practice-expense RVUs (and therefore the total allowed amount) can differ between non-facility settings (e.g., office) and facility settings (e.g., hospital), since overhead costs differ between the two.

RVUs — work 31.31, practice expense 17.86 (non-facility) / 17.86 (facility), malpractice 8.8 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on the national Medicare Physician Fee Schedule; actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-adjusted amounts vary by Medicare Administrative Contractor (MAC) jurisdiction — verify current rates with your local MAC before billing or appealing a denial.

Frequently asked

Why does the allowed amount for CPT 22802 differ by locality?

The RVUs for this code are adjusted using Geographic Practice Cost Indices (GPCIs), which account for regional variation in physician work, practice expense, and malpractice costs. Two localities can have different final amounts even though the underlying RVUs are the same.

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

When the practice-expense RVU is identical for both settings, as shown in the inputs here, the non-facility and facility allowed amounts calculate to the same total. This can happen for procedures where Medicare does not differentiate overhead costs between settings.

Is this the amount Medicare will actually pay?

No. This is an estimated allowed amount under the national Physician Fee Schedule formula. Actual Medicare payment is typically 80% of the allowed amount after the deductible, and can be further affected by modifiers, sequestration, and annual adjustments.

Where can I confirm the exact rate for my locality?

Your Medicare Administrative Contractor (MAC) publishes the finalized, locality-specific fee schedule each year, which should be used to confirm exact reimbursement before billing or during a claims dispute.

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.