Medicare Reimbursement for CPT 23040

CPT 23040 is a surgical procedure code reported to Medicare and other payers; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted for locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$673.03	$673.03
ALASKA* (AK)	$821.30	$821.30
ALABAMA (AL)	$608.38	$608.38
ARKANSAS (AR)	$600.40	$600.40
ARIZONA (AZ)	$654.61	$654.61
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$784.43	$784.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$796.64	$796.64
OXNARD-THOUSAND OAKS-VENTURA (CA)	$710.01	$710.01
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$717.11	$717.11
NAPA (CA)	$753.02	$753.02
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$786.65	$786.65
VALLEJO (CA)	$749.82	$749.82
BAKERSFIELD (CA)	$681.30	$681.30
CHICO (CA)	$675.88	$675.88
FRESNO (CA)	$675.88	$675.88
HANFORD-CORCORAN (CA)	$675.88	$675.88
MADERA (CA)	$675.88	$675.88
MERCED (CA)	$675.88	$675.88
MODESTO (CA)	$675.88	$675.88
REDDING (CA)	$675.88	$675.88
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$696.95	$696.95
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$701.34	$701.34
SALINAS (CA)	$698.60	$698.60
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$805.74	$805.74
SANTA CRUZ-WATSONVILLE (CA)	$711.66	$711.66
SANTA ROSA-PETALUMA (CA)	$718.28	$718.28
STOCKTON (CA)	$675.88	$675.88
VISALIA (CA)	$675.88	$675.88
YUBA CITY (CA)	$675.88	$675.88
EL CENTRO (CA)	$676.21	$676.21
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$709.40	$709.40
SAN LUIS OBISPO-PASO ROBLES (CA)	$688.35	$688.35
SANTA MARIA-SANTA BARBARA (CA)	$699.67	$699.67
REST OF CALIFORNIA (CA)	$675.88	$675.88
COLORADO (CO)	$681.06	$681.06
CONNECTICUT (CT)	$715.45	$715.45
DC + MD/VA SUBURBS (DC)	$749.18	$749.18
DELAWARE (DE)	$664.53	$664.53
FORT LAUDERDALE (FL)	$729.69	$729.69
MIAMI (FL)	$785.01	$785.01
REST OF FLORIDA (FL)	$693.20	$693.20
ATLANTA (GA)	$691.78	$691.78
REST OF GEORGIA (GA)	$654.29	$654.29
HAWAII, GUAM (HI)	$685.19	$685.19
IOWA (IA)	$608.91	$608.91
IDAHO (ID)	$615.33	$615.33
EAST ST. LOUIS (IL)	$716.22	$716.22
SUBURBAN CHICAGO (IL)	$733.62	$733.62
CHICAGO (IL)	$761.48	$761.48
REST OF ILLINOIS (IL)	$684.66	$684.66
INDIANA (IN)	$618.21	$618.21
KANSAS (KS)	$612.72	$612.72
KENTUCKY (KY)	$635.28	$635.28
NEW ORLEANS (LA)	$664.83	$664.83
REST OF LOUISIANA (LA)	$636.94	$636.94
METROPOLITAN BOSTON (MA)	$735.09	$735.09
REST OF MASSACHUSETTS (MA)	$680.19	$680.19
BALTIMORE/SURR. CNTYS (MD)	$714.79	$714.79
REST OF MARYLAND (MD)	$674.32	$674.32
SOUTHERN MAINE (ME)	$646.26	$646.26
REST OF MAINE (ME)	$625.09	$625.09
DETROIT (MI)	$707.79	$707.79
REST OF MICHIGAN (MI)	$656.25	$656.25
MINNESOTA (MN)	$635.35	$635.35
METROPOLITAN ST. LOUIS (MO)	$659.24	$659.24
METROPOLITAN KANSAS CITY (MO)	$653.84	$653.84
REST OF MISSOURI (MO)	$631.32	$631.32
MISSISSIPPI (MS)	$615.64	$615.64
MONTANA** (MT)	$672.90	$672.90
NORTH CAROLINA (NC)	$629.97	$629.97
NORTH DAKOTA** (ND)	$634.14	$634.14
NEBRASKA (NE)	$609.98	$609.98
NEW HAMPSHIRE (NH)	$676.73	$676.73
NORTHERN NJ (NJ)	$743.88	$743.88
REST OF NEW JERSEY (NJ)	$718.76	$718.76
NEW MEXICO (NM)	$662.12	$662.12
NEVADA** (NV)	$662.39	$662.39
MANHATTAN (NY)	$778.69	$778.69
NYC SUBURBS/LONG ISLAND (NY)	$804.26	$804.26
POUGHKPSIE/N NYC SUBURBS (NY)	$728.61	$728.61
QUEENS (NY)	$775.06	$775.06
REST OF NEW YORK (NY)	$639.09	$639.09
OHIO (OH)	$648.33	$648.33
OKLAHOMA (OK)	$627.41	$627.41
PORTLAND (OR)	$693.53	$693.53
REST OF OREGON (OR)	$652.43	$652.43
METROPOLITAN PHILADELPHIA (PA)	$703.27	$703.27
REST OF PENNSYLVANIA (PA)	$645.65	$645.65
PUERTO RICO (PR)	$675.24	$675.24
RHODE ISLAND (RI)	$681.56	$681.56
SOUTH CAROLINA (SC)	$641.17	$641.17
SOUTH DAKOTA** (SD)	$629.56	$629.56
TENNESSEE (TN)	$616.33	$616.33
BRAZORIA (TX)	$658.56	$658.56
DALLAS (TX)	$665.43	$665.43
GALVESTON (TX)	$662.28	$662.28
HOUSTON (TX)	$698.15	$698.15
BEAUMONT (TX)	$642.29	$642.29
FORT WORTH (TX)	$663.38	$663.38
AUSTIN (TX)	$683.02	$683.02
REST OF TEXAS (TX)	$651.89	$651.89
UTAH (UT)	$648.96	$648.96
VIRGINIA (VA)	$648.85	$648.85
VIRGIN ISLANDS (VI)	$675.24	$675.24
VERMONT (VT)	$637.79	$637.79
SEATTLE (KING CNTY) (WA)	$742.74	$742.74
REST OF WASHINGTON (WA)	$676.88	$676.88
WISCONSIN (WI)	$615.55	$615.55
WEST VIRGINIA (WV)	$663.26	$663.26
WYOMING** (WY)	$656.01	$656.01

