Medicare Reimbursement for CPT 22865
CPT 22865 is a surgical procedure code; the official descriptor is not reproduced here because CPT content is licensed by the AMA. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code, both nationally and adjusted for locality, and separately for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $2217.49 | $2217.49 |
| ALASKA* (AK) | $2586.89 | $2586.89 |
| ALABAMA (AL) | $1934.56 | $1934.56 |
| ARKANSAS (AR) | $1900.34 | $1900.34 |
| ARIZONA (AZ) | $2131.43 | $2131.43 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $2370.59 | $2370.59 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $2397.75 | $2397.75 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $2217.60 | $2217.60 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $2249.70 | $2249.70 |
| NAPA (CA) | $2305.08 | $2305.08 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $2385.44 | $2385.44 |
| VALLEJO (CA) | $2283.67 | $2283.67 |
| BAKERSFIELD (CA) | $2137.98 | $2137.98 |
| CHICO (CA) | $2104.02 | $2104.02 |
| FRESNO (CA) | $2104.02 | $2104.02 |
| HANFORD-CORCORAN (CA) | $2104.02 | $2104.02 |
| MADERA (CA) | $2104.02 | $2104.02 |
| MERCED (CA) | $2104.02 | $2104.02 |
| MODESTO (CA) | $2104.02 | $2104.02 |
| REDDING (CA) | $2104.02 | $2104.02 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $2243.54 | $2243.54 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $2173.68 | $2173.68 |
| SALINAS (CA) | $2165.52 | $2165.52 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $2458.48 | $2458.48 |
| SANTA CRUZ-WATSONVILLE (CA) | $2196.99 | $2196.99 |
| SANTA ROSA-PETALUMA (CA) | $2216.00 | $2216.00 |
| STOCKTON (CA) | $2104.02 | $2104.02 |
| VISALIA (CA) | $2104.02 | $2104.02 |
| YUBA CITY (CA) | $2104.02 | $2104.02 |
| EL CENTRO (CA) | $2106.20 | $2106.20 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $2194.73 | $2194.73 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $2136.12 | $2136.12 |
| SANTA MARIA-SANTA BARBARA (CA) | $2167.65 | $2167.65 |
| REST OF CALIFORNIA (CA) | $2104.02 | $2104.02 |
| COLORADO (CO) | $2181.99 | $2181.99 |
| CONNECTICUT (CT) | $2387.39 | $2387.39 |
| DC + MD/VA SUBURBS (DC) | $2455.57 | $2455.57 |
| DELAWARE (DE) | $2169.57 | $2169.57 |
| FORT LAUDERDALE (FL) | $2580.19 | $2580.19 |
| MIAMI (FL) | $2916.09 | $2916.09 |
| REST OF FLORIDA (FL) | $2404.39 | $2404.39 |
| ATLANTA (GA) | $2320.35 | $2320.35 |
| REST OF GEORGIA (GA) | $2220.74 | $2220.74 |
| HAWAII, GUAM (HI) | $2135.83 | $2135.83 |
| IOWA (IA) | $1890.59 | $1890.59 |
| IDAHO (ID) | $1927.53 | $1927.53 |
| EAST ST. LOUIS (IL) | $2600.77 | $2600.77 |
| SUBURBAN CHICAGO (IL) | $2582.15 | $2582.15 |
| CHICAGO (IL) | $2794.22 | $2794.22 |
| REST OF ILLINOIS (IL) | $2398.50 | $2398.50 |
| INDIANA (IN) | $1938.43 | $1938.43 |
| KANSAS (KS) | $1929.13 | $1929.13 |
| KENTUCKY (KY) | $2097.49 | $2097.49 |
| NEW ORLEANS (LA) | $2232.86 | $2232.86 |
| REST OF LOUISIANA (LA) | $2113.29 | $2113.29 |
| METROPOLITAN BOSTON (MA) | $2356.65 | $2356.65 |
| REST OF MASSACHUSETTS (MA) | $2184.91 | $2184.91 |
| BALTIMORE/SURR. CNTYS (MD) | $2392.07 | $2392.07 |
| REST OF MARYLAND (MD) | $2200.96 | $2200.96 |
| SOUTHERN MAINE (ME) | $2049.56 | $2049.56 |
| REST OF MAINE (ME) | $1992.62 | $1992.62 |
| DETROIT (MI) | $2491.06 | $2491.06 |
| REST OF MICHIGAN (MI) | $2208.90 | $2208.90 |
| MINNESOTA (MN) | $1931.57 | $1931.57 |
| METROPOLITAN ST. LOUIS (MO) | $2182.53 | $2182.53 |
| METROPOLITAN KANSAS CITY (MO) | $2161.90 | $2161.90 |
| REST OF MISSOURI (MO) | $2103.11 | $2103.11 |
| MISSISSIPPI (MS) | $1999.69 | $1999.69 |
| MONTANA** (MT) | $2216.61 | $2216.61 |
| NORTH CAROLINA (NC) | $2009.75 | $2009.75 |
| NORTH DAKOTA** (ND) | $1957.98 | $1957.98 |
