Medicare Reimbursement for CPT 22869

CPT 22869 is a procedure code reported to Medicare and other payers; the full descriptor is maintained by the AMA and is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjusted for locality, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$395.13	$395.13
ALASKA* (AK)	$509.01	$509.01
ALABAMA (AL)	$367.53	$367.53
ARKANSAS (AR)	$364.10	$364.10
ARIZONA (AZ)	$387.49	$387.49
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$463.35	$463.35
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$470.78	$470.78
OXNARD-THOUSAND OAKS-VENTURA (CA)	$419.49	$419.49
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$423.51	$423.51
NAPA (CA)	$444.59	$444.59
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$464.10	$464.10
VALLEJO (CA)	$443.51	$443.51
BAKERSFIELD (CA)	$404.71	$404.71
CHICO (CA)	$402.65	$402.65
FRESNO (CA)	$402.65	$402.65
HANFORD-CORCORAN (CA)	$402.65	$402.65
MADERA (CA)	$402.65	$402.65
MERCED (CA)	$402.65	$402.65
MODESTO (CA)	$402.65	$402.65
REDDING (CA)	$402.65	$402.65
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$409.86	$409.86
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$416.66	$416.66
SALINAS (CA)	$414.94	$414.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$473.85	$473.85
SANTA CRUZ-WATSONVILLE (CA)	$420.73	$420.73
SANTA ROSA-PETALUMA (CA)	$424.67	$424.67
STOCKTON (CA)	$402.65	$402.65
VISALIA (CA)	$402.65	$402.65
YUBA CITY (CA)	$402.65	$402.65
EL CENTRO (CA)	$402.76	$402.76
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$420.18	$420.18
SAN LUIS OBISPO-PASO ROBLES (CA)	$408.85	$408.85
SANTA MARIA-SANTA BARBARA (CA)	$415.26	$415.26
REST OF CALIFORNIA (CA)	$402.65	$402.65
COLORADO (CO)	$402.29	$402.29
CONNECTICUT (CT)	$415.45	$415.45
DC + MD/VA SUBURBS (DC)	$435.66	$435.66
DELAWARE (DE)	$392.32	$392.32
FORT LAUDERDALE (FL)	$414.82	$414.82
MIAMI (FL)	$434.75	$434.75
REST OF FLORIDA (FL)	$399.87	$399.87
ATLANTA (GA)	$402.56	$402.56
REST OF GEORGIA (GA)	$383.78	$383.78
HAWAII, GUAM (HI)	$405.62	$405.62
IOWA (IA)	$369.57	$369.57
IDAHO (ID)	$371.97	$371.97
EAST ST. LOUIS (IL)	$405.94	$405.94
SUBURBAN CHICAGO (IL)	$417.65	$417.65
CHICAGO (IL)	$426.00	$426.00
REST OF ILLINOIS (IL)	$394.99	$394.99
INDIANA (IN)	$373.27	$373.27
KANSAS (KS)	$370.35	$370.35
KENTUCKY (KY)	$377.24	$377.24
NEW ORLEANS (LA)	$389.62	$389.62
REST OF LOUISIANA (LA)	$377.61	$377.61
METROPOLITAN BOSTON (MA)	$430.08	$430.08
REST OF MASSACHUSETTS (MA)	$401.97	$401.97
BALTIMORE/SURR. CNTYS (MD)	$414.55	$414.55
REST OF MARYLAND (MD)	$397.34	$397.34
SOUTHERN MAINE (ME)	$385.70	$385.70
REST OF MAINE (ME)	$375.26	$375.26
DETROIT (MI)	$405.21	$405.21
REST OF MICHIGAN (MI)	$385.42	$385.42
MINNESOTA (MN)	$383.80	$383.80
METROPOLITAN ST. LOUIS (MO)	$388.25	$388.25
METROPOLITAN KANSAS CITY (MO)	$385.82	$385.82
REST OF MISSOURI (MO)	$374.65	$374.65
MISSISSIPPI (MS)	$369.32	$369.32
MONTANA** (MT)	$395.09	$395.09
NORTH CAROLINA (NC)	$377.51	$377.51
NORTH DAKOTA** (ND)	$382.04	$382.04
NEBRASKA (NE)	$370.31	$370.31
NEW HAMPSHIRE (NH)	$398.29	$398.29
NORTHERN NJ (NJ)	$434.13	$434.13
REST OF NEW JERSEY (NJ)	$419.70	$419.70
