Medicare Reimbursement for CPT Code 22855

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code (CPT descriptors are licensed by the AMA and not reproduced here). It shows both the national PFS estimate and how the amount can vary by locality, along with non-facility and facility rate comparisons where applicable.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1050.79	$1050.79
ALASKA* (AK)	$1259.59	$1259.59
ALABAMA (AL)	$933.42	$933.42
ARKANSAS (AR)	$919.14	$919.14
ARIZONA (AZ)	$1015.73	$1015.73
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1157.75	$1157.75
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1172.78	$1172.78
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1071.03	$1071.03
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1084.82	$1084.82
NAPA (CA)	$1120.70	$1120.70
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1163.31	$1163.31
VALLEJO (CA)	$1112.68	$1112.68
BAKERSFIELD (CA)	$1032.20	$1032.20
CHICO (CA)	$1019.22	$1019.22
FRESNO (CA)	$1019.22	$1019.22
HANFORD-CORCORAN (CA)	$1019.22	$1019.22
MADERA (CA)	$1019.22	$1019.22
MERCED (CA)	$1019.22	$1019.22
MODESTO (CA)	$1019.22	$1019.22
REDDING (CA)	$1019.22	$1019.22
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1071.62	$1071.62
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1053.87	$1053.87
SALINAS (CA)	$1049.81	$1049.81
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1195.53	$1195.53
SANTA CRUZ-WATSONVILLE (CA)	$1065.41	$1065.41
SANTA ROSA-PETALUMA (CA)	$1074.87	$1074.87
STOCKTON (CA)	$1019.22	$1019.22
VISALIA (CA)	$1019.22	$1019.22
YUBA CITY (CA)	$1019.22	$1019.22
EL CENTRO (CA)	$1020.04	$1020.04
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1063.99	$1063.99
SAN LUIS OBISPO-PASO ROBLES (CA)	$1035.16	$1035.16
SANTA MARIA-SANTA BARBARA (CA)	$1050.86	$1050.86
REST OF CALIFORNIA (CA)	$1019.22	$1019.22
COLORADO (CO)	$1044.87	$1044.87
CONNECTICUT (CT)	$1124.04	$1124.04
DC + MD/VA SUBURBS (DC)	$1163.16	$1163.16
DELAWARE (DE)	$1032.40	$1032.40
FORT LAUDERDALE (FL)	$1187.85	$1187.85
MIAMI (FL)	$1316.24	$1316.24
REST OF FLORIDA (FL)	$1116.80	$1116.80
ATLANTA (GA)	$1091.17	$1091.17
REST OF GEORGIA (GA)	$1042.17	$1042.17
HAWAII, GUAM (HI)	$1032.68	$1032.68
IOWA (IA)	$920.59	$920.59
IDAHO (ID)	$934.88	$934.88
EAST ST. LOUIS (IL)	$1187.09	$1187.09
SUBURBAN CHICAGO (IL)	$1190.77	$1190.77
CHICAGO (IL)	$1268.21	$1268.21
REST OF ILLINOIS (IL)	$1110.68	$1110.68
INDIANA (IN)	$939.60	$939.60
KANSAS (KS)	$934.02	$934.02
KENTUCKY (KY)	$995.73	$995.73
NEW ORLEANS (LA)	$1051.18	$1051.18
REST OF LOUISIANA (LA)	$1001.28	$1001.28
METROPOLITAN BOSTON (MA)	$1125.89	$1125.89
REST OF MASSACHUSETTS (MA)	$1045.48	$1045.48
BALTIMORE/SURR. CNTYS (MD)	$1124.91	$1124.91
REST OF MARYLAND (MD)	$1046.98	$1046.98
SOUTHERN MAINE (ME)	$987.06	$987.06
REST OF MAINE (ME)	$959.27	$959.27
DETROIT (MI)	$1150.09	$1150.09
REST OF MICHIGAN (MI)	$1039.65	$1039.65
MINNESOTA (MN)	$946.32	$946.32
METROPOLITAN ST. LOUIS (MO)	$1033.32	$1033.32
METROPOLITAN KANSAS CITY (MO)	$1024.41	$1024.41
REST OF MISSOURI (MO)	$995.37	$995.37
MISSISSIPPI (MS)	$956.54	$956.54
MONTANA** (MT)	$1050.46	$1050.46
NORTH CAROLINA (NC)	$966.87	$966.87
NORTH DAKOTA** (ND)	$953.58	$953.58
NEBRASKA (NE)	$920.45	$920.45
NEW HAMPSHIRE (NH)	$1045.54	$1045.54
NORTHERN NJ (NJ)	$1153.77	$1153.77
REST OF NEW JERSEY (NJ)	$1121.43	$1121.43
NEW MEXICO (NM)	$1052.92	$1052.92
NEVADA** (NV)	$1023.83	$1023.83
MANHATTAN (NY)	$1239.81	$1239.81
NYC SUBURBS/LONG ISLAND (NY)	$1294.17	$1294.17
POUGHKPSIE/N NYC SUBURBS (NY)	$1143.62	$1143.62
QUEENS (NY)	$1223.66	$1223.66
REST OF NEW YORK (NY)	$983.65	$983.65
OHIO (OH)	$1019.85	$1019.85
OKLAHOMA (OK)	$974.62	$974.62
PORTLAND (OR)	$1058.31	$1058.31
REST OF OREGON (OR)	$1000.70	$1000.70
METROPOLITAN PHILADELPHIA (PA)	$1106.88	$1106.88
REST OF PENNSYLVANIA (PA)	$1011.39	$1011.39
PUERTO RICO (PR)	$1052.42	$1052.42
RHODE ISLAND (RI)	$1055.16	$1055.16
SOUTH CAROLINA (SC)	$998.07	$998.07
SOUTH DAKOTA** (SD)	$942.12	$942.12
TENNESSEE (TN)	$941.28	$941.28
BRAZORIA (TX)	$1015.58	$1015.58
DALLAS (TX)	$1030.72	$1030.72
GALVESTON (TX)	$1024.18	$1024.18
HOUSTON (TX)	$1113.87	$1113.87
BEAUMONT (TX)	$1005.80	$1005.80
FORT WORTH (TX)	$1029.14	$1029.14
AUSTIN (TX)	$1054.67	$1054.67
REST OF TEXAS (TX)	$1016.01	$1016.01
UTAH (UT)	$1011.85	$1011.85
VIRGINIA (VA)	$996.37	$996.37
VIRGIN ISLANDS (VI)	$1052.42	$1052.42
VERMONT (VT)	$966.23	$966.23
SEATTLE (KING CNTY) (WA)	$1130.82	$1130.82
REST OF WASHINGTON (WA)	$1038.04	$1038.04
WISCONSIN (WI)	$921.97	$921.97
WEST VIRGINIA (WV)	$1072.76	$1072.76
WYOMING** (WY)	$1008.24	$1008.24

