Medicare Reimbursement for CPT 22861

CPT 22861 is a physician procedure code reported under Medicare's Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2248.88	$2248.88
ALASKA* (AK)	$2631.98	$2631.98
ALABAMA (AL)	$1961.88	$1961.88
ARKANSAS (AR)	$1927.23	$1927.23
ARIZONA (AZ)	$2161.03	$2161.03
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2376.95	$2376.95
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2402.93	$2402.93
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2234.50	$2234.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2268.13	$2268.13
NAPA (CA)	$2315.50	$2315.50
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2392.54	$2392.54
VALLEJO (CA)	$2293.03	$2293.03
BAKERSFIELD (CA)	$2157.78	$2157.78
CHICO (CA)	$2122.13	$2122.13
FRESNO (CA)	$2122.13	$2122.13
HANFORD-CORCORAN (CA)	$2122.13	$2122.13
MADERA (CA)	$2122.13	$2122.13
MERCED (CA)	$2122.13	$2122.13
MODESTO (CA)	$2122.13	$2122.13
REDDING (CA)	$2122.13	$2122.13
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2268.59	$2268.59
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2189.92	$2189.92
SALINAS (CA)	$2181.67	$2181.67
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2466.67	$2466.67
SANTA CRUZ-WATSONVILLE (CA)	$2210.22	$2210.22
SANTA ROSA-PETALUMA (CA)	$2229.15	$2229.15
STOCKTON (CA)	$2122.13	$2122.13
VISALIA (CA)	$2122.13	$2122.13
YUBA CITY (CA)	$2122.13	$2122.13
EL CENTRO (CA)	$2124.42	$2124.42
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2209.38	$2209.38
SAN LUIS OBISPO-PASO ROBLES (CA)	$2152.39	$2152.39
SANTA MARIA-SANTA BARBARA (CA)	$2183.34	$2183.34
REST OF CALIFORNIA (CA)	$2122.13	$2122.13
COLORADO (CO)	$2206.53	$2206.53
CONNECTICUT (CT)	$2421.11	$2421.11
DC + MD/VA SUBURBS (DC)	$2484.65	$2484.65
DELAWARE (DE)	$2199.55	$2199.55
FORT LAUDERDALE (FL)	$2628.58	$2628.58
MIAMI (FL)	$2978.93	$2978.93
REST OF FLORIDA (FL)	$2448.59	$2448.59
ATLANTA (GA)	$2355.58	$2355.58
REST OF GEORGIA (GA)	$2260.93	$2260.93
HAWAII, GUAM (HI)	$2152.23	$2152.23
IOWA (IA)	$1912.53	$1912.53
IDAHO (ID)	$1950.90	$1950.90
EAST ST. LOUIS (IL)	$2657.60	$2657.60
SUBURBAN CHICAGO (IL)	$2629.52	$2629.52
CHICAGO (IL)	$2853.89	$2853.89
REST OF ILLINOIS (IL)	$2445.84	$2445.84
INDIANA (IN)	$1961.79	$1961.79
KANSAS (KS)	$1953.86	$1953.86
KENTUCKY (KY)	$2131.79	$2131.79
NEW ORLEANS (LA)	$2269.73	$2269.73
REST OF LOUISIANA (LA)	$2148.69	$2148.69
METROPOLITAN BOSTON (MA)	$2379.51	$2379.51
REST OF MASSACHUSETTS (MA)	$2210.47	$2210.47
BALTIMORE/SURR. CNTYS (MD)	$2426.33	$2426.33
REST OF MARYLAND (MD)	$2230.59	$2230.59
SOUTHERN MAINE (ME)	$2073.33	$2073.33
REST OF MAINE (ME)	$2019.23	$2019.23
DETROIT (MI)	$2538.85	$2538.85
REST OF MICHIGAN (MI)	$2246.81	$2246.81
MINNESOTA (MN)	$1946.44	$1946.44
METROPOLITAN ST. LOUIS (MO)	$2216.02	$2216.02
METROPOLITAN KANSAS CITY (MO)	$2195.41	$2195.41
REST OF MISSOURI (MO)	$2139.84	$2139.84
MISSISSIPPI (MS)	$2031.37	$2031.37
MONTANA** (MT)	$2247.97	$2247.97
NORTH CAROLINA (NC)	$2036.18	$2036.18
NORTH DAKOTA** (ND)	$1976.48	$1976.48
NEBRASKA (NE)	$1909.45	$1909.45
NEW HAMPSHIRE (NH)	$2220.41	$2220.41
NORTHERN NJ (NJ)	$2461.12	$2461.12
REST OF NEW JERSEY (NJ)	$2401.57	$2401.57
NEW MEXICO (NM)	$2282.65	$2282.65
