Medicare Reimbursement for CPT 23075

This page covers CPT code 23075, a procedure code reported to Medicare for physician and outpatient services. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount, both at the national level and adjusted for your locality, and breaks out the difference between non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$554.79	$321.32
ALASKA* (AK)	$634.63	$385.98
ALABAMA (AL)	$493.06	$288.77
ARKANSAS (AR)	$485.30	$284.75
ARIZONA (AZ)	$538.36	$312.13
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$708.85	$379.65
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$722.43	$385.76
OXNARD-THOUSAND OAKS-VENTURA (CA)	$617.49	$341.53
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$620.92	$344.72
NAPA (CA)	$671.40	$363.68
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$709.89	$380.70
VALLEJO (CA)	$669.90	$362.18
BAKERSFIELD (CA)	$582.54	$326.65
CHICO (CA)	$580.02	$324.14
FRESNO (CA)	$580.02	$324.14
HANFORD-CORCORAN (CA)	$580.02	$324.14
MADERA (CA)	$580.02	$324.14
MERCED (CA)	$580.02	$324.14
MODESTO (CA)	$580.02	$324.14
REDDING (CA)	$580.02	$324.14
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$589.90	$334.01
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$608.56	$337.03
SALINAS (CA)	$606.33	$335.73
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$726.70	$390.03
SANTA CRUZ-WATSONVILLE (CA)	$626.64	$342.97
SANTA ROSA-PETALUMA (CA)	$632.90	$346.20
STOCKTON (CA)	$580.02	$324.14
VISALIA (CA)	$580.02	$324.14
YUBA CITY (CA)	$580.02	$324.14
EL CENTRO (CA)	$580.18	$324.29
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$620.70	$341.47
SAN LUIS OBISPO-PASO ROBLES (CA)	$596.67	$330.74
SANTA MARIA-SANTA BARBARA (CA)	$608.63	$336.40
REST OF CALIFORNIA (CA)	$580.02	$324.14
COLORADO (CO)	$574.48	$326.06
CONNECTICUT (CT)	$593.79	$342.34
DC + MD/VA SUBURBS (DC)	$634.56	$359.53
DELAWARE (DE)	$547.72	$317.05
FORT LAUDERDALE (FL)	$584.65	$348.14
MIAMI (FL)	$617.65	$374.60
REST OF FLORIDA (FL)	$553.21	$330.01
ATLANTA (GA)	$567.57	$330.36
REST OF GEORGIA (GA)	$518.88	$310.62
HAWAII, GUAM (HI)	$594.89	$329.43
IOWA (IA)	$503.35	$289.73
IDAHO (ID)	$507.63	$292.83
EAST ST. LOUIS (IL)	$554.98	$340.18
SUBURBAN CHICAGO (IL)	$589.92	$350.15
CHICAGO (IL)	$597.48	$362.84
REST OF ILLINOIS (IL)	$538.41	$325.25
INDIANA (IN)	$510.73	$294.31
KANSAS (KS)	$502.38	$291.33
KENTUCKY (KY)	$509.21	$301.65
NEW ORLEANS (LA)	$536.13	$316.43
REST OF LOUISIANA (LA)	$508.98	$302.36
METROPOLITAN BOSTON (MA)	$632.12	$353.36
REST OF MASSACHUSETTS (MA)	$571.26	$325.41
BALTIMORE/SURR. CNTYS (MD)	$592.52	$342.01
REST OF MARYLAND (MD)	$558.28	$322.01
SOUTHERN MAINE (ME)	$539.97	$308.59
REST OF MAINE (ME)	$512.20	$297.41
DETROIT (MI)	$562.32	$337.02
REST OF MICHIGAN (MI)	$525.07	$311.91
MINNESOTA (MN)	$544.38	$304.14
METROPOLITAN ST. LOUIS (MO)	$536.27	$314.00
METROPOLITAN KANSAS CITY (MO)	$530.47	$311.24
REST OF MISSOURI (MO)	$500.57	$299.31
MISSISSIPPI (MS)	$492.96	$291.94
MONTANA** (MT)	$554.73	$321.26
NORTH CAROLINA (NC)	$517.76	$299.93
NORTH DAKOTA** (ND)	$536.54	$303.06
NEBRASKA (NE)	$505.87	$290.37
NEW HAMPSHIRE (NH)	$566.82	$323.77
NORTHERN NJ (NJ)	$627.44	$356.62
REST OF NEW JERSEY (NJ)	$598.86	$343.91
NEW MEXICO (NM)	$528.83	$314.74
NEVADA** (NV)	$550.04	$316.34
MANHATTAN (NY)	$644.27	$372.98
NYC SUBURBS/LONG ISLAND (NY)	$663.05	$385.45
POUGHKPSIE/N NYC SUBURBS (NY)	$604.18	$348.53
QUEENS (NY)	$647.59	$371.63
REST OF NEW YORK (NY)	$526.31	$304.51
OHIO (OH)	$521.36	$308.20
OKLAHOMA (OK)	$506.51	$298.02
PORTLAND (OR)	$592.08	$332.70
REST OF OREGON (OR)	$544.11	$311.58
METROPOLITAN PHILADELPHIA (PA)	$579.06	$336.01
REST OF PENNSYLVANIA (PA)	$521.36	$307.03
PUERTO RICO (PR)	$558.59	$322.55
RHODE ISLAND (RI)	$566.85	$325.67
SOUTH CAROLINA (SC)	$520.76	$305.03
SOUTH DAKOTA** (SD)	$534.39	$300.91
TENNESSEE (TN)	$505.33	$293.11
BRAZORIA (TX)	$545.64	$314.27
DALLAS (TX)	$550.11	$317.57
GALVESTON (TX)	$547.89	$316.05
HOUSTON (TX)	$564.73	$332.89
BEAUMONT (TX)	$517.77	$305.31
FORT WORTH (TX)	$546.64	$316.43
AUSTIN (TX)	$574.01	$327.00
REST OF TEXAS (TX)	$532.07	$310.50
UTAH (UT)	$528.43	$308.96
VIRGINIA (VA)	$539.17	$309.67
VIRGIN ISLANDS (VI)	$558.59	$322.55
VERMONT (VT)	$535.74	$304.60
SEATTLE (KING CNTY) (WA)	$643.89	$357.42
REST OF WASHINGTON (WA)	$569.74	$323.90
WISCONSIN (WI)	$517.27	$293.60
WEST VIRGINIA (WV)	$517.32	$314.43
WYOMING** (WY)	$546.80	$313.33

