Medicare Reimbursement for CPT 22904

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and displays the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, including the national rate and how it may vary by locality, for both non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$985.33	$985.33
ALASKA* (AK)	$1220.87	$1220.87
ALABAMA (AL)	$891.08	$891.08
ARKANSAS (AR)	$879.59	$879.59
ARIZONA (AZ)	$957.36	$957.36
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1093.77	$1093.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1108.48	$1108.48
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1010.39	$1010.39
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1022.95	$1022.95
NAPA (CA)	$1057.82	$1057.82
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1098.06	$1098.06
VALLEJO (CA)	$1051.63	$1051.63
BAKERSFIELD (CA)	$976.59	$976.59
CHICO (CA)	$966.28	$966.28
FRESNO (CA)	$966.28	$966.28
HANFORD-CORCORAN (CA)	$966.28	$966.28
MADERA (CA)	$966.28	$966.28
MERCED (CA)	$966.28	$966.28
MODESTO (CA)	$966.28	$966.28
REDDING (CA)	$966.28	$966.28
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1006.85	$1006.85
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$997.76	$997.76
SALINAS (CA)	$993.78	$993.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1126.03	$1126.03
SANTA CRUZ-WATSONVILLE (CA)	$1006.02	$1006.02
SANTA ROSA-PETALUMA (CA)	$1015.01	$1015.01
STOCKTON (CA)	$966.28	$966.28
VISALIA (CA)	$966.28	$966.28
YUBA CITY (CA)	$966.28	$966.28
EL CENTRO (CA)	$966.91	$966.91
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1005.67	$1005.67
SAN LUIS OBISPO-PASO ROBLES (CA)	$979.86	$979.86
SANTA MARIA-SANTA BARBARA (CA)	$994.36	$994.36
REST OF CALIFORNIA (CA)	$966.28	$966.28
COLORADO (CO)	$984.40	$984.40
CONNECTICUT (CT)	$1047.01	$1047.01
DC + MD/VA SUBURBS (DC)	$1085.12	$1085.12
DELAWARE (DE)	$971.50	$971.50
FORT LAUDERDALE (FL)	$1091.44	$1091.44
MIAMI (FL)	$1191.31	$1191.31
REST OF FLORIDA (FL)	$1034.94	$1034.94
ATLANTA (GA)	$1017.38	$1017.38
REST OF GEORGIA (GA)	$975.48	$975.48
HAWAII, GUAM (HI)	$975.42	$975.42
IOWA (IA)	$882.37	$882.37
IDAHO (ID)	$893.54	$893.54
EAST ST. LOUIS (IL)	$1088.10	$1088.10
SUBURBAN CHICAGO (IL)	$1095.12	$1095.12
CHICAGO (IL)	$1154.21	$1154.21
REST OF ILLINOIS (IL)	$1028.95	$1028.95
INDIANA (IN)	$897.39	$897.39
KANSAS (KS)	$892.40	$892.40
KENTUCKY (KY)	$939.56	$939.56
NEW ORLEANS (LA)	$983.87	$983.87
REST OF LOUISIANA (LA)	$943.73	$943.73
METROPOLITAN BOSTON (MA)	$1054.95	$1054.95
REST OF MASSACHUSETTS (MA)	$985.12	$985.12
BALTIMORE/SURR. CNTYS (MD)	$1046.99	$1046.99
REST OF MARYLAND (MD)	$984.20	$984.20
SOUTHERN MAINE (ME)	$935.90	$935.90
REST OF MAINE (ME)	$912.35	$912.35
DETROIT (MI)	$1060.89	$1060.89
REST OF MICHIGAN (MI)	$974.15	$974.15
MINNESOTA (MN)	$905.60	$905.60
METROPOLITAN ST. LOUIS (MO)	$970.43	$970.43
METROPOLITAN KANSAS CITY (MO)	$963.17	$963.17
REST OF MISSOURI (MO)	$938.49	$938.49
MISSISSIPPI (MS)	$908.50	$908.50
MONTANA** (MT)	$985.07	$985.07
NORTH CAROLINA (NC)	$918.60	$918.60
NORTH DAKOTA** (ND)	$910.33	$910.33
NEBRASKA (NE)	$882.49	$882.49
NEW HAMPSHIRE (NH)	$982.49	$982.49
NORTHERN NJ (NJ)	$1078.65	$1078.65
