Medicare Reimbursement for CPT 22868
CPT 22868 is a procedure code billed under the Medicare Physician Fee Schedule (PFS); because it is a CPT code, its official descriptor cannot be reproduced here due to AMA licensing. This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $214.77 | $214.77 |
| ALASKA* (AK) | $264.45 | $264.45 |
| ALABAMA (AL) | $191.61 | $191.61 |
| ARKANSAS (AR) | $188.83 | $188.83 |
| ARIZONA (AZ) | $207.54 | $207.54 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $221.65 | $221.65 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $223.86 | $223.86 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $211.02 | $211.02 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $214.42 | $214.42 |
| NAPA (CA) | $216.84 | $216.84 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $223.04 | $223.04 |
| VALLEJO (CA) | $214.84 | $214.84 |
| BAKERSFIELD (CA) | $205.51 | $205.51 |
| CHICO (CA) | $202.28 | $202.28 |
| FRESNO (CA) | $202.28 | $202.28 |
| HANFORD-CORCORAN (CA) | $202.28 | $202.28 |
| MADERA (CA) | $202.28 | $202.28 |
| MERCED (CA) | $202.28 | $202.28 |
| MODESTO (CA) | $202.28 | $202.28 |
| REDDING (CA) | $202.28 | $202.28 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $215.32 | $215.32 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $207.68 | $207.68 |
| SALINAS (CA) | $206.86 | $206.86 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $229.53 | $229.53 |
| SANTA CRUZ-WATSONVILLE (CA) | $208.00 | $208.00 |
| SANTA ROSA-PETALUMA (CA) | $209.74 | $209.74 |
| STOCKTON (CA) | $202.28 | $202.28 |
| VISALIA (CA) | $202.28 | $202.28 |
| YUBA CITY (CA) | $202.28 | $202.28 |
| EL CENTRO (CA) | $202.48 | $202.48 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $208.59 | $208.59 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $204.16 | $204.16 |
| SANTA MARIA-SANTA BARBARA (CA) | $206.77 | $206.77 |
| REST OF CALIFORNIA (CA) | $202.28 | $202.28 |
| COLORADO (CO) | $210.21 | $210.21 |
| CONNECTICUT (CT) | $229.30 | $229.30 |
| DC + MD/VA SUBURBS (DC) | $234.20 | $234.20 |
| DELAWARE (DE) | $210.78 | $210.78 |
| FORT LAUDERDALE (FL) | $248.26 | $248.26 |
| MIAMI (FL) | $278.87 | $278.87 |
| REST OF FLORIDA (FL) | $233.34 | $233.34 |
| ATLANTA (GA) | $224.05 | $224.05 |
| REST OF GEORGIA (GA) | $217.87 | $217.87 |
| HAWAII, GUAM (HI) | $203.61 | $203.61 |
| IOWA (IA) | $186.48 | $186.48 |
| IDAHO (ID) | $189.79 | $189.79 |
| EAST ST. LOUIS (IL) | $252.59 | $252.59 |
| SUBURBAN CHICAGO (IL) | $248.32 | $248.32 |
| CHICAGO (IL) | $268.67 | $268.67 |
| REST OF ILLINOIS (IL) | $233.90 | $233.90 |
| INDIANA (IN) | $190.63 | $190.63 |
| KANSAS (KS) | $190.36 | $190.36 |
| KENTUCKY (KY) | $206.45 | $206.45 |
| NEW ORLEANS (LA) | $217.73 | $217.73 |
| REST OF LOUISIANA (LA) | $208.02 | $208.02 |
| METROPOLITAN BOSTON (MA) | $224.11 | $224.11 |
| REST OF MASSACHUSETTS (MA) | $210.90 | $210.90 |
| BALTIMORE/SURR. CNTYS (MD) | $229.70 | $229.70 |
| REST OF MARYLAND (MD) | $213.25 | $213.25 |
| SOUTHERN MAINE (ME) | $199.34 | $199.34 |
| REST OF MAINE (ME) | $195.86 | $195.86 |
| DETROIT (MI) | $241.19 | $241.19 |
| REST OF MICHIGAN (MI) | $216.22 | $216.22 |
| MINNESOTA (MN) | $187.35 | $187.35 |
| METROPOLITAN ST. LOUIS (MO) | $212.75 | $212.75 |
| METROPOLITAN KANSAS CITY (MO) | $211.16 | $211.16 |
| REST OF MISSOURI (MO) | $207.67 | $207.67 |
| MISSISSIPPI (MS) | $198.05 | $198.05 |
| MONTANA** (MT) | $214.69 | $214.69 |
| NORTH CAROLINA (NC) | $197.13 | $197.13 |
| NORTH DAKOTA** (ND) | $190.56 | $190.56 |
| NEBRASKA (NE) | $186.05 | $186.05 |
| NEW HAMPSHIRE (NH) | $211.47 | $211.47 |
| NORTHERN NJ (NJ) | $232.75 | $232.75 |