NEW MEXICO (NM)	$387.59	$387.59
NEVADA** (NV)	$391.60	$391.60
MANHATTAN (NY)	$446.07	$446.07
NYC SUBURBS/LONG ISLAND (NY)	$455.94	$455.94
POUGHKPSIE/N NYC SUBURBS (NY)	$423.77	$423.77
QUEENS (NY)	$445.78	$445.78
REST OF NEW YORK (NY)	$381.37	$381.37
OHIO (OH)	$382.76	$382.76
OKLAHOMA (OK)	$374.78	$374.78
PORTLAND (OR)	$409.17	$409.17
REST OF OREGON (OR)	$388.01	$388.01
METROPOLITAN PHILADELPHIA (PA)	$409.42	$409.42
REST OF PENNSYLVANIA (PA)	$382.09	$382.09
PUERTO RICO (PR)	$396.39	$396.39
RHODE ISLAND (RI)	$401.86	$401.86
SOUTH CAROLINA (SC)	$380.86	$380.86
SOUTH DAKOTA** (SD)	$380.50	$380.50
TENNESSEE (TN)	$371.80	$371.80
BRAZORIA (TX)	$390.81	$390.81
DALLAS (TX)	$393.48	$393.48
GALVESTON (TX)	$392.16	$392.16
HOUSTON (TX)	$404.24	$404.24
BEAUMONT (TX)	$380.58	$380.58
FORT WORTH (TX)	$392.33	$392.33
AUSTIN (TX)	$401.45	$401.45
REST OF TEXAS (TX)	$385.64	$385.64
UTAH (UT)	$384.23	$384.23
VIRGINIA (VA)	$386.20	$386.20
VIRGIN ISLANDS (VI)	$396.39	$396.39
VERMONT (VT)	$382.80	$382.80
SEATTLE (KING CNTY) (WA)	$435.29	$435.29
REST OF WASHINGTON (WA)	$400.49	$400.49
WISCONSIN (WI)	$373.82	$373.82
WEST VIRGINIA (WV)	$385.73	$385.73
WYOMING** (WY)	$389.40	$389.40

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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 each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility and facility settings can have different practice-expense RVUs, since facility settings assume some costs (like equipment and supplies) are borne by the facility rather than the billing physician.

RVUs — work 6.85, practice expense 4.32 (non-facility) / 4.32 (facility), malpractice 0.66 — × 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 payer is responsible for the remainder.
Actual payment can vary by locality, modifiers (e.g., bilateral, multiple procedure, assistant surgeon), claim-specific circumstances, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the allowed amount differ between facility and non-facility settings?

Practice-expense RVUs differ because non-facility settings assume the physician's practice bears costs like equipment, supplies, and staff, while in a facility setting those costs are typically borne by the facility instead.

Why might my locality's rate differ from the national amount shown here?

The national amount uses a national average; your actual rate is adjusted using GPCIs specific to your Medicare locality, which account for differences in local wages, rents, and malpractice costs.

Does this amount reflect what the patient will owe?

No. The allowed amount is the basis for payment, but after the deductible, Medicare generally pays 80%, leaving the patient or secondary insurer responsible for the remaining 20%, subject to any applicable adjustments.

Can modifiers or policy changes affect this estimate?

Yes. Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments to the conversion factor can all change the final paid amount relative to this estimate.

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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.