REST OF NEW JERSEY (NJ)	$1048.35	$1048.35
NEW MEXICO (NM)	$984.51	$984.51
NEVADA** (NV)	$964.56	$964.56
MANHATTAN (NY)	$1145.23	$1145.23
NYC SUBURBS/LONG ISLAND (NY)	$1187.96	$1187.96
POUGHKPSIE/N NYC SUBURBS (NY)	$1066.28	$1066.28
QUEENS (NY)	$1133.36	$1133.36
REST OF NEW YORK (NY)	$932.05	$932.05
OHIO (OH)	$958.88	$958.88
OKLAHOMA (OK)	$923.40	$923.40
PORTLAND (OR)	$996.74	$996.74
REST OF OREGON (OR)	$946.57	$946.57
METROPOLITAN PHILADELPHIA (PA)	$1032.42	$1032.42
REST OF PENNSYLVANIA (PA)	$952.50	$952.50
PUERTO RICO (PR)	$986.90	$986.90
RHODE ISLAND (RI)	$992.43	$992.43
SOUTH CAROLINA (SC)	$942.40	$942.40
SOUTH DAKOTA** (SD)	$901.49	$901.49
TENNESSEE (TN)	$898.15	$898.15
BRAZORIA (TX)	$959.06	$959.06
DALLAS (TX)	$971.03	$971.03
GALVESTON (TX)	$965.75	$965.75
HOUSTON (TX)	$1034.94	$1034.94
BEAUMONT (TX)	$947.95	$947.95
FORT WORTH (TX)	$969.51	$969.51
AUSTIN (TX)	$990.33	$990.33
REST OF TEXAS (TX)	$956.98	$956.98
UTAH (UT)	$953.51	$953.51
VIRGINIA (VA)	$942.84	$942.84
VIRGIN ISLANDS (VI)	$986.90	$986.90
VERMONT (VT)	$919.80	$919.80
SEATTLE (KING CNTY) (WA)	$1061.04	$1061.04
REST OF WASHINGTON (WA)	$978.94	$978.94
WISCONSIN (WI)	$884.70	$884.70
WEST VIRGINIA (WV)	$998.39	$998.39
WYOMING** (WY)	$952.50	$952.50

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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: Clinical. 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 this code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar figure set by CMS) to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs, reflecting whether overhead costs (like equipment and staff) are borne by the billing provider or a separate facility; for this code, those values are shown as reported.

RVUs — work 16.27, practice expense 9.45 (non-facility) / 9.45 (facility), malpractice 3.78 — × 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 by locality GPCI values, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the allowed amount differ by locality?

CMS applies locality-specific GPCIs to the work, practice expense, and malpractice RVUs to reflect regional differences in wages, rent, and other costs, which changes the final payment amount in each area.

Why are non-facility and facility amounts sometimes different?

The practice-expense RVU can differ depending on whether the service is performed in a non-facility setting (e.g., physician office, where the provider bears overhead costs) or a facility setting (e.g., hospital, where the facility bears some overhead). For this code, the same amount is shown for both settings based on current data.

Is this the amount my practice will actually receive?

Not necessarily. This figure is the Medicare-allowed amount before the beneficiary's deductible and coinsurance are applied, and it does not account for modifiers, secondary payer adjustments, or annual payment policy changes.

Where can I confirm the exact amount for my claim?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules and can confirm the final allowed amount, including any adjustments relevant to your 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.