Medicare Reimbursement for CPT 22854

CPT 22854 is a procedure code used in Medicare Part B billing; the exact clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$300.61	$300.61
ALASKA* (AK)	$366.44	$366.44
ALABAMA (AL)	$266.42	$266.42
ARKANSAS (AR)	$262.32	$262.32
ARIZONA (AZ)	$289.89	$289.89
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$306.93	$306.93
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$309.82	$309.82
OXNARD-THOUSAND OAKS-VENTURA (CA)	$293.39	$293.39
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$298.30	$298.30
NAPA (CA)	$300.77	$300.77
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$309.02	$309.02
VALLEJO (CA)	$297.76	$297.76
BAKERSFIELD (CA)	$285.75	$285.75
CHICO (CA)	$280.91	$280.91
FRESNO (CA)	$280.91	$280.91
HANFORD-CORCORAN (CA)	$280.91	$280.91
MADERA (CA)	$280.91	$280.91
MERCED (CA)	$280.91	$280.91
MODESTO (CA)	$280.91	$280.91
REDDING (CA)	$280.91	$280.91
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$300.57	$300.57
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$288.34	$288.34
SALINAS (CA)	$287.20	$287.20
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$318.36	$318.36
SANTA CRUZ-WATSONVILLE (CA)	$288.78	$288.78
SANTA ROSA-PETALUMA (CA)	$291.17	$291.17
STOCKTON (CA)	$280.91	$280.91
VISALIA (CA)	$280.91	$280.91
YUBA CITY (CA)	$280.91	$280.91
EL CENTRO (CA)	$281.21	$281.21
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$289.62	$289.62
SAN LUIS OBISPO-PASO ROBLES (CA)	$283.49	$283.49
SANTA MARIA-SANTA BARBARA (CA)	$287.08	$287.08
REST OF CALIFORNIA (CA)	$280.91	$280.91
COLORADO (CO)	$293.15	$293.15
CONNECTICUT (CT)	$321.72	$321.72
DC + MD/VA SUBURBS (DC)	$327.92	$327.92
DELAWARE (DE)	$294.57	$294.57
FORT LAUDERDALE (FL)	$351.05	$351.05
MIAMI (FL)	$397.04	$397.04
REST OF FLORIDA (FL)	$328.88	$328.88
ATLANTA (GA)	$314.46	$314.46
REST OF GEORGIA (GA)	$305.91	$305.91
HAWAII, GUAM (HI)	$282.97	$282.97
IOWA (IA)	$258.44	$258.44
IDAHO (ID)	$263.41	$263.41
EAST ST. LOUIS (IL)	$358.12	$358.12
SUBURBAN CHICAGO (IL)	$350.93	$350.93
CHICAGO (IL)	$381.75	$381.75
REST OF ILLINOIS (IL)	$329.98	$329.98
INDIANA (IN)	$264.63	$264.63
KANSAS (KS)	$264.35	$264.35
KENTUCKY (KY)	$288.71	$288.71
NEW ORLEANS (LA)	$305.42	$305.42
REST OF LOUISIANA (LA)	$291.11	$291.11
METROPOLITAN BOSTON (MA)	$312.85	$312.85
REST OF MASSACHUSETTS (MA)	$294.18	$294.18
BALTIMORE/SURR. CNTYS (MD)	$322.43	$322.43
REST OF MARYLAND (MD)	$298.08	$298.08
SOUTHERN MAINE (ME)	$277.39	$277.39
REST OF MAINE (ME)	$272.57	$272.57
DETROIT (MI)	$340.66	$340.66
REST OF MICHIGAN (MI)	$303.31	$303.31
MINNESOTA (MN)	$259.09	$259.09
METROPOLITAN ST. LOUIS (MO)	$297.85	$297.85
METROPOLITAN KANSAS CITY (MO)	$295.53	$295.53
REST OF MISSOURI (MO)	$290.71	$290.71
MISSISSIPPI (MS)	$276.21	$276.21
MONTANA** (MT)	$300.49	$300.49
NORTH CAROLINA (NC)	$274.39	$274.39
NORTH DAKOTA** (ND)	$264.10	$264.10
NEBRASKA (NE)	$257.75	$257.75
NEW HAMPSHIRE (NH)	$295.39	$295.39
NORTHERN NJ (NJ)	$325.69	$325.69
REST OF NEW JERSEY (NJ)	$319.26	$319.26
NEW MEXICO (NM)	$307.97	$307.97
NEVADA** (NV)	$290.40	$290.40
MANHATTAN (NY)	$357.82	$357.82
NYC SUBURBS/LONG ISLAND (NY)	$376.10	$376.10
POUGHKPSIE/N NYC SUBURBS (NY)	$327.28	$327.28
QUEENS (NY)	$350.17	$350.17
REST OF NEW YORK (NY)	$279.35	$279.35
OHIO (OH)	$295.87	$295.87
OKLAHOMA (OK)	$280.47	$280.47
PORTLAND (OR)	$294.41	$294.41
REST OF OREGON (OR)	$282.11	$282.11
METROPOLITAN PHILADELPHIA (PA)	$318.16	$318.16
REST OF PENNSYLVANIA (PA)	$292.30	$292.30
PUERTO RICO (PR)	$300.35	$300.35
RHODE ISLAND (RI)	$299.36	$299.36
SOUTH CAROLINA (SC)	$286.82	$286.82
SOUTH DAKOTA** (SD)	$259.80	$259.80
TENNESSEE (TN)	$266.68	$266.68
BRAZORIA (TX)	$287.98	$287.98
DALLAS (TX)	$293.25	$293.25
GALVESTON (TX)	$291.05	$291.05
HOUSTON (TX)	$324.73	$324.73
BEAUMONT (TX)	$290.83	$290.83
FORT WORTH (TX)	$293.45	$293.45
AUSTIN (TX)	$297.45	$297.45
REST OF TEXAS (TX)	$291.58	$291.58
UTAH (UT)	$290.73	$290.73
VIRGINIA (VA)	$281.52	$281.52
VIRGIN ISLANDS (VI)	$300.35	$300.35
VERMONT (VT)	$269.65	$269.65
SEATTLE (KING CNTY) (WA)	$311.96	$311.96
REST OF WASHINGTON (WA)	$291.43	$291.43
WISCONSIN (WI)	$255.55	$255.55
WEST VIRGINIA (WV)	$319.22	$319.22
WYOMING** (WY)	$284.63	$284.63

