Medicare Reimbursement for CPT 22849

This page covers a CPT procedure code (the official descriptor is not shown due to AMA licensing). It displays the Medicare Physician Fee Schedule (PFS) allowed amount nationally and shows how the amount can vary by locality, as well as how non-facility and facility settings compare.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1226.82	$1226.82
ALASKA* (AK)	$1478.88	$1478.88
ALABAMA (AL)	$1091.84	$1091.84
ARKANSAS (AR)	$1075.44	$1075.44
ARIZONA (AZ)	$1186.32	$1186.32
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1343.01	$1343.01
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1360.07	$1360.07
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1246.04	$1246.04
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1262.48	$1262.48
NAPA (CA)	$1301.38	$1301.38
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1349.57	$1349.57
VALLEJO (CA)	$1291.92	$1291.92
BAKERSFIELD (CA)	$1202.50	$1202.50
CHICO (CA)	$1187.16	$1187.16
FRESNO (CA)	$1187.16	$1187.16
HANFORD-CORCORAN (CA)	$1187.16	$1187.16
MADERA (CA)	$1187.16	$1187.16
MERCED (CA)	$1187.16	$1187.16
MODESTO (CA)	$1187.16	$1187.16
REDDING (CA)	$1187.16	$1187.16
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1248.98	$1248.98
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1226.46	$1226.46
SALINAS (CA)	$1221.70	$1221.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1386.90	$1386.90
SANTA CRUZ-WATSONVILLE (CA)	$1238.39	$1238.39
SANTA ROSA-PETALUMA (CA)	$1249.33	$1249.33
STOCKTON (CA)	$1187.16	$1187.16
VISALIA (CA)	$1187.16	$1187.16
YUBA CITY (CA)	$1187.16	$1187.16
EL CENTRO (CA)	$1188.13	$1188.13
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1237.38	$1237.38
SAN LUIS OBISPO-PASO ROBLES (CA)	$1204.77	$1204.77
SANTA MARIA-SANTA BARBARA (CA)	$1222.69	$1222.69
REST OF CALIFORNIA (CA)	$1187.16	$1187.16
COLORADO (CO)	$1218.23	$1218.23
CONNECTICUT (CT)	$1311.37	$1311.37
DC + MD/VA SUBURBS (DC)	$1355.23	$1355.23
DELAWARE (DE)	$1205.52	$1205.52
FORT LAUDERDALE (FL)	$1388.13	$1388.13
MIAMI (FL)	$1538.79	$1538.79
REST OF FLORIDA (FL)	$1305.91	$1305.91
ATLANTA (GA)	$1274.04	$1274.04
REST OF GEORGIA (GA)	$1219.66	$1219.66
HAWAII, GUAM (HI)	$1201.64	$1201.64
IOWA (IA)	$1075.59	$1075.59
IDAHO (ID)	$1092.31	$1092.31
EAST ST. LOUIS (IL)	$1389.82	$1389.82
SUBURBAN CHICAGO (IL)	$1391.28	$1391.28
CHICAGO (IL)	$1483.24	$1483.24
REST OF ILLINOIS (IL)	$1299.88	$1299.88
INDIANA (IN)	$1097.69	$1097.69
KANSAS (KS)	$1091.75	$1091.75
KENTUCKY (KY)	$1164.95	$1164.95
NEW ORLEANS (LA)	$1228.91	$1228.91
REST OF LOUISIANA (LA)	$1171.61	$1171.61
METROPOLITAN BOSTON (MA)	$1310.62	$1310.62
REST OF MASSACHUSETTS (MA)	$1219.32	$1219.32
BALTIMORE/SURR. CNTYS (MD)	$1312.45	$1312.45
REST OF MARYLAND (MD)	$1222.14	$1222.14
SOUTHERN MAINE (ME)	$1151.89	$1151.89
REST OF MAINE (ME)	$1121.08	$1121.08
DETROIT (MI)	$1344.92	$1344.92
REST OF MICHIGAN (MI)	$1216.09	$1216.09
MINNESOTA (MN)	$1102.78	$1102.78
METROPOLITAN ST. LOUIS (MO)	$1207.55	$1207.55
METROPOLITAN KANSAS CITY (MO)	$1197.40	$1197.40
REST OF MISSOURI (MO)	$1165.29	$1165.29
MISSISSIPPI (MS)	$1119.51	$1119.51
MONTANA** (MT)	$1226.43	$1226.43
NORTH CAROLINA (NC)	$1129.69	$1129.69
NORTH DAKOTA** (ND)	$1112.14	$1112.14
NEBRASKA (NE)	$1075.20	$1075.20
NEW HAMPSHIRE (NH)	$1219.47	$1219.47
NORTHERN NJ (NJ)	$1344.79	$1344.79
REST OF NEW JERSEY (NJ)	$1308.19	$1308.19
NEW MEXICO (NM)	$1231.63	$1231.63
NEVADA** (NV)	$1194.98	$1194.98
MANHATTAN (NY)	$1446.24	$1446.24
NYC SUBURBS/LONG ISLAND (NY)	$1509.61	$1509.61
POUGHKPSIE/N NYC SUBURBS (NY)	$1334.35	$1334.35
QUEENS (NY)	$1426.63	$1426.63
REST OF NEW YORK (NY)	$1149.00	$1149.00
OHIO (OH)	$1192.73	$1192.73
OKLAHOMA (OK)	$1139.95	$1139.95
PORTLAND (OR)	$1232.83	$1232.83
REST OF OREGON (OR)	$1167.84	$1167.84
METROPOLITAN PHILADELPHIA (PA)	$1292.10	$1292.10
REST OF PENNSYLVANIA (PA)	$1182.62	$1182.62
PUERTO RICO (PR)	$1228.42	$1228.42
RHODE ISLAND (RI)	$1231.34	$1231.34
SOUTH CAROLINA (SC)	$1166.73	$1166.73
SOUTH DAKOTA** (SD)	$1098.63	$1098.63
TENNESSEE (TN)	$1100.17	$1100.17
BRAZORIA (TX)	$1185.65	$1185.65
DALLAS (TX)	$1203.38	$1203.38
GALVESTON (TX)	$1195.74	$1195.74
HOUSTON (TX)	$1301.53	$1301.53
BEAUMONT (TX)	$1176.25	$1176.25
FORT WORTH (TX)	$1201.80	$1201.80
AUSTIN (TX)	$1229.81	$1229.81
REST OF TEXAS (TX)	$1187.20	$1187.20
UTAH (UT)	$1182.55	$1182.55
VIRGINIA (VA)	$1163.09	$1163.09
VIRGIN ISLANDS (VI)	$1228.42	$1228.42
VERMONT (VT)	$1127.35	$1127.35
SEATTLE (KING CNTY) (WA)	$1315.65	$1315.65
REST OF WASHINGTON (WA)	$1210.49	$1210.49
WISCONSIN (WI)	$1076.02	$1076.02
WEST VIRGINIA (WV)	$1256.38	$1256.38
WYOMING** (WY)	$1176.62	$1176.62