Look up another code or locality →

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) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted using the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is performed, reflecting local cost-of-living and practice-cost differences. The locality-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 can have different practice-expense RVUs, which is why the two amounts may differ; for this code, those PE RVUs happen to be the same, resulting in equal rates in both settings.

RVUs — work 15.46, practice expense 11.1 (non-facility) / 11.1 (facility), malpractice 4.9 — × 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 approved amount after the patient's annual deductible is met; the beneficiary or secondary insurance covers the remainder.
Actual payment can vary by locality GPCIs, applied modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality changes to the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the national rate shown here differ from what I see on my remittance advice?

Remittance amounts reflect your specific locality GPCIs, any applicable modifiers, sequestration, and other claim-level adjustments, while this page shows a national or locality-level estimate for comparison purposes.

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

The facility and non-facility amounts differ only when the practice-expense RVU differs between settings. For this code, the practice-expense RVU is identical in both settings, so the calculated amounts match.

Does this amount include the patient's coinsurance?

No. The PFS allowed amount is the total approved payment; Medicare generally pays 80% of it after the deductible, with the remaining 20% owed by the patient or a secondary payer.

Will this rate change next year?

Yes. CMS updates the conversion factor and may revise RVUs annually, and budget-neutrality adjustments can shift fees even if RVUs stay the same.

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.