Medicare Reimbursement for CPT 22804

CPT 22804 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjustable by locality, and compares non-facility versus facility payment settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2222.50	$2222.50
ALASKA* (AK)	$2720.29	$2720.29
ALABAMA (AL)	$1990.40	$1990.40
ARKANSAS (AR)	$1962.27	$1962.27
ARIZONA (AZ)	$2152.35	$2152.35
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2408.22	$2408.22
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2437.82	$2437.82
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2245.50	$2245.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2276.22	$2276.22
NAPA (CA)	$2337.57	$2337.57
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2419.98	$2419.98
VALLEJO (CA)	$2320.62	$2320.62
BAKERSFIELD (CA)	$2173.31	$2173.31
CHICO (CA)	$2145.61	$2145.61
FRESNO (CA)	$2145.61	$2145.61
HANFORD-CORCORAN (CA)	$2145.61	$2145.61
MADERA (CA)	$2145.61	$2145.61
MERCED (CA)	$2145.61	$2145.61
MODESTO (CA)	$2145.61	$2145.61
REDDING (CA)	$2145.61	$2145.61
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2256.52	$2256.52
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2212.72	$2212.72
SALINAS (CA)	$2203.99	$2203.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2485.92	$2485.92
SANTA CRUZ-WATSONVILLE (CA)	$2228.48	$2228.48
SANTA ROSA-PETALUMA (CA)	$2247.98	$2247.98
STOCKTON (CA)	$2145.61	$2145.61
VISALIA (CA)	$2145.61	$2145.61
YUBA CITY (CA)	$2145.61	$2145.61
EL CENTRO (CA)	$2147.34	$2147.34
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2229.09	$2229.09
SAN LUIS OBISPO-PASO ROBLES (CA)	$2173.79	$2173.79
SANTA MARIA-SANTA BARBARA (CA)	$2204.91	$2204.91
REST OF CALIFORNIA (CA)	$2145.61	$2145.61
COLORADO (CO)	$2203.31	$2203.31
CONNECTICUT (CT)	$2370.05	$2370.05
DC + MD/VA SUBURBS (DC)	$2444.19	$2444.19
DELAWARE (DE)	$2185.79	$2185.79
FORT LAUDERDALE (FL)	$2510.61	$2510.61
MIAMI (FL)	$2778.45	$2778.45
REST OF FLORIDA (FL)	$2367.72	$2367.72
ATLANTA (GA)	$2306.20	$2306.20
REST OF GEORGIA (GA)	$2218.16	$2218.16
HAWAII, GUAM (HI)	$2166.60	$2166.60
IOWA (IA)	$1958.14	$1958.14
IDAHO (ID)	$1987.71	$1987.71
EAST ST. LOUIS (IL)	$2520.95	$2520.95
SUBURBAN CHICAGO (IL)	$2515.88	$2515.88
CHICAGO (IL)	$2682.43	$2682.43
REST OF ILLINOIS (IL)	$2360.30	$2360.30
INDIANA (IN)	$1996.80	$1996.80
KANSAS (KS)	$1987.95	$1987.95
KENTUCKY (KY)	$2120.34	$2120.34
NEW ORLEANS (LA)	$2230.89	$2230.89
REST OF LOUISIANA (LA)	$2132.60	$2132.60
METROPOLITAN BOSTON (MA)	$2361.63	$2361.63
REST OF MASSACHUSETTS (MA)	$2206.52	$2206.52
BALTIMORE/SURR. CNTYS (MD)	$2371.88	$2371.88
REST OF MARYLAND (MD)	$2214.20	$2214.20
SOUTHERN MAINE (ME)	$2088.91	$2088.91
REST OF MAINE (ME)	$2039.27	$2039.27
DETROIT (MI)	$2436.94	$2436.94
REST OF MICHIGAN (MI)	$2210.12	$2210.12
MINNESOTA (MN)	$1997.89	$1997.89
METROPOLITAN ST. LOUIS (MO)	$2191.73	$2191.73
METROPOLITAN KANSAS CITY (MO)	$2174.56	$2174.56
REST OF MISSOURI (MO)	$2123.06	$2123.06
MISSISSIPPI (MS)	$2041.09	$2041.09
MONTANA** (MT)	$2221.80	$2221.80
NORTH CAROLINA (NC)	$2053.67	$2053.67
NORTH DAKOTA** (ND)	$2016.95	$2016.95
NEBRASKA (NE)	$1956.80	$1956.80
NEW HAMPSHIRE (NH)	$2206.11	$2206.11
NORTHERN NJ (NJ)	$2427.81	$2427.81
REST OF NEW JERSEY (NJ)	$2365.20	$2365.20
NEW MEXICO (NM)	$2237.66	$2237.66
NEVADA** (NV)	$2165.36	$2165.36
MANHATTAN (NY)	$2609.59	$2609.59
NYC SUBURBS/LONG ISLAND (NY)	$2721.06	$2721.06
POUGHKPSIE/N NYC SUBURBS (NY)	$2412.37	$2412.37
QUEENS (NY)	$2572.86	$2572.86
REST OF NEW YORK (NY)	$2086.96	$2086.96
OHIO (OH)	$2168.25	$2168.25
OKLAHOMA (OK)	$2075.21	$2075.21
PORTLAND (OR)	$2226.19	$2226.19
REST OF OREGON (OR)	$2117.10	$2117.10
METROPOLITAN PHILADELPHIA (PA)	$2338.13	$2338.13
REST OF PENNSYLVANIA (PA)	$2149.73	$2149.73
PUERTO RICO (PR)	$2224.51	$2224.51
RHODE ISLAND (RI)	$2229.95	$2229.95
SOUTH CAROLINA (SC)	$2120.79	$2120.79
SOUTH DAKOTA** (SD)	$1992.73	$1992.73
TENNESSEE (TN)	$2002.65	$2002.65
BRAZORIA (TX)	$2150.24	$2150.24
DALLAS (TX)	$2181.73	$2181.73
GALVESTON (TX)	$2168.16	$2168.16
HOUSTON (TX)	$2357.79	$2357.79
BEAUMONT (TX)	$2138.95	$2138.95
FORT WORTH (TX)	$2179.67	$2179.67
AUSTIN (TX)	$2223.50	$2223.50
REST OF TEXAS (TX)	$2155.51	$2155.51
UTAH (UT)	$2147.88	$2147.88
VIRGINIA (VA)	$2109.62	$2109.62
VIRGIN ISLANDS (VI)	$2224.51	$2224.51
VERMONT (VT)	$2045.00	$2045.00
SEATTLE (KING CNTY) (WA)	$2368.99	$2368.99
REST OF WASHINGTON (WA)	$2190.40	$2190.40
WISCONSIN (WI)	$1955.52	$1955.52
WEST VIRGINIA (WV)	$2285.79	$2285.79
WYOMING** (WY)	$2132.53	$2132.53

