Medicare Reimbursement for CPT Code 22860

CPT code 22860 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code, both nationally and adjusted for locality, in non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$344.36	$344.36
ALASKA* (AK)	$435.40	$435.40
ALABAMA (AL)	$311.99	$311.99
ARKANSAS (AR)	$308.11	$308.11
ARIZONA (AZ)	$334.29	$334.29
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$359.68	$359.68
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$363.53	$363.53
OXNARD-THOUSAND OAKS-VENTURA (CA)	$341.16	$341.16
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$346.43	$346.43
NAPA (CA)	$351.27	$351.27
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$361.59	$361.59
VALLEJO (CA)	$348.52	$348.52
BAKERSFIELD (CA)	$332.84	$332.84
CHICO (CA)	$328.29	$328.29
FRESNO (CA)	$328.29	$328.29
HANFORD-CORCORAN (CA)	$328.29	$328.29
MADERA (CA)	$328.29	$328.29
MERCED (CA)	$328.29	$328.29
MODESTO (CA)	$328.29	$328.29
REDDING (CA)	$328.29	$328.29
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$346.31	$346.31
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$336.85	$336.85
SALINAS (CA)	$335.47	$335.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$371.33	$371.33
SANTA CRUZ-WATSONVILLE (CA)	$336.82	$336.82
SANTA ROSA-PETALUMA (CA)	$339.67	$339.67
STOCKTON (CA)	$328.29	$328.29
VISALIA (CA)	$328.29	$328.29
YUBA CITY (CA)	$328.29	$328.29
EL CENTRO (CA)	$328.57	$328.57
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$337.96	$337.96
SAN LUIS OBISPO-PASO ROBLES (CA)	$331.05	$331.05
SANTA MARIA-SANTA BARBARA (CA)	$335.25	$335.25
REST OF CALIFORNIA (CA)	$328.29	$328.29
COLORADO (CO)	$338.87	$338.87
CONNECTICUT (CT)	$365.57	$365.57
DC + MD/VA SUBURBS (DC)	$374.22	$374.22
DELAWARE (DE)	$339.05	$339.05
FORT LAUDERDALE (FL)	$390.54	$390.54
MIAMI (FL)	$432.79	$432.79
REST OF FLORIDA (FL)	$369.77	$369.77
ATLANTA (GA)	$357.34	$357.34
REST OF GEORGIA (GA)	$348.21	$348.21
HAWAII, GUAM (HI)	$329.53	$329.53
IOWA (IA)	$305.08	$305.08
IDAHO (ID)	$309.66	$309.66
EAST ST. LOUIS (IL)	$396.13	$396.13
SUBURBAN CHICAGO (IL)	$390.98	$390.98
CHICAGO (IL)	$418.92	$418.92
REST OF ILLINOIS (IL)	$370.38	$370.38
INDIANA (IN)	$310.84	$310.84
KANSAS (KS)	$310.37	$310.37
KENTUCKY (KY)	$332.48	$332.48
NEW ORLEANS (LA)	$348.21	$348.21
REST OF LOUISIANA (LA)	$334.63	$334.63
METROPOLITAN BOSTON (MA)	$359.82	$359.82
REST OF MASSACHUSETTS (MA)	$339.96	$339.96
BALTIMORE/SURR. CNTYS (MD)	$365.93	$365.93
REST OF MARYLAND (MD)	$342.77	$342.77
SOUTHERN MAINE (ME)	$323.08	$323.08
REST OF MAINE (ME)	$318.02	$318.02
DETROIT (MI)	$380.61	$380.61
REST OF MICHIGAN (MI)	$346.02	$346.02
MINNESOTA (MN)	$306.72	$306.72
METROPOLITAN ST. LOUIS (MO)	$341.40	$341.40
METROPOLITAN KANSAS CITY (MO)	$339.16	$339.16
REST OF MISSOURI (MO)	$334.05	$334.05
MISSISSIPPI (MS)	$320.80	$320.80
MONTANA** (MT)	$344.25	$344.25
NORTH CAROLINA (NC)	$319.81	$319.81
NORTH DAKOTA** (ND)	$311.03	$311.03
NEBRASKA (NE)	$304.52	$304.52
NEW HAMPSHIRE (NH)	$339.98	$339.98
NORTHERN NJ (NJ)	$372.56	$372.56
REST OF NEW JERSEY (NJ)	$364.67	$364.67
NEW MEXICO (NM)	$350.32	$350.32
NEVADA** (NV)	$335.06	$335.06
MANHATTAN (NY)	$401.98	$401.98
NYC SUBURBS/LONG ISLAND (NY)	$418.92	$418.92
POUGHKPSIE/N NYC SUBURBS (NY)	$372.32	$372.32
QUEENS (NY)	$395.18	$395.18
REST OF NEW YORK (NY)	$324.49	$324.49
OHIO (OH)	$339.23	$339.23
OKLAHOMA (OK)	$324.99	$324.99
PORTLAND (OR)	$340.70	$340.70
REST OF OREGON (OR)	$327.44	$327.44
METROPOLITAN PHILADELPHIA (PA)	$361.86	$361.86
REST OF PENNSYLVANIA (PA)	$336.02	$336.02
PUERTO RICO (PR)	$344.23	$344.23
RHODE ISLAND (RI)	$344.68	$344.68
SOUTH CAROLINA (SC)	$331.07	$331.07
SOUTH DAKOTA** (SD)	$307.10	$307.10
TENNESSEE (TN)	$312.55	$312.55
BRAZORIA (TX)	$333.23	$333.23
DALLAS (TX)	$338.16	$338.16
GALVESTON (TX)	$336.06	$336.06
HOUSTON (TX)	$366.81	$366.81
BEAUMONT (TX)	$334.61	$334.61
FORT WORTH (TX)	$338.24	$338.24
AUSTIN (TX)	$342.13	$342.13
REST OF TEXAS (TX)	$335.65	$335.65
UTAH (UT)	$334.79	$334.79
VIRGINIA (VA)	$326.78	$326.78
VIRGIN ISLANDS (VI)	$344.23	$344.23
VERMONT (VT)	$316.00	$316.00
SEATTLE (KING CNTY) (WA)	$359.86	$359.86
REST OF WASHINGTON (WA)	$337.26	$337.26
WISCONSIN (WI)	$302.84	$302.84
WEST VIRGINIA (WV)	$360.15	$360.15
WYOMING** (WY)	$329.77	$329.77

