Medicare Reimbursement for CPT 22905

CPT 22905 is a procedure code valued under the Medicare Physician Fee Schedule (PFS); the official descriptor is not reproduced here due to AMA licensing. This page shows the estimated Medicare PFS allowed amount nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1237.50	$1237.50
ALASKA* (AK)	$1540.72	$1540.72
ALABAMA (AL)	$1120.81	$1120.81
ARKANSAS (AR)	$1106.61	$1106.61
ARIZONA (AZ)	$1202.70	$1202.70
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1364.61	$1364.61
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1382.58	$1382.58
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1264.32	$1264.32
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1280.45	$1280.45
NAPA (CA)	$1321.15	$1321.15
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1370.09	$1370.09
VALLEJO (CA)	$1313.25	$1313.25
BAKERSFIELD (CA)	$1223.63	$1223.63
CHICO (CA)	$1210.44	$1210.44
FRESNO (CA)	$1210.44	$1210.44
HANFORD-CORCORAN (CA)	$1210.44	$1210.44
MADERA (CA)	$1210.44	$1210.44
MERCED (CA)	$1210.44	$1210.44
MODESTO (CA)	$1210.44	$1210.44
REDDING (CA)	$1210.44	$1210.44
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1262.29	$1262.29
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1248.81	$1248.81
SALINAS (CA)	$1243.81	$1243.81
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1405.00	$1405.00
SANTA CRUZ-WATSONVILLE (CA)	$1257.69	$1257.69
SANTA ROSA-PETALUMA (CA)	$1268.87	$1268.87
STOCKTON (CA)	$1210.44	$1210.44
VISALIA (CA)	$1210.44	$1210.44
YUBA CITY (CA)	$1210.44	$1210.44
EL CENTRO (CA)	$1211.25	$1211.25
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1257.89	$1257.89
SAN LUIS OBISPO-PASO ROBLES (CA)	$1226.50	$1226.50
SANTA MARIA-SANTA BARBARA (CA)	$1244.31	$1244.31
REST OF CALIFORNIA (CA)	$1210.44	$1210.44
COLORADO (CO)	$1234.50	$1234.50
CONNECTICUT (CT)	$1314.19	$1314.19
DC + MD/VA SUBURBS (DC)	$1360.15	$1360.15
DELAWARE (DE)	$1220.24	$1220.24
FORT LAUDERDALE (FL)	$1372.71	$1372.71
MIAMI (FL)	$1499.48	$1499.48
REST OF FLORIDA (FL)	$1302.22	$1302.22
ATLANTA (GA)	$1278.01	$1278.01
REST OF GEORGIA (GA)	$1228.15	$1228.15
HAWAII, GUAM (HI)	$1220.74	$1220.74
IOWA (IA)	$1108.48	$1108.48
IDAHO (ID)	$1122.61	$1122.61
EAST ST. LOUIS (IL)	$1371.21	$1371.21
SUBURBAN CHICAGO (IL)	$1377.05	$1377.05
CHICAGO (IL)	$1453.21	$1453.21
REST OF ILLINOIS (IL)	$1295.84	$1295.84
INDIANA (IN)	$1127.32	$1127.32
KANSAS (KS)	$1121.64	$1121.64
KENTUCKY (KY)	$1182.34	$1182.34
NEW ORLEANS (LA)	$1237.41	$1237.41
REST OF LOUISIANA (LA)	$1187.78	$1187.78
METROPOLITAN BOSTON (MA)	$1321.01	$1321.01
REST OF MASSACHUSETTS (MA)	$1235.79	$1235.79
BALTIMORE/SURR. CNTYS (MD)	$1314.24	$1314.24
REST OF MARYLAND (MD)	$1235.78	$1235.78
SOUTHERN MAINE (ME)	$1174.61	$1174.61
REST OF MAINE (ME)	$1146.65	$1146.65
DETROIT (MI)	$1335.10	$1335.10
REST OF MICHIGAN (MI)	$1225.83	$1225.83
MINNESOTA (MN)	$1134.76	$1134.76
METROPOLITAN ST. LOUIS (MO)	$1219.90	$1219.90
METROPOLITAN KANSAS CITY (MO)	$1211.01	$1211.01
REST OF MISSOURI (MO)	$1181.78	$1181.78
MISSISSIPPI (MS)	$1143.49	$1143.49
MONTANA** (MT)	$1237.18	$1237.18
NORTH CAROLINA (NC)	$1154.25	$1154.25
NORTH DAKOTA** (ND)	$1141.68	$1141.68
NEBRASKA (NE)	$1108.40	$1108.40
NEW HAMPSHIRE (NH)	$1232.65	$1232.65
NORTHERN NJ (NJ)	$1352.49	$1352.49
REST OF NEW JERSEY (NJ)	$1315.62	$1315.62
NEW MEXICO (NM)	$1238.94	$1238.94
NEVADA** (NV)	$1210.94	$1210.94
MANHATTAN (NY)	$1437.51	$1437.51
NYC SUBURBS/LONG ISLAND (NY)	$1491.31	$1491.31
POUGHKPSIE/N NYC SUBURBS (NY)	$1338.48	$1338.48
QUEENS (NY)	$1421.75	$1421.75
REST OF NEW YORK (NY)	$1170.92	$1170.92
OHIO (OH)	$1206.31	$1206.31
OKLAHOMA (OK)	$1161.57	$1161.57
PORTLAND (OR)	$1248.90	$1248.90
REST OF OREGON (OR)	$1188.10	$1188.10
METROPOLITAN PHILADELPHIA (PA)	$1296.60	$1296.60
REST OF PENNSYLVANIA (PA)	$1198.01	$1198.01
PUERTO RICO (PR)	$1239.19	$1239.19
RHODE ISLAND (RI)	$1245.76	$1245.76
SOUTH CAROLINA (SC)	$1184.92	$1184.92
SOUTH DAKOTA** (SD)	$1130.38	$1130.38
TENNESSEE (TN)	$1128.83	$1128.83
BRAZORIA (TX)	$1204.27	$1204.27
DALLAS (TX)	$1219.43	$1219.43
GALVESTON (TX)	$1212.76	$1212.76
HOUSTON (TX)	$1301.17	$1301.17
BEAUMONT (TX)	$1192.44	$1192.44
FORT WORTH (TX)	$1217.79	$1217.79
AUSTIN (TX)	$1242.18	$1242.18
REST OF TEXAS (TX)	$1202.81	$1202.81
UTAH (UT)	$1198.64	$1198.64
VIRGINIA (VA)	$1183.73	$1183.73
VIRGIN ISLANDS (VI)	$1239.19	$1239.19
VERMONT (VT)	$1154.07	$1154.07
SEATTLE (KING CNTY) (WA)	$1327.89	$1327.89
REST OF WASHINGTON (WA)	$1227.87	$1227.87
WISCONSIN (WI)	$1110.18	$1110.18
WEST VIRGINIA (WV)	$1258.12	$1258.12
WYOMING** (WY)	$1195.56	$1195.56

