Medicare Reimbursement for CPT 22838
This page provides an estimate of the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code (CPT descriptors are AMA-licensed and not reproduced here). Amounts are shown at the national level and can be adjusted for locality, as well as for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $1684.07 | $1684.07 |
| ALASKA* (AK) | $2239.14 | $2239.14 |
| ALABAMA (AL) | $1581.41 | $1581.41 |
| ARKANSAS (AR) | $1568.84 | $1568.84 |
| ARIZONA (AZ) | $1654.06 | $1654.06 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1881.87 | $1881.87 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1908.32 | $1908.32 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1740.01 | $1740.01 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1760.78 | $1760.78 |
| NAPA (CA) | $1819.20 | $1819.20 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1886.13 | $1886.13 |
| VALLEJO (CA) | $1813.06 | $1813.06 |
| BAKERSFIELD (CA) | $1694.47 | $1694.47 |
| CHICO (CA) | $1682.99 | $1682.99 |
| FRESNO (CA) | $1682.99 | $1682.99 |
| HANFORD-CORCORAN (CA) | $1682.99 | $1682.99 |
| MADERA (CA) | $1682.99 | $1682.99 |
| MERCED (CA) | $1682.99 | $1682.99 |
| MODESTO (CA) | $1682.99 | $1682.99 |
| REDDING (CA) | $1682.99 | $1682.99 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $1723.86 | $1723.86 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1731.15 | $1731.15 |
| SALINAS (CA) | $1723.74 | $1723.74 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1925.73 | $1925.73 |
| SANTA CRUZ-WATSONVILLE (CA) | $1733.66 | $1733.66 |
| SANTA ROSA-PETALUMA (CA) | $1749.24 | $1749.24 |
| STOCKTON (CA) | $1682.99 | $1682.99 |
| VISALIA (CA) | $1682.99 | $1682.99 |
| YUBA CITY (CA) | $1682.99 | $1682.99 |
| EL CENTRO (CA) | $1683.61 | $1683.61 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1737.62 | $1737.62 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $1699.60 | $1699.60 |
| SANTA MARIA-SANTA BARBARA (CA) | $1722.93 | $1722.93 |
| REST OF CALIFORNIA (CA) | $1682.99 | $1682.99 |
| COLORADO (CO) | $1695.44 | $1695.44 |
| CONNECTICUT (CT) | $1763.58 | $1763.58 |
| DC + MD/VA SUBURBS (DC) | $1830.32 | $1830.32 |
| DELAWARE (DE) | $1672.65 | $1672.65 |
| FORT LAUDERDALE (FL) | $1790.30 | $1790.30 |
| MIAMI (FL) | $1891.43 | $1891.43 |
| REST OF FLORIDA (FL) | $1730.07 | $1730.07 |
| ATLANTA (GA) | $1718.95 | $1718.95 |
| REST OF GEORGIA (GA) | $1666.39 | $1666.39 |
| HAWAII, GUAM (HI) | $1684.29 | $1684.29 |
| IOWA (IA) | $1575.70 | $1575.70 |
| IDAHO (ID) | $1587.15 | $1587.15 |
| EAST ST. LOUIS (IL) | $1780.16 | $1780.16 |
| SUBURBAN CHICAGO (IL) | $1799.41 | $1799.41 |
| CHICAGO (IL) | $1856.42 | $1856.42 |
| REST OF ILLINOIS (IL) | $1720.97 | $1720.97 |
| INDIANA (IN) | $1591.48 | $1591.48 |
| KANSAS (KS) | $1584.85 | $1584.85 |
| KENTUCKY (KY) | $1630.53 | $1630.53 |
| NEW ORLEANS (LA) | $1678.31 | $1678.31 |
| REST OF LOUISIANA (LA) | $1634.37 | $1634.37 |
| METROPOLITAN BOSTON (MA) | $1793.33 | $1793.33 |
| REST OF MASSACHUSETTS (MA) | $1697.89 | $1697.89 |
| BALTIMORE/SURR. CNTYS (MD) | $1760.73 | $1760.73 |
| REST OF MARYLAND (MD) | $1690.16 | $1690.16 |
| SOUTHERN MAINE (ME) | $1634.38 | $1634.38 |
| REST OF MAINE (ME) | $1605.81 | $1605.81 |
| DETROIT (MI) | $1756.47 | $1756.47 |
| REST OF MICHIGAN (MI) | $1666.61 | $1666.61 |
| MINNESOTA (MN) | $1607.10 | $1607.10 |
| METROPOLITAN ST. LOUIS (MO) | $1665.77 | $1665.77 |
| METROPOLITAN KANSAS CITY (MO) | $1657.62 | $1657.62 |
| REST OF MISSOURI (MO) | $1627.49 | $1627.49 |
| MISSISSIPPI (MS) | $1597.67 | $1597.67 |
| MONTANA** (MT) | $1683.82 | $1683.82 |
| NORTH CAROLINA (NC) | $1612.96 | $1612.96 |