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units 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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ depending on whether the service is billed in a non-facility setting (like a private office, where the practice bears more overhead) versus a facility setting (like a hospital, where the facility itself is paid separately for overhead), which is why non-facility and facility rates differ. These calculations are updated annually and can shift due to CMS rulemaking and budget-neutrality adjustments.

RVUs — work 4.1, practice expense 11.59 (non-facility) / 4.6 (facility), malpractice 0.92 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure 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 insurer is responsible for the rest.
Actual payment can vary by locality, facility type, applicable modifiers, claim-specific circumstances, and sequestration or other federal adjustments.
Annual conversion factor changes and budget-neutrality adjustments can alter amounts from one year to the next.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why is the non-facility amount different from the facility amount for CPT 23075?

The non-facility rate includes higher practice-expense RVUs because the billing provider is assumed to bear the overhead costs (space, staff, supplies). In a facility setting, the facility bills separately for overhead, so the physician's practice-expense RVU — and therefore the allowed amount — is lower.

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

Not exactly. The national figure uses an average GPCI, while your actual payment depends on the GPCIs assigned to your specific Medicare locality, which adjust work, practice expense, and malpractice costs for regional variation.

Does this amount reflect what my practice will actually collect?

No. This is the Medicare-allowed amount before patient responsibility, deductibles, secondary payers, modifiers, or any sequestration reduction are applied.

Why might the amount change next year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, which can increase or decrease the allowed amount for a given code.

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.