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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 (PE), and malpractice (MP) — 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 performed in a non-facility (e.g., office) or facility (e.g., hospital) setting, the resulting allowed amount can differ between these two settings.

RVUs — work 36.56, practice expense 19.62 (non-facility) / 19.62 (facility), malpractice 10.36 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount 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 payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final payment.
Locality-specific GPCIs and conversion factor updates can shift this amount year to year.
Always verify the current, locality-specific rate with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

The practice expense RVU component accounts for overhead costs, which differ depending on whether the physician's practice bears those costs (non-facility) or whether a hospital/ASC does (facility). This can make the non-facility and facility allowed amounts different, even though the work and malpractice RVUs stay the same.

Does this page reflect what my practice will actually be paid?

No. This is a national or locality-adjusted estimate based on standard PFS inputs. Your actual payment depends on your specific locality GPCIs, any applicable modifiers, secondary payer coordination, and MAC-specific adjustments.

Why might the amount I see on a remittance advice not match this figure?

Differences can arise from sequestration reductions, multiple-procedure payment adjustments, modifier-driven changes, incorrect place-of-service coding, or mid-year/annual updates to RVUs, GPCIs, or the conversion factor.

Where can I confirm the official rate for my area?

Contact your Medicare Administrative Contractor (MAC) or consult the CMS Physician Fee Schedule Look-Up Tool for the most current, locality-specific rate.

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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.