Medicare Reimbursement for CPT 22856

This page covers CPT code 22856, a physician procedure billed under Medicare Part B. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount nationally and reflects how the amount can vary by locality, as well as any differences between non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1522.08	$1522.08
ALASKA* (AK)	$1834.68	$1834.68
ALABAMA (AL)	$1353.35	$1353.35
ARKANSAS (AR)	$1332.88	$1332.88
ARIZONA (AZ)	$1471.25	$1471.25
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1655.95	$1655.95
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1676.51	$1676.51
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1540.31	$1540.31
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1561.12	$1561.12
NAPA (CA)	$1606.17	$1606.17
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1664.35	$1664.35
VALLEJO (CA)	$1594.05	$1594.05
BAKERSFIELD (CA)	$1487.52	$1487.52
CHICO (CA)	$1467.91	$1467.91
FRESNO (CA)	$1467.91	$1467.91
HANFORD-CORCORAN (CA)	$1467.91	$1467.91
MADERA (CA)	$1467.91	$1467.91
MERCED (CA)	$1467.91	$1467.91
MODESTO (CA)	$1467.91	$1467.91
REDDING (CA)	$1467.91	$1467.91
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1547.04	$1547.04
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1515.73	$1515.73
SALINAS (CA)	$1509.85	$1509.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1710.87	$1710.87
SANTA CRUZ-WATSONVILLE (CA)	$1529.55	$1529.55
SANTA ROSA-PETALUMA (CA)	$1542.99	$1542.99
STOCKTON (CA)	$1467.91	$1467.91
VISALIA (CA)	$1467.91	$1467.91
YUBA CITY (CA)	$1467.91	$1467.91
EL CENTRO (CA)	$1469.14	$1469.14
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1528.74	$1528.74
SAN LUIS OBISPO-PASO ROBLES (CA)	$1489.05	$1489.05
SANTA MARIA-SANTA BARBARA (CA)	$1510.94	$1510.94
REST OF CALIFORNIA (CA)	$1467.91	$1467.91
COLORADO (CO)	$1508.81	$1508.81
CONNECTICUT (CT)	$1627.51	$1627.51
DC + MD/VA SUBURBS (DC)	$1679.82	$1679.82
DELAWARE (DE)	$1495.13	$1495.13
FORT LAUDERDALE (FL)	$1728.18	$1728.18
MIAMI (FL)	$1920.15	$1920.15
REST OF FLORIDA (FL)	$1624.77	$1624.77
ATLANTA (GA)	$1581.98	$1581.98
REST OF GEORGIA (GA)	$1516.44	$1516.44
HAWAII, GUAM (HI)	$1485.38	$1485.38
IOWA (IA)	$1331.25	$1331.25
IDAHO (ID)	$1352.49	$1352.49
EAST ST. LOUIS (IL)	$1733.37	$1733.37
SUBURBAN CHICAGO (IL)	$1731.65	$1731.65
CHICAGO (IL)	$1850.10	$1850.10
REST OF ILLINOIS (IL)	$1618.46	$1618.46
INDIANA (IN)	$1359.14	$1359.14
KANSAS (KS)	$1352.28	$1352.28
KENTUCKY (KY)	$1446.50	$1446.50
NEW ORLEANS (LA)	$1526.69	$1526.69
REST OF LOUISIANA (LA)	$1455.16	$1455.16
METROPOLITAN BOSTON (MA)	$1622.39	$1622.39
REST OF MASSACHUSETTS (MA)	$1510.49	$1510.49
BALTIMORE/SURR. CNTYS (MD)	$1629.08	$1629.08
REST OF MARYLAND (MD)	$1515.54	$1515.54
SOUTHERN MAINE (ME)	$1426.45	$1426.45
REST OF MAINE (ME)	$1389.32	$1389.32
DETROIT (MI)	$1674.43	$1674.43
REST OF MICHIGAN (MI)	$1511.19	$1511.19
MINNESOTA (MN)	$1362.33	$1362.33
METROPOLITAN ST. LOUIS (MO)	$1498.97	$1498.97
METROPOLITAN KANSAS CITY (MO)	$1486.40	$1486.40
REST OF MISSOURI (MO)	$1447.80	$1447.80
MISSISSIPPI (MS)	$1389.23	$1389.23
MONTANA** (MT)	$1521.58	$1521.58
NORTH CAROLINA (NC)	$1399.91	$1399.91
NORTH DAKOTA** (ND)	$1375.26	$1375.26