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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 PFS amounts are built from 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 furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor to produce the allowed amount. Non-facility and facility rates can differ because the practice-expense RVU often changes depending on whether the service is performed in a physician office (non-facility) versus a hospital or ASC setting (facility); malpractice and work RVUs stay generally the same across settings.

RVUs — work 18.69, practice expense 12.26 (non-facility) / 12.26 (facility), malpractice 5.78 — × 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 annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can be affected by modifiers, place-of-service coding, sequestration reductions, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Locality-specific GPCIs can meaningfully change the amount from the national figure shown here.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

The practice-expense RVU component can differ because overhead costs (equipment, supplies, staff time) are treated differently depending on whether the service is furnished in an office versus a facility like a hospital, where some overhead is billed separately by the facility.

Why might my locality's reimbursement differ from the national amount shown?

GPCIs adjust the work, practice expense, and malpractice RVUs based on regional cost-of-living and practice-cost differences, so the same code can pay more or less depending on where the service was performed.

Does this amount reflect what Medicare will actually pay?

No — this is an estimated allowed amount based on the standard PFS formula. Actual payment depends on the patient's deductible status, applicable modifiers, sequestration, and any other adjustments specific to the claim.

Where can I find the official descriptor for CPT 22849?

CPT code descriptors are copyrighted by the American Medical Association. Refer to your licensed CPT codebook or AMA resources for the official language of this code.

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.