| NORTH DAKOTA** (ND) | $1609.67 | $1609.67 |
| NEBRASKA (NE) | $1576.41 | $1576.41 |
| NEW HAMPSHIRE (NH) | $1684.26 | $1684.26 |
| NORTHERN NJ (NJ) | $1828.28 | $1828.28 |
| REST OF NEW JERSEY (NJ) | $1778.67 | $1778.67 |
| NEW MEXICO (NM) | $1677.17 | $1677.17 |
| NEVADA** (NV) | $1663.54 | $1663.54 |
| MANHATTAN (NY) | $1895.11 | $1895.11 |
| NYC SUBURBS/LONG ISLAND (NY) | $1939.49 | $1939.49 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1799.85 | $1799.85 |
| QUEENS (NY) | $1884.80 | $1884.80 |
| REST OF NEW YORK (NY) | $1627.55 | $1627.55 |
| OHIO (OH) | $1651.45 | $1651.45 |
| OKLAHOMA (OK) | $1614.79 | $1614.79 |
| PORTLAND (OR) | $1713.66 | $1713.66 |
| REST OF OREGON (OR) | $1645.33 | $1645.33 |
| METROPOLITAN PHILADELPHIA (PA) | $1745.19 | $1745.19 |
| REST OF PENNSYLVANIA (PA) | $1645.50 | $1645.50 |
| PUERTO RICO (PR) | $1686.45 | $1686.45 |
| RHODE ISLAND (RI) | $1705.57 | $1705.57 |
| SOUTH CAROLINA (SC) | $1635.92 | $1635.92 |
| SOUTH DAKOTA** (SD) | $1600.91 | $1600.91 |
| TENNESSEE (TN) | $1590.91 | $1590.91 |
| BRAZORIA (TX) | $1662.42 | $1662.42 |
| DALLAS (TX) | $1675.29 | $1675.29 |
| GALVESTON (TX) | $1669.20 | $1669.20 |
| HOUSTON (TX) | $1737.84 | $1737.84 |
| BEAUMONT (TX) | $1640.40 | $1640.40 |
| FORT WORTH (TX) | $1673.06 | $1673.06 |
| AUSTIN (TX) | $1694.55 | $1694.55 |
| REST OF TEXAS (TX) | $1652.21 | $1652.21 |
| UTAH (UT) | $1648.11 | $1648.11 |
| VIRGINIA (VA) | $1640.68 | $1640.68 |
| VIRGIN ISLANDS (VI) | $1686.45 | $1686.45 |
| VERMONT (VT) | $1618.33 | $1618.33 |
| SEATTLE (KING CNTY) (WA) | $1807.49 | $1807.49 |
| REST OF WASHINGTON (WA) | $1689.86 | $1689.86 |
| WISCONSIN (WI) | $1581.17 | $1581.17 |
| WEST VIRGINIA (WV) | $1687.43 | $1687.43 |
| WYOMING** (WY) | $1651.51 | $1651.51 |
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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 pricing for each code starts with three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why two allowed amounts are usually shown, though for this code the non-facility and facility PE RVUs are the same, resulting in equal amounts.
RVUs — work 35.1, practice expense 11.57 (non-facility) / 11.57 (facility), malpractice 3.75 — × 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 patient meets the annual deductible; the patient or secondary insurer is responsible for the remainder.
- Actual payment can vary based on locality, applicable modifiers, sequestration, and annual budget-neutrality adjustments.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).
Frequently asked
Why do non-facility and facility amounts sometimes differ?
Practice expense RVUs can vary by setting because the resources a provider furnishes differ between an office and a facility like a hospital. For this code, the practice expense RVUs happen to be the same in both settings, so the allowed amounts match.
Does this amount apply to my specific locality?
The figure shown is a national estimate. Actual payment is adjusted using locality-specific GPCIs, which can raise or lower the amount compared to the national average.
Will modifiers change the payment amount?
Yes. Modifiers such as those indicating bilateral procedures, assistant surgeon involvement, or reduced services can increase or decrease the allowed amount from the base fee schedule rate.
Why might this number change next year?
The conversion factor and RVUs are updated annually by CMS, often due to budget-neutrality adjustments, legislative changes, or revised relative value calculations.
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.
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