| NEBRASKA (NE) | $1888.26 | $1888.26 |
| NEW HAMPSHIRE (NH) | $2193.48 | $2193.48 |
| NORTHERN NJ (NJ) | $2431.78 | $2431.78 |
| REST OF NEW JERSEY (NJ) | $2369.91 | $2369.91 |
| NEW MEXICO (NM) | $2243.34 | $2243.34 |
| NEVADA** (NV) | $2145.27 | $2145.27 |
| MANHATTAN (NY) | $2660.62 | $2660.62 |
| NYC SUBURBS/LONG ISLAND (NY) | $2799.17 | $2799.17 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $2426.68 | $2426.68 |
| QUEENS (NY) | $2612.64 | $2612.64 |
| REST OF NEW YORK (NY) | $2050.41 | $2050.41 |
| OHIO (OH) | $2156.03 | $2156.03 |
| OKLAHOMA (OK) | $2040.18 | $2040.18 |
| PORTLAND (OR) | $2205.05 | $2205.05 |
| REST OF OREGON (OR) | $2084.75 | $2084.75 |
| METROPOLITAN PHILADELPHIA (PA) | $2351.02 | $2351.02 |
| REST OF PENNSYLVANIA (PA) | $2132.24 | $2132.24 |
| PUERTO RICO (PR) | $2219.14 | $2219.14 |
| RHODE ISLAND (RI) | $2214.58 | $2214.58 |
| SOUTH CAROLINA (SC) | $2095.22 | $2095.22 |
| SOUTH DAKOTA** (SD) | $1927.39 | $1927.39 |
| TENNESSEE (TN) | $1947.28 | $1947.28 |
| BRAZORIA (TX) | $2122.93 | $2122.93 |
| DALLAS (TX) | $2161.77 | $2161.77 |
| GALVESTON (TX) | $2145.39 | $2145.39 |
| HOUSTON (TX) | $2384.80 | $2384.80 |
| BEAUMONT (TX) | $2119.28 | $2119.28 |
| FORT WORTH (TX) | $2159.98 | $2159.98 |
| AUSTIN (TX) | $2213.05 | $2213.05 |
| REST OF TEXAS (TX) | $2137.04 | $2137.04 |
| UTAH (UT) | $2128.13 | $2128.13 |
| VIRGINIA (VA) | $2076.35 | $2076.35 |
| VIRGIN ISLANDS (VI) | $2219.14 | $2219.14 |
| VERMONT (VT) | $1994.20 | $1994.20 |
| SEATTLE (KING CNTY) (WA) | $2358.70 | $2358.70 |
| REST OF WASHINGTON (WA) | $2166.08 | $2166.08 |
| WISCONSIN (WI) | $1883.81 | $1883.81 |
| WEST VIRGINIA (WV) | $2307.99 | $2307.99 |
| WYOMING** (WY) | $2103.90 | $2103.90 |
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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 — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost differences. The locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Because practice-expense RVUs can differ between non-facility (e.g., office) and facility (e.g., hospital) settings, the resulting allowed amount may differ between the two; for this code the practice-expense RVU shown is the same in both settings.
RVUs — work 30.96, practice expense 22.35 (non-facility) / 22.35 (facility), malpractice 13.08 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
- Actual payment can vary due to modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
- Locality-specific GPCIs mean the final amount can differ from the national figure shown here.
- Always verify the current allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.
Frequently asked
Why does the allowed amount differ by locality?
Medicare applies Geographic Practice Cost Indices (GPCIs) to the work, practice-expense, and malpractice RVUs to account for regional differences in costs, which changes the final allowed amount for the same code.
Why are the non-facility and facility amounts the same for this code?
The practice-expense RVU used in the calculation is identical for both settings for this code, so the resulting PFS allowed amounts match.
Does this amount reflect what Medicare will actually pay?
No. It reflects the estimated allowed amount before cost-sharing; Medicare generally pays 80% after the deductible, and modifiers or policy adjustments can change the final payment.
Where can I confirm the exact payment for a specific claim?
Your Medicare Administrative Contractor (MAC) publishes the current locality-specific fee schedule and can confirm the exact allowed amount applicable to a claim.
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.
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