Medicare Reimbursement for CPT 23000

This page covers CPT code 23000, a physician procedure code defined by the American Medical Association. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount, both nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$571.49	$336.01
ALASKA* (AK)	$660.11	$409.33
ALABAMA (AL)	$511.07	$305.03
ARKANSAS (AR)	$503.45	$301.17
ARIZONA (AZ)	$555.66	$327.48
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$736.79	$404.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$751.20	$411.64
OXNARD-THOUSAND OAKS-VENTURA (CA)	$639.95	$361.62
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$643.21	$364.64
NAPA (CA)	$697.06	$386.71
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$737.59	$405.57
VALLEJO (CA)	$695.92	$385.56
BAKERSFIELD (CA)	$603.73	$345.64
CHICO (CA)	$601.73	$343.65
FRESNO (CA)	$601.73	$343.65
HANFORD-CORCORAN (CA)	$601.73	$343.65
MADERA (CA)	$601.73	$343.65
MERCED (CA)	$601.73	$343.65
MODESTO (CA)	$601.73	$343.65
REDDING (CA)	$601.73	$343.65
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$609.29	$351.20
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$631.45	$357.59
SALINAS (CA)	$629.11	$356.19
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$754.45	$414.89
SANTA CRUZ-WATSONVILLE (CA)	$650.17	$364.06
SANTA ROSA-PETALUMA (CA)	$656.71	$367.54
STOCKTON (CA)	$601.73	$343.65
VISALIA (CA)	$601.73	$343.65
YUBA CITY (CA)	$601.73	$343.65
EL CENTRO (CA)	$601.85	$343.76
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$643.98	$362.35
SAN LUIS OBISPO-PASO ROBLES (CA)	$619.02	$350.81
SANTA MARIA-SANTA BARBARA (CA)	$631.48	$356.92
REST OF CALIFORNIA (CA)	$601.73	$343.65
COLORADO (CO)	$593.86	$343.31
CONNECTICUT (CT)	$610.28	$356.68
DC + MD/VA SUBURBS (DC)	$653.60	$376.20
DELAWARE (DE)	$565.03	$332.38
FORT LAUDERDALE (FL)	$595.61	$357.07
MIAMI (FL)	$623.73	$378.60
REST OF FLORIDA (FL)	$565.56	$340.44
ATLANTA (GA)	$583.06	$343.82
REST OF GEORGIA (GA)	$532.55	$322.50
HAWAII, GUAM (HI)	$616.74	$349.00
IOWA (IA)	$523.21	$307.75
IDAHO (ID)	$527.00	$310.36
EAST ST. LOUIS (IL)	$563.03	$346.39
SUBURBAN CHICAGO (IL)	$601.42	$359.58
CHICAGO (IL)	$604.80	$368.15
REST OF ILLINOIS (IL)	$549.67	$334.68
INDIANA (IN)	$530.12	$311.83
KANSAS (KS)	$521.29	$308.42
KENTUCKY (KY)	$524.86	$315.53
NEW ORLEANS (LA)	$550.94	$329.36
REST OF LOUISIANA (LA)	$524.26	$315.86
METROPOLITAN BOSTON (MA)	$652.92	$371.76
REST OF MASSACHUSETTS (MA)	$590.39	$342.44
BALTIMORE/SURR. CNTYS (MD)	$608.72	$356.06
REST OF MARYLAND (MD)	$575.86	$337.56
SOUTHERN MAINE (ME)	$559.24	$325.89
REST OF MAINE (ME)	$530.48	$313.84
DETROIT (MI)	$573.45	$346.22
REST OF MICHIGAN (MI)	$539.52	$324.53
MINNESOTA (MN)	$566.69	$324.39
METROPOLITAN ST. LOUIS (MO)	$552.23	$328.06
METROPOLITAN KANSAS CITY (MO)	$546.42	$325.31
REST OF MISSOURI (MO)	$515.39	$312.40
MISSISSIPPI (MS)	$509.49	$306.74
MONTANA** (MT)	$571.44	$335.97
NORTH CAROLINA (NC)	$536.11	$316.41
NORTH DAKOTA** (ND)	$557.60	$322.12
NEBRASKA (NE)	$525.98	$308.64
NEW HAMPSHIRE (NH)	$585.05	$339.92
NORTHERN NJ (NJ)	$646.62	$373.47
REST OF NEW JERSEY (NJ)	$616.59	$359.45
NEW MEXICO (NM)	$542.81	$326.88
NEVADA** (NV)	$567.99	$332.28
MANHATTAN (NY)	$659.68	$386.06
NYC SUBURBS/LONG ISLAND (NY)	$676.87	$396.89
POUGHKPSIE/N NYC SUBURBS (NY)	$621.17	$363.32
QUEENS (NY)	$664.36	$386.02
REST OF NEW YORK (NY)	$544.44	$320.74
OHIO (OH)	$536.69	$321.70
OKLAHOMA (OK)	$523.25	$312.97
PORTLAND (OR)	$612.48	$350.86
REST OF OREGON (OR)	$562.94	$328.40
METROPOLITAN PHILADELPHIA (PA)	$595.12	$349.99
REST OF PENNSYLVANIA (PA)	$537.23	$321.06
PUERTO RICO (PR)	$575.56	$337.50
RHODE ISLAND (RI)	$585.01	$341.76
SOUTH CAROLINA (SC)	$537.42	$319.84
SOUTH DAKOTA** (SD)	$555.96	$320.49
TENNESSEE (TN)	$524.07	$310.02
BRAZORIA (TX)	$563.89	$330.54
DALLAS (TX)	$567.87	$333.34
GALVESTON (TX)	$565.82	$331.99
HOUSTON (TX)	$578.63	$344.81
BEAUMONT (TX)	$533.64	$319.35
FORT WORTH (TX)	$564.16	$331.98
AUSTIN (TX)	$592.44	$343.31
REST OF TEXAS (TX)	$548.71	$325.24
UTAH (UT)	$544.98	$323.63
VIRGINIA (VA)	$557.78	$326.31
VIRGIN ISLANDS (VI)	$575.56	$337.50
VERMONT (VT)	$555.92	$322.80
SEATTLE (KING CNTY) (WA)	$665.80	$376.87
REST OF WASHINGTON (WA)	$589.11	$341.16
WISCONSIN (WI)	$538.42	$312.83
WEST VIRGINIA (WV)	$528.89	$324.26
WYOMING** (WY)	$565.41	$329.93

