Medicare Reimbursement for CPT 22864

CPT 22864 is a surgical procedure code; its exact clinical description is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both nationally and adjustable by locality, with non-facility and facility rates shown separately.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2021.09	$2021.09
ALASKA* (AK)	$2360.94	$2360.94
ALABAMA (AL)	$1763.06	$1763.06
ARKANSAS (AR)	$1731.88	$1731.88
ARIZONA (AZ)	$1942.38	$1942.38
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2149.34	$2149.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2173.45	$2173.45
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2015.16	$2015.16
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2044.87	$2044.87
NAPA (CA)	$2091.70	$2091.70
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2163.11	$2163.11
VALLEJO (CA)	$2071.87	$2071.87
BAKERSFIELD (CA)	$1944.23	$1944.23
CHICO (CA)	$1912.76	$1912.76
FRESNO (CA)	$1912.76	$1912.76
HANFORD-CORCORAN (CA)	$1912.76	$1912.76
MADERA (CA)	$1912.76	$1912.76
MERCED (CA)	$1912.76	$1912.76
MODESTO (CA)	$1912.76	$1912.76
REDDING (CA)	$1912.76	$1912.76
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2042.05	$2042.05
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1975.09	$1975.09
SALINAS (CA)	$1967.67	$1967.67
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2229.72	$2229.72
SANTA CRUZ-WATSONVILLE (CA)	$1994.98	$1994.98
SANTA ROSA-PETALUMA (CA)	$2012.16	$2012.16
STOCKTON (CA)	$1912.76	$1912.76
VISALIA (CA)	$1912.76	$1912.76
YUBA CITY (CA)	$1912.76	$1912.76
EL CENTRO (CA)	$1914.79	$1914.79
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1993.51	$1993.51
SAN LUIS OBISPO-PASO ROBLES (CA)	$1941.09	$1941.09
SANTA MARIA-SANTA BARBARA (CA)	$1969.40	$1969.40
REST OF CALIFORNIA (CA)	$1912.76	$1912.76
COLORADO (CO)	$1986.08	$1986.08
CONNECTICUT (CT)	$2175.97	$2175.97
DC + MD/VA SUBURBS (DC)	$2235.79	$2235.79
DELAWARE (DE)	$1977.09	$1977.09
FORT LAUDERDALE (FL)	$2356.74	$2356.74
MIAMI (FL)	$2667.06	$2667.06
REST OF FLORIDA (FL)	$2195.73	$2195.73
ATLANTA (GA)	$2115.87	$2115.87
REST OF GEORGIA (GA)	$2027.68	$2027.68
HAWAII, GUAM (HI)	$1940.90	$1940.90
IOWA (IA)	$1721.00	$1721.00
IDAHO (ID)	$1755.06	$1755.06
EAST ST. LOUIS (IL)	$2378.88	$2378.88
SUBURBAN CHICAGO (IL)	$2358.10	$2358.10
CHICAGO (IL)	$2555.33	$2555.33
REST OF ILLINOIS (IL)	$2191.70	$2191.70
INDIANA (IN)	$1764.93	$1764.93
KANSAS (KS)	$1757.07	$1757.07
KENTUCKY (KY)	$1913.57	$1913.57
NEW ORLEANS (LA)	$2037.28	$2037.28
REST OF LOUISIANA (LA)	$1928.34	$1928.34
METROPOLITAN BOSTON (MA)	$2143.60	$2143.60
REST OF MASSACHUSETTS (MA)	$1989.14	$1989.14
BALTIMORE/SURR. CNTYS (MD)	$2180.43	$2180.43
REST OF MARYLAND (MD)	$2005.37	$2005.37
SOUTHERN MAINE (ME)	$1865.78	$1865.78
REST OF MAINE (ME)	$1815.37	$1815.37
DETROIT (MI)	$2275.74	$2275.74
REST OF MICHIGAN (MI)	$2016.01	$2016.01
MINNESOTA (MN)	$1755.20	$1755.20
METROPOLITAN ST. LOUIS (MO)	$1990.28	$1990.28
METROPOLITAN KANSAS CITY (MO)	$1971.60	$1971.60
REST OF MISSOURI (MO)	$1919.67	$1919.67
MISSISSIPPI (MS)	$1823.88	$1823.88
MONTANA** (MT)	$2020.28	$2020.28
NORTH CAROLINA (NC)	$1830.82	$1830.82
NORTH DAKOTA** (ND)	$1780.63	$1780.63
NEBRASKA (NE)	$1718.57	$1718.57
NEW HAMPSHIRE (NH)	$1997.49	$1997.49
NORTHERN NJ (NJ)	$2214.33	$2214.33
REST OF NEW JERSEY (NJ)	$2159.26	$2159.26
NEW MEXICO (NM)	$2047.79	$2047.79
NEVADA** (NV)	$1954.14	$1954.14
MANHATTAN (NY)	$2426.30	$2426.30
NYC SUBURBS/LONG ISLAND (NY)	$2553.79	$2553.79
POUGHKPSIE/N NYC SUBURBS (NY)	$2211.77	$2211.77
QUEENS (NY)	$2381.18	$2381.18
REST OF NEW YORK (NY)	$1867.92	$1867.92
OHIO (OH)	$1967.02	$1967.02
OKLAHOMA (OK)	$1860.34	$1860.34
PORTLAND (OR)	$2005.89	$2005.89
REST OF OREGON (OR)	$1898.22	$1898.22
METROPOLITAN PHILADELPHIA (PA)	$2143.46	$2143.46
REST OF PENNSYLVANIA (PA)	$1944.81	$1944.81
PUERTO RICO (PR)	$2022.26	$2022.26
RHODE ISLAND (RI)	$2017.30	$2017.30
SOUTH CAROLINA (SC)	$1910.31	$1910.31
SOUTH DAKOTA** (SD)	$1752.29	$1752.29
TENNESSEE (TN)	$1773.72	$1773.72
BRAZORIA (TX)	$1933.76	$1933.76
DALLAS (TX)	$1969.59	$1969.59
GALVESTON (TX)	$1954.51	$1954.51
HOUSTON (TX)	$2176.35	$2176.35
BEAUMONT (TX)	$1933.07	$1933.07
FORT WORTH (TX)	$1968.26	$1968.26
AUSTIN (TX)	$2015.06	$2015.06
REST OF TEXAS (TX)	$1948.23	$1948.23
UTAH (UT)	$1940.28	$1940.28
VIRGINIA (VA)	$1890.87	$1890.87
VIRGIN ISLANDS (VI)	$2022.26	$2022.26
VERMONT (VT)	$1814.52	$1814.52
SEATTLE (KING CNTY) (WA)	$2144.40	$2144.40
REST OF WASHINGTON (WA)	$1971.69	$1971.69
WISCONSIN (WI)	$1713.29	$1713.29
WEST VIRGINIA (WV)	$2109.28	$2109.28
WYOMING** (WY)	$1915.84	$1915.84

