Medicare Reimbursement for CPT 22858
CPT 22858 is a procedure code used in Medicare Part B billing. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code at the national level and (where available) by locality, broken out for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $449.24 | $449.24 |
| ALASKA* (AK) | $553.83 | $553.83 |
| ALABAMA (AL) | $401.07 | $401.07 |
| ARKANSAS (AR) | $395.29 | $395.29 |
| ARIZONA (AZ) | $434.21 | $434.21 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $463.70 | $463.70 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $468.33 | $468.33 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $441.45 | $441.45 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $448.58 | $448.58 |
| NAPA (CA) | $453.63 | $453.63 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $466.58 | $466.58 |
| VALLEJO (CA) | $449.47 | $449.47 |
| BAKERSFIELD (CA) | $429.99 | $429.99 |
| CHICO (CA) | $423.25 | $423.25 |
| FRESNO (CA) | $423.25 | $423.25 |
| HANFORD-CORCORAN (CA) | $423.25 | $423.25 |
| MADERA (CA) | $423.25 | $423.25 |
| MERCED (CA) | $423.25 | $423.25 |
| MODESTO (CA) | $423.25 | $423.25 |
| REDDING (CA) | $423.25 | $423.25 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $450.42 | $450.42 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $434.53 | $434.53 |
| SALINAS (CA) | $432.80 | $432.80 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $480.12 | $480.12 |
| SANTA CRUZ-WATSONVILLE (CA) | $435.15 | $435.15 |
| SANTA ROSA-PETALUMA (CA) | $438.80 | $438.80 |
| STOCKTON (CA) | $423.25 | $423.25 |
| VISALIA (CA) | $423.25 | $423.25 |
| YUBA CITY (CA) | $423.25 | $423.25 |
| EL CENTRO (CA) | $423.67 | $423.67 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $436.40 | $436.40 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $427.16 | $427.16 |
| SANTA MARIA-SANTA BARBARA (CA) | $432.62 | $432.62 |
| REST OF CALIFORNIA (CA) | $423.25 | $423.25 |
| COLORADO (CO) | $439.76 | $439.76 |
| CONNECTICUT (CT) | $479.52 | $479.52 |
| DC + MD/VA SUBURBS (DC) | $489.77 | $489.77 |
| DELAWARE (DE) | $440.95 | $440.95 |
| FORT LAUDERDALE (FL) | $518.97 | $518.97 |
| MIAMI (FL) | $582.68 | $582.68 |
| REST OF FLORIDA (FL) | $487.92 | $487.92 |
| ATLANTA (GA) | $468.57 | $468.57 |
| REST OF GEORGIA (GA) | $455.72 | $455.72 |
| HAWAII, GUAM (HI) | $425.97 | $425.97 |
| IOWA (IA) | $390.36 | $390.36 |
| IDAHO (ID) | $397.26 | $397.26 |
| EAST ST. LOUIS (IL) | $528.00 | $528.00 |
| SUBURBAN CHICAGO (IL) | $519.11 | $519.11 |
| CHICAGO (IL) | $561.48 | $561.48 |
| REST OF ILLINOIS (IL) | $489.10 | $489.10 |
| INDIANA (IN) | $399.00 | $399.00 |
| KANSAS (KS) | $398.44 | $398.44 |
| KENTUCKY (KY) | $431.95 | $431.95 |
| NEW ORLEANS (LA) | $455.42 | $455.42 |
| REST OF LOUISIANA (LA) | $435.23 | $435.23 |
| METROPOLITAN BOSTON (MA) | $468.75 | $468.75 |
| REST OF MASSACHUSETTS (MA) | $441.21 | $441.21 |
| BALTIMORE/SURR. CNTYS (MD) | $480.36 | $480.36 |
| REST OF MARYLAND (MD) | $446.11 | $446.11 |
| SOUTHERN MAINE (ME) | $417.12 | $417.12 |
| REST OF MAINE (ME) | $409.91 | $409.91 |
| DETROIT (MI) | $504.26 | $504.26 |
| REST OF MICHIGAN (MI) | $452.28 | $452.28 |
| MINNESOTA (MN) | $392.15 | $392.15 |
| METROPOLITAN ST. LOUIS (MO) | $445.05 | $445.05 |
| METROPOLITAN KANSAS CITY (MO) | $441.75 | $441.75 |
| REST OF MISSOURI (MO) | $434.50 | $434.50 |
| MISSISSIPPI (MS) | $414.47 | $414.47 |
| MONTANA** (MT) | $449.07 | $449.07 |
| NORTH CAROLINA (NC) | $412.53 | $412.53 |
| NORTH DAKOTA** (ND) | $398.85 | $398.85 |
| NEBRASKA (NE) | $389.48 | $389.48 |
