Medicare Reimbursement for CPT 23031

This page covers CPT code 23031, a physician procedure code reported under Medicare Part B. It shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and by locality, broken out separately for non-facility (e.g., office) and facility (e.g., hospital, ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$464.94	$215.77
ALASKA* (AK)	$524.90	$259.53
ALABAMA (AL)	$412.30	$194.27
ARKANSAS (AR)	$405.64	$191.61
ARIZONA (AZ)	$451.19	$209.75
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$608.20	$256.86
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$620.39	$261.08
OXNARD-THOUSAND OAKS-VENTURA (CA)	$524.93	$230.41
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$527.24	$232.47
NAPA (CA)	$574.20	$245.80
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$608.84	$257.51
VALLEJO (CA)	$573.27	$244.86
BAKERSFIELD (CA)	$493.31	$220.22
CHICO (CA)	$491.74	$218.64
FRESNO (CA)	$491.74	$218.64
HANFORD-CORCORAN (CA)	$491.74	$218.64
MADERA (CA)	$491.74	$218.64
MERCED (CA)	$491.74	$218.64
MODESTO (CA)	$491.74	$218.64
REDDING (CA)	$491.74	$218.64
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$497.86	$224.77
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$517.25	$227.47
SALINAS (CA)	$515.38	$226.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$623.03	$263.73
SANTA CRUZ-WATSONVILLE (CA)	$534.35	$231.61
SANTA ROSA-PETALUMA (CA)	$539.78	$233.80
STOCKTON (CA)	$491.74	$218.64
VISALIA (CA)	$491.74	$218.64
YUBA CITY (CA)	$491.74	$218.64
EL CENTRO (CA)	$491.83	$218.74
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$528.54	$230.53
SAN LUIS OBISPO-PASO ROBLES (CA)	$507.00	$223.20
SANTA MARIA-SANTA BARBARA (CA)	$517.59	$227.06
REST OF CALIFORNIA (CA)	$491.74	$218.64
COLORADO (CO)	$484.58	$219.47
CONNECTICUT (CT)	$498.09	$229.74
DC + MD/VA SUBURBS (DC)	$535.20	$241.67
DELAWARE (DE)	$459.21	$213.03
FORT LAUDERDALE (FL)	$484.94	$232.53
MIAMI (FL)	$508.61	$249.22
REST OF FLORIDA (FL)	$458.89	$220.69
ATLANTA (GA)	$474.72	$221.56
REST OF GEORGIA (GA)	$430.25	$207.99
HAWAII, GUAM (HI)	$505.57	$222.26
IOWA (IA)	$423.28	$195.29
IDAHO (ID)	$426.50	$197.27
EAST ST. LOUIS (IL)	$455.84	$226.60
SUBURBAN CHICAGO (IL)	$489.86	$233.96
CHICAGO (IL)	$492.01	$241.59
REST OF ILLINOIS (IL)	$444.77	$217.28
INDIANA (IN)	$429.24	$198.25
KANSAS (KS)	$421.41	$196.16
KENTUCKY (KY)	$423.91	$202.40
NEW ORLEANS (LA)	$446.58	$212.11
REST OF LOUISIANA (LA)	$423.31	$202.79
METROPOLITAN BOSTON (MA)	$535.45	$237.94
REST OF MASSACHUSETTS (MA)	$481.35	$218.97
BALTIMORE/SURR. CNTYS (MD)	$496.83	$229.46
REST OF MARYLAND (MD)	$468.55	$216.39
SOUTHERN MAINE (ME)	$454.72	$207.79
REST OF MAINE (ME)	$429.34	$200.10
DETROIT (MI)	$465.57	$225.12
REST OF MICHIGAN (MI)	$436.51	$209.01
MINNESOTA (MN)	$461.83	$205.44
METROPOLITAN ST. LOUIS (MO)	$447.94	$210.73
METROPOLITAN KANSAS CITY (MO)	$442.84	$208.87
REST OF MISSOURI (MO)	$415.45	$200.66
MISSISSIPPI (MS)	$410.62	$196.08
MONTANA** (MT)	$464.90	$215.73
NORTH CAROLINA (NC)	$434.28	$201.80
NORTH DAKOTA** (ND)	$453.63	$204.46
NEBRASKA (NE)	$425.76	$195.78
NEW HAMPSHIRE (NH)	$477.12	$217.73
NORTHERN NJ (NJ)	$528.77	$239.73
REST OF NEW JERSEY (NJ)	$503.09	$230.99
NEW MEXICO (NM)	$439.30	$210.81
NEVADA** (NV)	$462.12	$212.70
MANHATTAN (NY)	$539.43	$249.89
NYC SUBURBS/LONG ISLAND (NY)	$554.18	$257.91
POUGHKPSIE/N NYC SUBURBS (NY)	$506.76	$233.91
QUEENS (NY)	$543.79	$249.27
REST OF NEW YORK (NY)	$441.53	$204.82
OHIO (OH)	$434.20	$206.71
OKLAHOMA (OK)	$422.70	$200.19
PORTLAND (OR)	$500.93	$224.10
REST OF OREGON (OR)	$457.87	$209.69
METROPOLITAN PHILADELPHIA (PA)	$484.81	$225.42
REST OF PENNSYLVANIA (PA)	$434.78	$206.04
PUERTO RICO (PR)	$468.56	$216.65
RHODE ISLAND (RI)	$476.33	$218.93
SOUTH CAROLINA (SC)	$435.10	$204.87
SOUTH DAKOTA** (SD)	$452.30	$203.13
TENNESSEE (TN)	$423.82	$197.32
BRAZORIA (TX)	$458.28	$211.36
DALLAS (TX)	$461.63	$213.46
GALVESTON (TX)	$459.91	$212.48
HOUSTON (TX)	$470.34	$222.91
BEAUMONT (TX)	$431.63	$204.89
FORT WORTH (TX)	$458.33	$212.65
AUSTIN (TX)	$483.54	$219.92
REST OF TEXAS (TX)	$444.99	$208.52
UTAH (UT)	$441.70	$207.48
VIRGINIA (VA)	$453.31	$208.37
VIRGIN ISLANDS (VI)	$468.56	$216.65
VERMONT (VT)	$451.98	$205.31
SEATTLE (KING CNTY) (WA)	$546.60	$240.86
REST OF WASHINGTON (WA)	$480.39	$218.01
WISCONSIN (WI)	$436.85	$198.15
WEST VIRGINIA (WV)	$426.63	$210.11
WYOMING** (WY)	$459.99	$210.82

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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) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is furnished, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility amounts differ mainly because the practice-expense RVU is lower in facility settings, reflecting that the facility (not the billing physician) incurs certain overhead costs.

RVUs — work 2.72, practice expense 10.63 (non-facility) / 3.17 (facility), malpractice 0.57 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates 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 generally responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean actual payment will differ from the national average shown here.
Always confirm current-year rates and locality pricing with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount for this code?

The practice-expense RVU is lower in the facility setting because the facility, rather than the billing physician, bears most of the overhead and supply costs for that setting.

Will my locality's payment match the national amount shown here?

Not necessarily. The national figure applies standard GPCIs; your local Medicare contractor applies locality-specific GPCIs, which can raise or lower the allowed amount.

Does this amount reflect what Medicare will actually pay?

No — it reflects the Medicare-allowed amount before the 80/20 coinsurance split, deductible status, modifiers, or sequestration are applied, so actual payment may be lower.

Why isn't the CPT code description shown on this page?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so they cannot be reproduced here; refer to your CPT codebook or EHR for the official descriptor.

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.