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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 Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice expense RVUs can differ between non-facility (e.g., office) and facility (e.g., hospital) settings, reflecting different overhead costs; for this code, the practice expense RVU is the same in both settings, so the non-facility and facility national amounts shown are equal. Final payment also reflects the Medicare Economic Index and any annual budget-neutrality adjustments built into the conversion factor.

RVUs — work 28.67, practice expense 19.72 (non-facility) / 19.72 (facility), malpractice 12.12 — × 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 insurer is responsible for the remainder.
Actual payment varies by locality GPCIs, applicable modifiers, claim-specific adjustments, and annual sequestration or budget-neutrality changes.
Confirm final allowed amounts and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

For some codes, the practice expense RVU is identical regardless of site of service, so the non-facility and facility PFS amounts calculate to the same estimated total.

Why does the amount shown differ from what my MAC actually paid?

Locality-specific GPCIs, modifiers, secondary payer rules, sequestration, and annual recalculations can all change the final paid amount from the national estimate shown here.

Does this amount reflect what the patient owes?

No. This figure is the Medicare-allowed amount before cost-sharing; the patient (or secondary insurance) is typically responsible for 20% after the deductible is met.

Can I use this number to predict a specific claim payment?

Use it only as a general estimate. Specific claims may be adjusted based on locality, modifiers, place of service, and other claim-level factors not reflected in the national figure.

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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.