Medicare Reimbursement for CPT 22812

This page covers CPT code 22812, a surgical procedure code, and shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount, both nationally and adjusted for your locality. Amounts are shown separately for non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1970.99	$1970.99
ALASKA* (AK)	$2462.00	$2462.00
ALABAMA (AL)	$1790.54	$1790.54
ARKANSAS (AR)	$1768.52	$1768.52
ARIZONA (AZ)	$1917.59	$1917.59
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2193.54	$2193.54
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2223.38	$2223.38
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2025.02	$2025.02
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2049.89	$2049.89
NAPA (CA)	$2120.74	$2120.74
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2201.62	$2201.62
VALLEJO (CA)	$2109.09	$2109.09
BAKERSFIELD (CA)	$1958.51	$1958.51
CHICO (CA)	$1938.92	$1938.92
FRESNO (CA)	$1938.92	$1938.92
HANFORD-CORCORAN (CA)	$1938.92	$1938.92
MADERA (CA)	$1938.92	$1938.92
MERCED (CA)	$1938.92	$1938.92
MODESTO (CA)	$1938.92	$1938.92
REDDING (CA)	$1938.92	$1938.92
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2015.42	$2015.42
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2001.51	$2001.51
SALINAS (CA)	$1993.46	$1993.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2256.44	$2256.44
SANTA CRUZ-WATSONVILLE (CA)	$2016.91	$2016.91
SANTA ROSA-PETALUMA (CA)	$2034.98	$2034.98
STOCKTON (CA)	$1938.92	$1938.92
VISALIA (CA)	$1938.92	$1938.92
YUBA CITY (CA)	$1938.92	$1938.92
EL CENTRO (CA)	$1940.11	$1940.11
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2016.64	$2016.64
SAN LUIS OBISPO-PASO ROBLES (CA)	$1965.49	$1965.49
SANTA MARIA-SANTA BARBARA (CA)	$1994.44	$1994.44
REST OF CALIFORNIA (CA)	$1938.92	$1938.92
COLORADO (CO)	$1971.84	$1971.84
CONNECTICUT (CT)	$2090.81	$2090.81
DC + MD/VA SUBURBS (DC)	$2168.07	$2168.07
DELAWARE (DE)	$1945.13	$1945.13
FORT LAUDERDALE (FL)	$2171.17	$2171.17
MIAMI (FL)	$2359.94	$2359.94
REST OF FLORIDA (FL)	$2063.42	$2063.42
ATLANTA (GA)	$2032.02	$2032.02
REST OF GEORGIA (GA)	$1949.91	$1949.91
HAWAII, GUAM (HI)	$1955.52	$1955.52
IOWA (IA)	$1775.06	$1775.06
IDAHO (ID)	$1796.23	$1796.23
EAST ST. LOUIS (IL)	$2162.70	$2162.70
SUBURBAN CHICAGO (IL)	$2179.07	$2179.07
CHICAGO (IL)	$2289.85	$2289.85
REST OF ILLINOIS (IL)	$2051.12	$2051.12
INDIANA (IN)	$1803.64	$1803.64
KANSAS (KS)	$1793.71	$1793.71
KENTUCKY (KY)	$1882.18	$1882.18
NEW ORLEANS (LA)	$1966.87	$1966.87
REST OF LOUISIANA (LA)	$1889.94	$1889.94
METROPOLITAN BOSTON (MA)	$2110.43	$2110.43
REST OF MASSACHUSETTS (MA)	$1973.30	$1973.30
BALTIMORE/SURR. CNTYS (MD)	$2090.30	$2090.30
REST OF MARYLAND (MD)	$1970.05	$1970.05
SOUTHERN MAINE (ME)	$1877.67	$1877.67
REST OF MAINE (ME)	$1831.66	$1831.66
DETROIT (MI)	$2112.50	$2112.50
REST OF MICHIGAN (MI)	$1947.91	$1947.91
MINNESOTA (MN)	$1821.49	$1821.49
METROPOLITAN ST. LOUIS (MO)	$1941.80	$1941.80
METROPOLITAN KANSAS CITY (MO)	$1927.82	$1927.82
REST OF MISSOURI (MO)	$1879.53	$1879.53
MISSISSIPPI (MS)	$1823.03	$1823.03
MONTANA** (MT)	$1970.51	$1970.51
NORTH CAROLINA (NC)	$1843.74	$1843.74
NORTH DAKOTA** (ND)	$1829.73	$1829.73
NEBRASKA (NE)	$1775.49	$1775.49
NEW HAMPSHIRE (NH)	$1966.59	$1966.59
NORTHERN NJ (NJ)	$2156.29	$2156.29
REST OF NEW JERSEY (NJ)	$2095.51	$2095.51
NEW MEXICO (NM)	$1967.50	$1967.50
NEVADA** (NV)	$1931.89	$1931.89
MANHATTAN (NY)	$2281.83	$2281.83
NYC SUBURBS/LONG ISLAND (NY)	$2362.96	$2362.96
POUGHKPSIE/N NYC SUBURBS (NY)	$2129.82	$2129.82
QUEENS (NY)	$2259.94	$2259.94
REST OF NEW YORK (NY)	$1869.46	$1869.46
OHIO (OH)	$1919.13	$1919.13
OKLAHOMA (OK)	$1851.84	$1851.84
PORTLAND (OR)	$1996.54	$1996.54
REST OF OREGON (OR)	$1897.88	$1897.88
METROPOLITAN PHILADELPHIA (PA)	$2062.29	$2062.29
REST OF PENNSYLVANIA (PA)	$1907.24	$1907.24
PUERTO RICO (PR)	$1974.22	$1974.22
RHODE ISLAND (RI)	$1986.88	$1986.88
SOUTH CAROLINA (SC)	$1888.35	$1888.35
SOUTH DAKOTA** (SD)	$1813.08	$1813.08
TENNESSEE (TN)	$1804.65	$1804.65
BRAZORIA (TX)	$1922.03	$1922.03
DALLAS (TX)	$1944.78	$1944.78
GALVESTON (TX)	$1934.68	$1934.68
HOUSTON (TX)	$2065.00	$2065.00
BEAUMONT (TX)	$1898.49	$1898.49
FORT WORTH (TX)	$1941.70	$1941.70
AUSTIN (TX)	$1981.95	$1981.95
REST OF TEXAS (TX)	$1916.41	$1916.41
UTAH (UT)	$1909.66	$1909.66
VIRGINIA (VA)	$1890.57	$1890.57
VIRGIN ISLANDS (VI)	$1974.22	$1974.22
VERMONT (VT)	$1847.33	$1847.33
SEATTLE (KING CNTY) (WA)	$2123.50	$2123.50
REST OF WASHINGTON (WA)	$1961.40	$1961.40
WISCONSIN (WI)	$1780.47	$1780.47
WEST VIRGINIA (WV)	$1992.54	$1992.54
WYOMING** (WY)	$1909.16	$1909.16