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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

Each CPT code is assigned three Relative Value Units (RVUs) — for physician work, practice expense, and malpractice risk. These RVUs are each adjusted by the Geographic Practice Cost Indices (GPCIs) for a specific locality, then summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates can differ because the practice-expense RVU changes depending on whether the service is performed in a physician office (non-facility) or a hospital/facility setting. For this code, the practice-expense RVU is the same in both settings, so the national amounts shown are equal; locality-adjusted amounts may still vary by GPCI.

RVUs — work 6.71, practice expense 1.92 (non-facility) / 1.92 (facility), malpractice 1.68 — × 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 their deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can be affected by modifiers, place-of-service codes, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments.
Always verify the final allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility amount the same as the non-facility amount for this code?

Facility and non-facility amounts can differ when the practice-expense RVU changes based on site of service. For this code, the practice-expense RVU is identical in both settings, so the computed national amounts match.

Why might my local Medicare payment differ from the national amount shown?

The national amount uses a GPCI value of 1.0 for all cost components. Actual payments are adjusted using locality-specific GPCIs for work, practice expense, and malpractice, which can raise or lower the amount compared to the national figure.

Does this amount reflect what the patient will owe?

No. This figure represents the full Medicare-allowed amount. After the deductible is met, Medicare generally pays 80%, leaving the patient or supplemental insurance responsible for the remaining 20%, subject to any applicable modifiers or adjustments.

Can modifiers change this amount?

Yes. Modifiers such as bilateral procedure, multiple procedure, or assistant-at-surgery indicators can increase or decrease the final allowed amount relative to the base PFS rate shown here.

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.