NEBRASKA (NE)	$1330.48	$1330.48
NEW HAMPSHIRE (NH)	$1511.34	$1511.34
NORTHERN NJ (NJ)	$1666.90	$1666.90
REST OF NEW JERSEY (NJ)	$1622.62	$1622.62
NEW MEXICO (NM)	$1530.95	$1530.95
NEVADA** (NV)	$1481.29	$1481.29
MANHATTAN (NY)	$1796.70	$1796.70
NYC SUBURBS/LONG ISLAND (NY)	$1876.95	$1876.95
POUGHKPSIE/N NYC SUBURBS (NY)	$1655.94	$1655.94
QUEENS (NY)	$1770.94	$1770.94
REST OF NEW YORK (NY)	$1424.09	$1424.09
OHIO (OH)	$1481.28	$1481.28
OKLAHOMA (OK)	$1414.35	$1414.35
PORTLAND (OR)	$1525.91	$1525.91
REST OF OREGON (OR)	$1446.70	$1446.70
METROPOLITAN PHILADELPHIA (PA)	$1604.04	$1604.04
REST OF PENNSYLVANIA (PA)	$1468.17	$1468.17
PUERTO RICO (PR)	$1523.78	$1523.78
RHODE ISLAND (RI)	$1526.49	$1526.49
SOUTH CAROLINA (SC)	$1447.64	$1447.64
SOUTH DAKOTA** (SD)	$1357.96	$1357.96
TENNESSEE (TN)	$1362.90	$1362.90
BRAZORIA (TX)	$1469.54	$1469.54
DALLAS (TX)	$1492.06	$1492.06
GALVESTON (TX)	$1482.39	$1482.39
HOUSTON (TX)	$1617.84	$1617.84
BEAUMONT (TX)	$1460.28	$1460.28
FORT WORTH (TX)	$1490.36	$1490.36
AUSTIN (TX)	$1523.98	$1523.98
REST OF TEXAS (TX)	$1473.03	$1473.03
UTAH (UT)	$1467.37	$1467.37
VIRGINIA (VA)	$1441.05	$1441.05
VIRGIN ISLANDS (VI)	$1523.78	$1523.78
VERMONT (VT)	$1395.06	$1395.06
SEATTLE (KING CNTY) (WA)	$1627.62	$1627.62
REST OF WASHINGTON (WA)	$1499.25	$1499.25
WISCONSIN (WI)	$1330.39	$1330.39
WEST VIRGINIA (WV)	$1564.20	$1564.20
WYOMING** (WY)	$1457.82	$1457.82

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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'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 performed. These adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which can cause the payment to vary by place of service. The conversion factor and RVU values are updated annually by CMS and are subject to budget-neutrality adjustments.

RVUs — work 23.45, practice expense 14.72 (non-facility) / 14.72 (facility), malpractice 7.4 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the actual allowed amount will differ from the national figure shown here.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the Medicare amount differ by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust work, practice expense, and malpractice RVUs for regional cost differences before multiplying by the conversion factor, so the same code can price differently across localities.

Why might the non-facility and facility amounts be the same or different?

The difference comes from the practice-expense RVU component, which accounts for overhead costs. When the practice-expense RVU is identical for both settings, the resulting allowed amounts will match; otherwise they diverge.

Does this figure represent what Medicare will actually pay?

No. It represents the estimated allowed amount under the PFS formula. Actual payment depends on patient deductible status, the 80% coinsurance rule, applicable modifiers, and any claim-specific adjustments.

Where can I confirm the exact rate for my claim?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules and can confirm the final adjusted rate for a given code, modifier, and place of service.

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.