Medicare Reimbursement for CPT 22842

CPT 22842 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and adjusted for your locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$680.04	$680.04
ALASKA* (AK)	$833.39	$833.39
ALABAMA (AL)	$604.80	$604.80
ARKANSAS (AR)	$595.77	$595.77
ARIZONA (AZ)	$656.51	$656.51
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$698.05	$698.05
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$704.81	$704.81
OXNARD-THOUSAND OAKS-VENTURA (CA)	$665.93	$665.93
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$676.88	$676.88
NAPA (CA)	$683.47	$683.47
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$702.60	$702.60
VALLEJO (CA)	$676.91	$676.91
BAKERSFIELD (CA)	$648.59	$648.59
CHICO (CA)	$638.00	$638.00
FRESNO (CA)	$638.00	$638.00
HANFORD-CORCORAN (CA)	$638.00	$638.00
MADERA (CA)	$638.00	$638.00
MERCED (CA)	$638.00	$638.00
MODESTO (CA)	$638.00	$638.00
REDDING (CA)	$638.00	$638.00
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$680.86	$680.86
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$654.95	$654.95
SALINAS (CA)	$652.35	$652.35
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$723.43	$723.43
SANTA CRUZ-WATSONVILLE (CA)	$655.93	$655.93
SANTA ROSA-PETALUMA (CA)	$661.39	$661.39
STOCKTON (CA)	$638.00	$638.00
VISALIA (CA)	$638.00	$638.00
YUBA CITY (CA)	$638.00	$638.00
EL CENTRO (CA)	$638.67	$638.67
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$657.81	$657.81
SAN LUIS OBISPO-PASO ROBLES (CA)	$643.89	$643.89
SANTA MARIA-SANTA BARBARA (CA)	$652.08	$652.08
REST OF CALIFORNIA (CA)	$638.00	$638.00
COLORADO (CO)	$664.38	$664.38
CONNECTICUT (CT)	$726.90	$726.90
DC + MD/VA SUBURBS (DC)	$741.65	$741.65
DELAWARE (DE)	$666.92	$666.92
FORT LAUDERDALE (FL)	$790.04	$790.04
MIAMI (FL)	$890.45	$890.45
REST OF FLORIDA (FL)	$741.39	$741.39
ATLANTA (GA)	$710.38	$710.38
REST OF GEORGIA (GA)	$690.97	$690.97
HAWAII, GUAM (HI)	$642.42	$642.42
IOWA (IA)	$587.64	$587.64
IDAHO (ID)	$598.50	$598.50
EAST ST. LOUIS (IL)	$804.90	$804.90
SUBURBAN CHICAGO (IL)	$790.00	$790.00
CHICAGO (IL)	$857.04	$857.04
REST OF ILLINOIS (IL)	$743.54	$743.54
INDIANA (IN)	$601.20	$601.20
KANSAS (KS)	$600.46	$600.46
KENTUCKY (KY)	$653.46	$653.46
NEW ORLEANS (LA)	$690.18	$690.18
REST OF LOUISIANA (LA)	$658.67	$658.67
METROPOLITAN BOSTON (MA)	$708.65	$708.65
REST OF MASSACHUSETTS (MA)	$666.66	$666.66
BALTIMORE/SURR. CNTYS (MD)	$728.33	$728.33
REST OF MARYLAND (MD)	$674.79	$674.79
SOUTHERN MAINE (ME)	$629.39	$629.39
REST OF MAINE (ME)	$618.46	$618.46
DETROIT (MI)	$767.13	$767.13
REST OF MICHIGAN (MI)	$685.41	$685.41
MINNESOTA (MN)	$589.72	$589.72
METROPOLITAN ST. LOUIS (MO)	$673.74	$673.74
METROPOLITAN KANSAS CITY (MO)	$668.61	$668.61
REST OF MISSOURI (MO)	$657.66	$657.66
MISSISSIPPI (MS)	$626.05	$626.05
MONTANA** (MT)	$679.77	$679.77
NORTH CAROLINA (NC)	$622.52	$622.52
NORTH DAKOTA** (ND)	$600.48	$600.48
NEBRASKA (NE)	$586.19	$586.19
NEW HAMPSHIRE (NH)	$668.91	$668.91
NORTHERN NJ (NJ)	$736.84	$736.84
REST OF NEW JERSEY (NJ)	$722.00	$722.00
NEW MEXICO (NM)	$695.60	$695.60
NEVADA** (NV)	$657.81	$657.81
MANHATTAN (NY)	$806.90	$806.90
NYC SUBURBS/LONG ISLAND (NY)	$846.90	$846.90
POUGHKPSIE/N NYC SUBURBS (NY)	$739.59	$739.59
QUEENS (NY)	$790.35	$790.35
REST OF NEW YORK (NY)	$633.42	$633.42
OHIO (OH)	$669.20	$669.20
OKLAHOMA (OK)	$635.52	$635.52
PORTLAND (OR)	$667.50	$667.50
REST OF OREGON (OR)	$639.72	$639.72
METROPOLITAN PHILADELPHIA (PA)	$718.87	$718.87
REST OF PENNSYLVANIA (PA)	$661.45	$661.45
PUERTO RICO (PR)	$679.54	$679.54
RHODE ISLAND (RI)	$677.87	$677.87
SOUTH CAROLINA (SC)	$649.54	$649.54
SOUTH DAKOTA** (SD)	$591.11	$591.11
TENNESSEE (TN)	$605.57	$605.57
BRAZORIA (TX)	$652.62	$652.62
DALLAS (TX)	$664.16	$664.16
GALVESTON (TX)	$659.32	$659.32
HOUSTON (TX)	$732.72	$732.72
BEAUMONT (TX)	$658.21	$658.21
FORT WORTH (TX)	$664.53	$664.53
AUSTIN (TX)	$673.53	$673.53
REST OF TEXAS (TX)	$660.07	$660.07
UTAH (UT)	$658.16	$658.16
VIRGINIA (VA)	$638.34	$638.34
VIRGIN ISLANDS (VI)	$679.54	$679.54
VERMONT (VT)	$612.51	$612.51
SEATTLE (KING CNTY) (WA)	$707.08	$707.08
REST OF WASHINGTON (WA)	$660.61	$660.61
WISCONSIN (WI)	$581.61	$581.61
WEST VIRGINIA (WV)	$719.83	$719.83
WYOMING** (WY)	$645.22	$645.22

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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: Clinical. 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

The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. These geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs, since overhead costs differ, which can result in different allowed amounts for the same code depending on place of service.

RVUs — work 12.25, practice expense 4.1 (non-facility) / 4.1 (facility), malpractice 4.01 — × 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 their deductible; the patient or secondary insurer is generally responsible for the remainder.
Modifiers, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs and the conversion factor are updated periodically, so amounts can shift year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

Practice-expense RVUs differ by place of service because overhead costs (staff, equipment, supplies) are treated differently when a service is performed in a facility versus a non-facility setting like a physician's office.

Does this amount reflect what the patient will owe?

No. The figure shown is the Medicare-allowed amount. Patient responsibility depends on deductible status, coinsurance, and any secondary coverage.

Why might my actual payment differ from the national amount shown?

The national amount uses standardized GPCIs. Actual payment depends on the GPCIs for your specific locality, any applicable modifiers, and timing-related adjustments like sequestration.

Where do the RVU and conversion factor values come from?

They come from the annual Medicare Physician Fee Schedule final rule published by CMS, which sets work, practice-expense, and malpractice RVUs along with the yearly conversion factor.

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.