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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 PFS amounts are built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. The GPCI-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which is why the two allowed amounts can vary; for some codes they may be the same. The conversion factor is updated annually and can shift due to legislation or budget-neutrality adjustments.

RVUs — work 21.04, practice expense 11.18 (non-facility) / 11.18 (facility), malpractice 4.83 — × 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 Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and locality-specific GPCIs can change the actual paid amount.
Annual conversion factor and RVU updates (including budget-neutrality adjustments) can change this amount year to year.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why do the non-facility and facility amounts differ for some codes?

Practice-expense RVUs account for overhead like staff, supplies, and equipment. When a service is performed in a facility (e.g., hospital), Medicare assumes the facility absorbs more of that overhead, so the facility practice-expense RVU is often lower than the non-facility RVU, resulting in a lower facility payment. For some codes, these amounts are nearly identical.

Why does the amount change by locality?

Each Medicare locality has its own GPCIs reflecting local costs for physician work, practice expense, and malpractice insurance. These indices adjust the RVUs before the conversion factor is applied, so the same code can price differently across the country.

Does this figure reflect what Medicare will actually pay?

No. It reflects the estimated Medicare-allowed amount before deductible and coinsurance. Medicare generally pays 80% of this amount after the deductible, and the actual claim payment may be further adjusted by modifiers, sequestration, or other claim-specific factors.

Where can I confirm the exact rate for my locality?

Your Medicare Administrative Contractor (MAC) publishes the finalized locality-specific fee schedule, which should be used to confirm the precise allowed amount for billing and appeals.

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.