Medicare Reimbursement for CPT 22862

CPT 22862 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated PFS allowed amount for 2026 at the national level and, where applicable, how it can vary by locality and by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2267.92	$2267.92
ALASKA* (AK)	$2646.61	$2646.61
ALABAMA (AL)	$1978.43	$1978.43
ARKANSAS (AR)	$1943.42	$1943.42
ARIZONA (AZ)	$2179.79	$2179.79
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2420.58	$2420.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2448.14	$2448.14
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2265.93	$2265.93
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2298.92	$2298.92
NAPA (CA)	$2354.30	$2354.30
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2435.86	$2435.86
VALLEJO (CA)	$2332.29	$2332.29
BAKERSFIELD (CA)	$2185.05	$2185.05
CHICO (CA)	$2150.13	$2150.13
FRESNO (CA)	$2150.13	$2150.13
HANFORD-CORCORAN (CA)	$2150.13	$2150.13
MADERA (CA)	$2150.13	$2150.13
MERCED (CA)	$2150.13	$2150.13
MODESTO (CA)	$2150.13	$2150.13
REDDING (CA)	$2150.13	$2150.13
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2293.60	$2293.60
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2220.98	$2220.98
SALINAS (CA)	$2212.64	$2212.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2510.58	$2510.58
SANTA CRUZ-WATSONVILLE (CA)	$2244.37	$2244.37
SANTA ROSA-PETALUMA (CA)	$2263.76	$2263.76
STOCKTON (CA)	$2150.13	$2150.13
VISALIA (CA)	$2150.13	$2150.13
YUBA CITY (CA)	$2150.13	$2150.13
EL CENTRO (CA)	$2152.38	$2152.38
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2242.26	$2242.26
SAN LUIS OBISPO-PASO ROBLES (CA)	$2182.65	$2182.65
SANTA MARIA-SANTA BARBARA (CA)	$2214.75	$2214.75
REST OF CALIFORNIA (CA)	$2150.13	$2150.13
COLORADO (CO)	$2230.68	$2230.68
CONNECTICUT (CT)	$2441.74	$2441.74
DC + MD/VA SUBURBS (DC)	$2510.66	$2510.66
DELAWARE (DE)	$2218.79	$2218.79
FORT LAUDERDALE (FL)	$2640.74	$2640.74
MIAMI (FL)	$2985.82	$2985.82
REST OF FLORIDA (FL)	$2460.62	$2460.62
ATLANTA (GA)	$2373.51	$2373.51
REST OF GEORGIA (GA)	$2272.51	$2272.51
HAWAII, GUAM (HI)	$2182.39	$2182.39
IOWA (IA)	$1932.75	$1932.75
IDAHO (ID)	$1970.67	$1970.67
EAST ST. LOUIS (IL)	$2662.96	$2662.96
SUBURBAN CHICAGO (IL)	$2642.59	$2642.59
CHICAGO (IL)	$2860.91	$2860.91
REST OF ILLINOIS (IL)	$2455.06	$2455.06
INDIANA (IN)	$1981.81	$1981.81
KANSAS (KS)	$1972.50	$1972.50
KENTUCKY (KY)	$2145.80	$2145.80
NEW ORLEANS (LA)	$2284.40	$2284.40
REST OF LOUISIANA (LA)	$2162.09	$2162.09
METROPOLITAN BOSTON (MA)	$2408.77	$2408.77
REST OF MASSACHUSETTS (MA)	$2233.80	$2233.80
BALTIMORE/SURR. CNTYS (MD)	$2446.59	$2446.59
REST OF MARYLAND (MD)	$2250.78	$2250.78
SOUTHERN MAINE (ME)	$2095.35	$2095.35
REST OF MAINE (ME)	$2037.61	$2037.61
DETROIT (MI)	$2549.63	$2549.63
REST OF MICHIGAN (MI)	$2260.08	$2260.08
MINNESOTA (MN)	$1973.58	$1973.58
METROPOLITAN ST. LOUIS (MO)	$2232.52	$2232.52
METROPOLITAN KANSAS CITY (MO)	$2211.46	$2211.46
REST OF MISSOURI (MO)	$2151.89	$2151.89
MISSISSIPPI (MS)	$2045.56	$2045.56
MONTANA** (MT)	$2267.02	$2267.02
NORTH CAROLINA (NC)	$2055.08	$2055.08
NORTH DAKOTA** (ND)	$2001.07	$2001.07
NEBRASKA (NE)	$1930.27	$1930.27
NEW HAMPSHIRE (NH)	$2242.77	$2242.77
NORTHERN NJ (NJ)	$2486.40	$2486.40
REST OF NEW JERSEY (NJ)	$2423.57	$2423.57
NEW MEXICO (NM)	$2295.45	$2295.45
NEVADA** (NV)	$2193.65	$2193.65
MANHATTAN (NY)	$2721.68	$2721.68
NYC SUBURBS/LONG ISLAND (NY)	$2863.84	$2863.84
POUGHKPSIE/N NYC SUBURBS (NY)	$2481.91	$2481.91
QUEENS (NY)	$2672.11	$2672.11
REST OF NEW YORK (NY)	$2096.69	$2096.69
OHIO (OH)	$2205.73	$2205.73
OKLAHOMA (OK)	$2086.83	$2086.83
PORTLAND (OR)	$2253.85	$2253.85
REST OF OREGON (OR)	$2131.47	$2131.47
METROPOLITAN PHILADELPHIA (PA)	$2404.75	$2404.75
REST OF PENNSYLVANIA (PA)	$2181.20	$2181.20
PUERTO RICO (PR)	$2269.50	$2269.50
RHODE ISLAND (RI)	$2264.54	$2264.54
SOUTH CAROLINA (SC)	$2143.06	$2143.06
SOUTH DAKOTA** (SD)	$1969.62	$1969.62
TENNESSEE (TN)	$1991.11	$1991.11
BRAZORIA (TX)	$2170.78	$2170.78
DALLAS (TX)	$2210.67	$2210.67
GALVESTON (TX)	$2193.86	$2193.86
HOUSTON (TX)	$2440.04	$2440.04
BEAUMONT (TX)	$2167.97	$2167.97
FORT WORTH (TX)	$2208.94	$2208.94
AUSTIN (TX)	$2262.69	$2262.69
REST OF TEXAS (TX)	$2185.78	$2185.78
UTAH (UT)	$2176.73	$2176.73
VIRGINIA (VA)	$2122.99	$2122.99
VIRGIN ISLANDS (VI)	$2269.50	$2269.50
VERMONT (VT)	$2038.43	$2038.43
SEATTLE (KING CNTY) (WA)	$2410.49	$2410.49
REST OF WASHINGTON (WA)	$2214.44	$2214.44
WISCONSIN (WI)	$1925.29	$1925.29
WEST VIRGINIA (WV)	$2362.48	$2362.48
WYOMING** (WY)	$2151.12	$2151.12