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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 allowed amount is calculated by combining three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. These geographically adjusted RVUs are summed and then multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility rates (e.g., private office) typically include higher practice-expense RVUs than facility rates (e.g., hospital), since the facility bears more of the overhead cost in that setting. The resulting national or locality-specific figure represents the full Medicare-approved amount before patient cost-sharing is applied.

RVUs — work 4.37, practice expense 12.04 (non-facility) / 4.99 (facility), malpractice 0.7 — × 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 their deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claims-processing adjustments (e.g., sequestration), and annual budget-neutrality changes to RVUs or the conversion factor.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

Facility rates use lower practice-expense RVUs because the facility (not the physician's office) incurs most of the overhead costs, such as equipment and staff, for the procedure.

Does this amount reflect what Medicare actually pays?

It reflects the Medicare-allowed amount. Medicare generally pays 80% of this figure after the deductible; the remaining 20% is typically billed to the patient or a secondary payer.

Why might my locality's amount differ from the national figure?

Locality-specific Geographic Practice Cost Indices (GPCIs) adjust the RVUs to reflect regional differences in wages, rent, and malpractice costs, so the final allowed amount can be higher or lower than the national average.

Can modifiers change this amount?

Yes. Modifiers (e.g., for bilateral procedures, reduced services, or assistant surgeons) can increase or decrease the allowed amount from the base rate shown here.

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.