| REST OF NEW JERSEY (NJ) | $227.96 | $227.96 |
| NEW MEXICO (NM) | $219.33 | $219.33 |
| NEVADA** (NV) | $208.01 | $208.01 |
| MANHATTAN (NY) | $254.07 | $254.07 |
| NYC SUBURBS/LONG ISLAND (NY) | $266.30 | $266.30 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $233.34 | $233.34 |
| QUEENS (NY) | $249.08 | $249.08 |
| REST OF NEW YORK (NY) | $200.48 | $200.48 |
| OHIO (OH) | $211.29 | $211.29 |
| OKLAHOMA (OK) | $201.00 | $201.00 |
| PORTLAND (OR) | $211.28 | $211.28 |
| REST OF OREGON (OR) | $202.49 | $202.49 |
| METROPOLITAN PHILADELPHIA (PA) | $226.77 | $226.77 |
| REST OF PENNSYLVANIA (PA) | $208.94 | $208.94 |
| PUERTO RICO (PR) | $214.64 | $214.64 |
| RHODE ISLAND (RI) | $214.29 | $214.29 |
| SOUTH CAROLINA (SC) | $205.33 | $205.33 |
| SOUTH DAKOTA** (SD) | $187.71 | $187.71 |
| TENNESSEE (TN) | $191.92 | $191.92 |
| BRAZORIA (TX) | $206.45 | $206.45 |
| DALLAS (TX) | $209.98 | $209.98 |
| GALVESTON (TX) | $208.49 | $208.49 |
| HOUSTON (TX) | $230.83 | $230.83 |
| BEAUMONT (TX) | $207.94 | $207.94 |
| FORT WORTH (TX) | $210.07 | $210.07 |
| AUSTIN (TX) | $212.92 | $212.92 |
| REST OF TEXAS (TX) | $208.58 | $208.58 |
| UTAH (UT) | $207.99 | $207.99 |
| VIRGINIA (VA) | $202.04 | $202.04 |
| VIRGIN ISLANDS (VI) | $214.64 | $214.64 |
| VERMONT (VT) | $194.20 | $194.20 |
| SEATTLE (KING CNTY) (WA) | $223.76 | $223.76 |
| REST OF WASHINGTON (WA) | $209.04 | $209.04 |
| WISCONSIN (WI) | $184.73 | $184.73 |
| WEST VIRGINIA (WV) | $226.60 | $226.60 |
| WYOMING** (WY) | $204.17 | $204.17 |
Look up another code or locality →
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 pricing for this code starts with three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — which are each adjusted by the Geographic Practice Cost Indices (GPCIs) for the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the allowed amount can vary by place of service. GPCIs and the conversion factor are updated annually and can shift the final amount even if RVUs stay the same.
RVUs — work 3.9, practice expense 1.31 (non-facility) / 1.31 (facility), malpractice 1.22 — × 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 deductible; the patient or secondary payer is responsible for the rest.
- Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can change the actual payment.
- Annual budget-neutrality adjustments and locality-specific GPCIs mean amounts can differ from the national figures shown here.
- Always confirm final pricing and coverage rules with your Medicare Administrative Contractor (MAC).
Frequently asked
Why does the allowed amount differ by locality for the same code?
Medicare adjusts the work, practice expense, and malpractice RVUs using locality-specific GPCIs to account for regional cost differences before applying the conversion factor.
Why might the facility and non-facility amounts be the same or different for this code?
The amounts depend on the practice-expense RVU assigned to each setting; some codes have identical non-facility and facility practice-expense RVUs, while others differ because overhead costs vary by place of service.
Does this page tell me what Medicare will actually pay my practice?
No — it provides an estimate based on current RVUs, GPCIs, and the conversion factor. Actual payment can be affected by modifiers, sequestration, deductibles, and MAC-specific policies.
Can I see the official CPT descriptor for this code on this page?
No. CPT descriptors are copyrighted by the AMA, so this page refers to the code generically rather than reproducing the licensed text.
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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