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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 — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar allowance. Practice expense RVUs typically differ between non-facility and facility settings because overhead costs vary by site of service; for this code, those values are the same, resulting in identical non-facility and facility national amounts. Local wage, rent, and liability cost differences mean the final allowed amount can vary meaningfully from one locality to another, even for the same code.

RVUs — work 33.39, practice expense 18.5 (non-facility) / 18.5 (facility), malpractice 7.12 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment depends on your specific Medicare Administrative Contractor (MAC) and locality.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the beneficiary or secondary insurer is responsible for the remainder.
Modifiers, bilateral/multiple procedure rules, and other claim-specific factors can increase or decrease the final payment.
Annual conversion factor updates and budget-neutrality adjustments can change amounts from year to year.
Sequestration or other federal payment reductions may apply and are not reflected in this estimate.
Always confirm the exact allowed amount with your MAC or current fee schedule file before billing or appealing a denial.

Frequently asked

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

When the practice expense RVUs are identical for both settings, the calculated PFS amount comes out the same regardless of where the service is performed.

Why does the Medicare payment for this code differ by state or region?

The RVUs are adjusted by locality-specific GPCIs that reflect differences in wages, rent, and malpractice costs, so the same code can price differently across localities.

Does this amount reflect what the patient or secondary payer will pay?

No. The figure shown is the full Medicare-allowed amount; Medicare generally pays 80% of it after the deductible, with the remainder owed by the patient or a secondary payer.

Can this amount change after the start of the year?

Yes. CMS can issue corrections, and factors like sequestration or claim-specific modifiers can alter the actual payment from the baseline PFS estimate.

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.