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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 PFS amounts are built from three Relative Value Units (RVUs) — physician work, practice expense (PE), and malpractice (MP) — assigned to each code. Each RVU component is adjusted by locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which is why the same code can have two different allowed amounts. For CPT 22862, the non-facility and facility PE RVUs shown here are equal, so the resulting national amounts are the same in this case, though locality adjustments can still cause variation.

RVUs — work 31.81, practice expense 22.64 (non-facility) / 22.64 (facility), malpractice 13.45 — × 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 by locality GPCIs, applicable modifiers, claim-level adjustments, and sequestration.
Annual updates to RVUs and the conversion factor, along with budget-neutrality adjustments, can change amounts from year to year.
Always verify the final allowed amount and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does CPT 22862 show the same amount for non-facility and facility settings?

The practice-expense RVUs used for this code are identical in both settings for this year, so the calculated national amounts match. This can change in future years if RVUs are updated differently by setting.

Will my locality's payment match the national amount shown?

Not necessarily. The national figure uses standard GPCI inputs; actual payment in a specific locality is adjusted using that locality's own GPCI values, which can raise or lower the amount.

Does this amount reflect what the patient will owe?

No. This figure is the Medicare-allowed amount before cost-sharing. Patients generally owe 20% coinsurance after the deductible, and any applicable modifiers or secondary coverage can change the final out-of-pocket amount.

Can modifiers change the reimbursement for this code?

Yes. Modifiers (such as those indicating bilateral procedures, reduced services, or multiple procedures) can increase, decrease, or otherwise adjust the base PFS amount shown here.

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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.