| NEW HAMPSHIRE (NH) | $442.36 | $442.36 |
| NORTHERN NJ (NJ) | $486.78 | $486.78 |
| REST OF NEW JERSEY (NJ) | $476.77 | $476.77 |
| NEW MEXICO (NM) | $458.75 | $458.75 |
| NEVADA** (NV) | $435.16 | $435.16 |
| MANHATTAN (NY) | $531.18 | $531.18 |
| NYC SUBURBS/LONG ISLAND (NY) | $556.63 | $556.63 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $488.00 | $488.00 |
| QUEENS (NY) | $520.78 | $520.78 |
| REST OF NEW YORK (NY) | $419.50 | $419.50 |
| OHIO (OH) | $442.02 | $442.02 |
| OKLAHOMA (OK) | $420.60 | $420.60 |
| PORTLAND (OR) | $441.98 | $441.98 |
| REST OF OREGON (OR) | $423.68 | $423.68 |
| METROPOLITAN PHILADELPHIA (PA) | $474.26 | $474.26 |
| REST OF PENNSYLVANIA (PA) | $437.13 | $437.13 |
| PUERTO RICO (PR) | $448.97 | $448.97 |
| RHODE ISLAND (RI) | $448.28 | $448.28 |
| SOUTH CAROLINA (SC) | $429.61 | $429.61 |
| SOUTH DAKOTA** (SD) | $392.91 | $392.91 |
| TENNESSEE (TN) | $401.69 | $401.69 |
| BRAZORIA (TX) | $431.95 | $431.95 |
| DALLAS (TX) | $439.29 | $439.29 |
| GALVESTON (TX) | $436.20 | $436.20 |
| HOUSTON (TX) | $482.69 | $482.69 |
| BEAUMONT (TX) | $435.04 | $435.04 |
| FORT WORTH (TX) | $439.49 | $439.49 |
| AUSTIN (TX) | $445.39 | $445.39 |
| REST OF TEXAS (TX) | $436.38 | $436.38 |
| UTAH (UT) | $435.14 | $435.14 |
| VIRGINIA (VA) | $422.76 | $422.76 |
| VIRGIN ISLANDS (VI) | $448.97 | $448.97 |
| VERMONT (VT) | $406.42 | $406.42 |
| SEATTLE (KING CNTY) (WA) | $468.02 | $468.02 |
| REST OF WASHINGTON (WA) | $437.34 | $437.34 |
| WISCONSIN (WI) | $386.72 | $386.72 |
| WEST VIRGINIA (WV) | $473.91 | $473.91 |
| WYOMING** (WY) | $427.18 | $427.18 |
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
The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility rates can differ because the practice-expense RVU is typically higher in non-facility (e.g., office) settings, where the practicing physician bears more overhead costs, versus facility settings like hospitals where overhead is billed separately.
RVUs — work 8.19, practice expense 2.72 (non-facility) / 2.72 (facility), malpractice 2.54 — × 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 the annual Part B deductible; the patient or secondary insurer is responsible for the remainder.
- Actual payment can vary based on locality, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
- Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why is the facility and non-facility amount sometimes the same?
When the practice-expense RVU is identical for both settings, the resulting allowed amounts will be the same; this happens for some codes where site-of-service doesn't change the PE RVU.
Does this amount reflect what the patient will actually owe?
No. This is the Medicare-allowed amount before cost-sharing. After the deductible is met, Medicare generally pays 80%, leaving the patient or secondary payer responsible for the remaining 20%, subject to any applicable modifiers or adjustments.
Why might my MAC pay a different amount than shown here?
Local GPCI values, provider-specific modifiers, claim edits, sequestration, and mid-year or annual budget-neutrality adjustments can all cause the actual paid amount to differ from this estimate.
Can I use this figure to predict a denial or underpayment?
No. This page provides a fee-schedule reference only. Denials and underpayments typically involve coverage policy, documentation, or coding issues that this estimate does not address.
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.
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