NEVADA** (NV)	$2173.00	$2173.00
MANHATTAN (NY)	$2701.17	$2701.17
NYC SUBURBS/LONG ISLAND (NY)	$2844.45	$2844.45
POUGHKPSIE/N NYC SUBURBS (NY)	$2460.94	$2460.94
QUEENS (NY)	$2649.20	$2649.20
REST OF NEW YORK (NY)	$2077.49	$2077.49
OHIO (OH)	$2191.32	$2191.32
OKLAHOMA (OK)	$2071.31	$2071.31
PORTLAND (OR)	$2226.98	$2226.98
REST OF OREGON (OR)	$2109.87	$2109.87
METROPOLITAN PHILADELPHIA (PA)	$2385.80	$2385.80
REST OF PENNSYLVANIA (PA)	$2165.95	$2165.95
PUERTO RICO (PR)	$2249.75	$2249.75
RHODE ISLAND (RI)	$2243.22	$2243.22
SOUTH CAROLINA (SC)	$2126.61	$2126.61
SOUTH DAKOTA** (SD)	$1944.38	$1944.38
TENNESSEE (TN)	$1972.51	$1972.51
BRAZORIA (TX)	$2150.35	$2150.35
DALLAS (TX)	$2190.73	$2190.73
GALVESTON (TX)	$2173.77	$2173.77
HOUSTON (TX)	$2425.08	$2425.08
BEAUMONT (TX)	$2152.98	$2152.98
FORT WORTH (TX)	$2189.65	$2189.65
AUSTIN (TX)	$2239.59	$2239.59
REST OF TEXAS (TX)	$2168.51	$2168.51
UTAH (UT)	$2159.88	$2159.88
VIRGINIA (VA)	$2102.09	$2102.09
VIRGIN ISLANDS (VI)	$2249.75	$2249.75
VERMONT (VT)	$2015.30	$2015.30
SEATTLE (KING CNTY) (WA)	$2379.04	$2379.04
REST OF WASHINGTON (WA)	$2190.70	$2190.70
WISCONSIN (WI)	$1901.98	$1901.98
WEST VIRGINIA (WV)	$2354.34	$2354.34
WYOMING** (WY)	$2129.65	$2129.65

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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 the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. The geographically adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (equipment, supplies, staff time) are treated differently depending on where the service is furnished. For this code, the non-facility and facility practice-expense RVUs shown are the same, so the resulting allowed amounts are identical in both settings — though this can vary for other codes.

RVUs — work 32.53, practice expense 21.07 (non-facility) / 21.07 (facility), malpractice 13.73 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates based on the national PFS formula and may not reflect your exact payment.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary payer 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 same code can price differently across regions.
Always confirm final payment rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the amount differ from what my MAC paid?

Actual payments can reflect modifiers, place-of-service adjustments, claim edits, sequestration, or local coverage determinations not captured in this national estimate.

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

Because the practice-expense RVUs used in the formula are identical for both settings for this particular code, the calculated allowed amount comes out the same in each.

Does this amount include the patient's deductible and coinsurance?

No. The figure shown is the full Medicare-allowed amount; Medicare generally pays 80% of this after the deductible, with the remaining 20% owed by the beneficiary or secondary insurance.

Will this rate change next year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can shift allowed amounts even if RVUs stay the same.

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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.