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 4 units 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

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 billed. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollars-per-RVU figure set by CMS) to produce the allowed amount. Practice-expense RVUs can differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings, which is why two allowed amounts are often shown; for this code, the practice-expense RVU inputs appear the same across both settings. Work and malpractice RVUs are generally the same in both settings. The resulting allowed amount represents the full Medicare-approved rate before patient cost-sharing is applied.

RVUs — work 5.36, practice expense 1.8 (non-facility) / 1.8 (facility), malpractice 1.84 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national GPCI and conversion factor inputs — actual payment may differ by locality, carrier, or contract.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify current rates with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why do I see two different amounts for non-facility and facility?

The settings use different practice-expense RVUs to reflect different overhead costs; in some codes, including this one, those RVU inputs are equal, so the resulting amounts match.

Is this the amount Medicare will actually pay me?

No — it's an estimated allowed amount. Medicare generally pays 80% of this figure after the deductible, and local adjustments, modifiers, and policy changes can alter the final payment.

Why isn't the CPT code description shown here?

CPT descriptors are copyrighted and licensed by the American Medical Association, so this page refers to the code generically rather than reproducing its official language.

Where can I find the official rate for my area?

Your Medicare Administrative Contractor (MAC) publishes the finalized, locality-specific fee schedule, which should be used for billing and appeals.

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.