Medicare Reimbursement for CPT 22859

This page covers CPT code 22859, a procedure code defined by the American Medical Association (CPT descriptor not reproduced here due to licensing). It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$300.27	$300.27
ALASKA* (AK)	$366.42	$366.42
ALABAMA (AL)	$266.33	$266.33
ARKANSAS (AR)	$262.27	$262.27
ARIZONA (AZ)	$289.65	$289.65
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$307.11	$307.11
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$310.03	$310.03
OXNARD-THOUSAND OAKS-VENTURA (CA)	$293.37	$293.37
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$298.25	$298.25
NAPA (CA)	$300.87	$300.87
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$309.18	$309.18
VALLEJO (CA)	$297.89	$297.89
BAKERSFIELD (CA)	$285.71	$285.71
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)	$300.36	$300.36
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$288.37	$288.37
SALINAS (CA)	$287.23	$287.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$318.48	$318.48
SANTA CRUZ-WATSONVILLE (CA)	$288.83	$288.83
SANTA ROSA-PETALUMA (CA)	$291.22	$291.22
STOCKTON (CA)	$280.91	$280.91
VISALIA (CA)	$280.91	$280.91
YUBA CITY (CA)	$280.91	$280.91
EL CENTRO (CA)	$281.22	$281.22
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$289.65	$289.65
SAN LUIS OBISPO-PASO ROBLES (CA)	$283.51	$283.51
SANTA MARIA-SANTA BARBARA (CA)	$287.12	$287.12
REST OF CALIFORNIA (CA)	$280.91	$280.91
COLORADO (CO)	$292.98	$292.98
CONNECTICUT (CT)	$321.28	$321.28
DC + MD/VA SUBURBS (DC)	$327.57	$327.57
DELAWARE (DE)	$294.30	$294.30
FORT LAUDERDALE (FL)	$350.18	$350.18
MIAMI (FL)	$395.70	$395.70
REST OF FLORIDA (FL)	$328.19	$328.19
ATLANTA (GA)	$314.00	$314.00
REST OF GEORGIA (GA)	$305.42	$305.42
HAWAII, GUAM (HI)	$282.96	$282.96
IOWA (IA)	$258.48	$258.48
IDAHO (ID)	$263.40	$263.40
EAST ST. LOUIS (IL)	$357.08	$357.08
SUBURBAN CHICAGO (IL)	$350.09	$350.09
CHICAGO (IL)	$380.55	$380.55
REST OF ILLINOIS (IL)	$329.24	$329.24
INDIANA (IN)	$264.61	$264.61
KANSAS (KS)	$264.32	$264.32
KENTUCKY (KY)	$288.40	$288.40
NEW ORLEANS (LA)	$304.97	$304.97
REST OF LOUISIANA (LA)	$290.77	$290.77
METROPOLITAN BOSTON (MA)	$312.66	$312.66
REST OF MASSACHUSETTS (MA)	$294.00	$294.00
BALTIMORE/SURR. CNTYS (MD)	$321.96	$321.96
REST OF MARYLAND (MD)	$297.81	$297.81
SOUTHERN MAINE (ME)	$277.30	$277.30
REST OF MAINE (ME)	$272.46	$272.46
DETROIT (MI)	$339.86	$339.86
REST OF MICHIGAN (MI)	$302.86	$302.86
MINNESOTA (MN)	$259.23	$259.23
METROPOLITAN ST. LOUIS (MO)	$297.49	$297.49
METROPOLITAN KANSAS CITY (MO)	$295.19	$295.19
REST OF MISSOURI (MO)	$290.35	$290.35
MISSISSIPPI (MS)	$276.00	$276.00
MONTANA** (MT)	$300.15	$300.15
NORTH CAROLINA (NC)	$274.28	$274.28
NORTH DAKOTA** (ND)	$264.17	$264.17
NEBRASKA (NE)	$257.81	$257.81
NEW HAMPSHIRE (NH)	$295.15	$295.15
NORTHERN NJ (NJ)	$325.36	$325.36
REST OF NEW JERSEY (NJ)	$318.89	$318.89
NEW MEXICO (NM)	$307.47	$307.47
NEVADA** (NV)	$290.18	$290.18
MANHATTAN (NY)	$357.15	$357.15
NYC SUBURBS/LONG ISLAND (NY)	$375.25	$375.25
POUGHKPSIE/N NYC SUBURBS (NY)	$326.84	$326.84
QUEENS (NY)	$349.60	$349.60
REST OF NEW YORK (NY)	$279.20	$279.20
OHIO (OH)	$295.50	$295.50
OKLAHOMA (OK)	$280.25	$280.25
PORTLAND (OR)	$294.29	$294.29
REST OF OREGON (OR)	$281.98	$281.98
METROPOLITAN PHILADELPHIA (PA)	$317.71	$317.71
REST OF PENNSYLVANIA (PA)	$291.97	$291.97
PUERTO RICO (PR)	$300.03	$300.03
RHODE ISLAND (RI)	$299.11	$299.11
SOUTH CAROLINA (SC)	$286.56	$286.56
SOUTH DAKOTA** (SD)	$259.91	$259.91
TENNESSEE (TN)	$266.63	$266.63
BRAZORIA (TX)	$287.79	$287.79
DALLAS (TX)	$293.01	$293.01
GALVESTON (TX)	$290.83	$290.83
HOUSTON (TX)	$324.14	$324.14
BEAUMONT (TX)	$290.52	$290.52
FORT WORTH (TX)	$293.20	$293.20
AUSTIN (TX)	$297.21	$297.21
REST OF TEXAS (TX)	$291.29	$291.29
UTAH (UT)	$290.45	$290.45
VIRGINIA (VA)	$281.37	$281.37
VIRGIN ISLANDS (VI)	$300.03	$300.03
VERMONT (VT)	$269.64	$269.64
SEATTLE (KING CNTY) (WA)	$311.82	$311.82
REST OF WASHINGTON (WA)	$291.28	$291.28
WISCONSIN (WI)	$255.67	$255.67
WEST VIRGINIA (WV)	$318.55	$318.55
WYOMING** (WY)	$284.47	$284.47

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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) assigned to the code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility settings often differ because the practice-expense RVU is typically lower in a facility setting, since the facility itself bears some overhead costs.

RVUs — work 5.36, practice expense 1.81 (non-facility) / 1.81 (facility), malpractice 1.82 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
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 by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The practice-expense RVU component is usually lower in a facility setting because the facility, rather than the billing physician, covers certain overhead costs like equipment and staff.

Does this amount reflect what Medicare will actually pay?

No — it's an estimate based on standard PFS inputs. Final payment depends on the patient's deductible status, applicable modifiers, the specific locality, and any budget-neutrality or sequestration adjustments in effect.

Why isn't the CPT code description shown?

CPT code descriptors are copyrighted by the American Medical Association, so we reference the code generically rather than reproducing the licensed text.

How often do these fee schedule amounts change?

Medicare updates the conversion factor and RVUs annually, and can make mid-year adjustments, so amounts should be verified each year or billing cycle.

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.