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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 fee schedule 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 performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar figure set each year) to produce the allowed amount. Non-facility and facility rates can differ because the practice-expense RVU often varies depending on where the service is furnished (e.g., physician office versus hospital or ASC).

RVUs — work 9.51, practice expense 8.68 (non-facility) / 8.68 (facility), malpractice 1.96 — × 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 generally responsible for the remainder.
Actual payment can vary based on locality GPCIs, applicable modifiers, claims-processing adjustments, sequestration, and annual budget-neutrality changes to RVUs or the conversion factor.
Always verify current rates and coverage policies 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?

The two amounts can differ because the practice-expense RVU component often varies depending on whether the service is furnished in a non-facility setting (like a physician's office) or a facility setting (like a hospital or ambulatory surgical center), where the facility itself bears more overhead costs.

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

The national amount uses a GPCI value of 1.0 for all components, while locality-specific amounts apply the actual GPCIs for work, practice expense, and malpractice in that geographic area, which can raise or lower the final payment.

Does this page tell me what CPT 23040 describes clinically?

No. CPT code descriptors are copyrighted by the American Medical Association and are not reproduced here. Consult your CPT codebook or AMA-licensed resource for the official descriptor.

Will modifiers change this amount?

Yes, modifiers (such as bilateral, multiple procedure, or assistant-at-surgery modifiers) can increase or decrease the allowed amount, and those adjustments are not reflected in the base figures shown on this page.

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.