Medicare Reimbursement for CPT 23076

This page covers CPT code 23076, a procedure code defined by the American Medical Association (AMA) and not reproduced here due to licensing restrictions. It shows the Medicare Physician Fee Schedule (PFS) allowed amount nationally and adjusted for your locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$523.39	$523.39
ALASKA* (AK)	$634.33	$634.33
ALABAMA (AL)	$471.29	$471.29
ARKANSAS (AR)	$464.87	$464.87
ARIZONA (AZ)	$508.49	$508.49
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$608.39	$608.39
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$617.77	$617.77
OXNARD-THOUSAND OAKS-VENTURA (CA)	$551.08	$551.08
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$556.67	$556.67
NAPA (CA)	$584.24	$584.24
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$610.24	$610.24
VALLEJO (CA)	$581.57	$581.57
BAKERSFIELD (CA)	$528.55	$528.55
CHICO (CA)	$524.10	$524.10
FRESNO (CA)	$524.10	$524.10
HANFORD-CORCORAN (CA)	$524.10	$524.10
MADERA (CA)	$524.10	$524.10
MERCED (CA)	$524.10	$524.10
MODESTO (CA)	$524.10	$524.10
REDDING (CA)	$524.10	$524.10
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$541.60	$541.60
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$543.94	$543.94
SALINAS (CA)	$541.83	$541.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$625.34	$625.34
SANTA CRUZ-WATSONVILLE (CA)	$552.17	$552.17
SANTA ROSA-PETALUMA (CA)	$557.30	$557.30
STOCKTON (CA)	$524.10	$524.10
VISALIA (CA)	$524.10	$524.10
YUBA CITY (CA)	$524.10	$524.10
EL CENTRO (CA)	$524.37	$524.37
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$550.34	$550.34
SAN LUIS OBISPO-PASO ROBLES (CA)	$533.89	$533.89
SANTA MARIA-SANTA BARBARA (CA)	$542.70	$542.70
REST OF CALIFORNIA (CA)	$524.10	$524.10
COLORADO (CO)	$528.94	$528.94
CONNECTICUT (CT)	$557.19	$557.19
DC + MD/VA SUBURBS (DC)	$583.11	$583.11
DELAWARE (DE)	$516.37	$516.37
FORT LAUDERDALE (FL)	$570.34	$570.34
MIAMI (FL)	$615.98	$615.98
REST OF FLORIDA (FL)	$540.75	$540.75
ATLANTA (GA)	$538.70	$538.70
REST OF GEORGIA (GA)	$509.24	$509.24
HAWAII, GUAM (HI)	$531.68	$531.68
IOWA (IA)	$471.20	$471.20
IDAHO (ID)	$476.48	$476.48
EAST ST. LOUIS (IL)	$560.37	$560.37
SUBURBAN CHICAGO (IL)	$573.26	$573.26
CHICAGO (IL)	$596.72	$596.72
REST OF ILLINOIS (IL)	$534.23	$534.23
INDIANA (IN)	$478.78	$478.78
KANSAS (KS)	$474.52	$474.52
KENTUCKY (KY)	$493.48	$493.48
NEW ORLEANS (LA)	$517.36	$517.36
REST OF LOUISIANA (LA)	$494.91	$494.91
METROPOLITAN BOSTON (MA)	$571.48	$571.48
REST OF MASSACHUSETTS (MA)	$528.27	$528.27
BALTIMORE/SURR. CNTYS (MD)	$556.78	$556.78
REST OF MARYLAND (MD)	$524.07	$524.07
SOUTHERN MAINE (ME)	$501.25	$501.25
REST OF MAINE (ME)	$484.59	$484.59
DETROIT (MI)	$552.77	$552.77
REST OF MICHIGAN (MI)	$510.60	$510.60
MINNESOTA (MN)	$491.67	$491.67
METROPOLITAN ST. LOUIS (MO)	$512.57	$512.57
METROPOLITAN KANSAS CITY (MO)	$508.24	$508.24
REST OF MISSOURI (MO)	$490.54	$490.54
MISSISSIPPI (MS)	$477.52	$477.52
MONTANA** (MT)	$523.28	$523.28
NORTH CAROLINA (NC)	$488.48	$488.48
NORTH DAKOTA** (ND)	$491.05	$491.05
NEBRASKA (NE)	$471.99	$471.99
NEW HAMPSHIRE (NH)	$525.93	$525.93
NORTHERN NJ (NJ)	$578.73	$578.73
REST OF NEW JERSEY (NJ)	$559.28	$559.28
NEW MEXICO (NM)	$515.43	$515.43
NEVADA** (NV)	$514.53	$514.53
MANHATTAN (NY)	$607.63	$607.63
NYC SUBURBS/LONG ISLAND (NY)	$628.54	$628.54
POUGHKPSIE/N NYC SUBURBS (NY)	$567.32	$567.32
QUEENS (NY)	$604.35	$604.35
REST OF NEW YORK (NY)	$495.83	$495.83
OHIO (OH)	$504.01	$504.01
OKLAHOMA (OK)	$486.88	$486.88
PORTLAND (OR)	$538.60	$538.60
REST OF OREGON (OR)	$506.31	$506.31
METROPOLITAN PHILADELPHIA (PA)	$547.58	$547.58
REST OF PENNSYLVANIA (PA)	$501.72	$501.72
PUERTO RICO (PR)	$525.08	$525.08
RHODE ISLAND (RI)	$529.61	$529.61
SOUTH CAROLINA (SC)	$497.91	$497.91
SOUTH DAKOTA** (SD)	$487.24	$487.24
TENNESSEE (TN)	$477.46	$477.46
BRAZORIA (TX)	$511.29	$511.29
DALLAS (TX)	$516.92	$516.92
GALVESTON (TX)	$514.36	$514.36
HOUSTON (TX)	$544.20	$544.20
BEAUMONT (TX)	$499.03	$499.03
FORT WORTH (TX)	$515.35	$515.35
AUSTIN (TX)	$530.88	$530.88
REST OF TEXAS (TX)	$506.49	$506.49
UTAH (UT)	$504.17	$504.17
VIRGINIA (VA)	$503.51	$503.51
VIRGIN ISLANDS (VI)	$525.08	$525.08
VERMONT (VT)	$494.22	$494.22
SEATTLE (KING CNTY) (WA)	$577.20	$577.20
REST OF WASHINGTON (WA)	$525.59	$525.59
WISCONSIN (WI)	$476.15	$476.15
WEST VIRGINIA (WV)	$517.02	$517.02
WYOMING** (WY)	$509.24	$509.24

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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

The Medicare PFS allowed 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 the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, reflecting local cost-of-living and practice cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can use different practice-expense RVUs, which is why the same code may have two different allowed amounts depending on place of service.

RVUs — work 7.22, practice expense 6.82 (non-facility) / 6.82 (facility), malpractice 1.63 — × 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 annual Part B deductible is met; the patient or secondary insurer is generally responsible for the rest.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean the actual allowed amount in your area may differ from the national figure shown.
Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does CPT 23076 show two different amounts for facility and non-facility?

Practice-expense RVUs differ by place of service because overhead costs (staff, supplies, equipment) are treated differently when a service is performed in a facility versus a non-facility setting like a physician's office.

Why might my local Medicare payment differ from the national amount shown here?

The national amount uses a standard GPCI baseline, while actual payments are adjusted using the GPCIs specific to the locality where the service was rendered, which can raise or lower the amount.

Does this amount include the patient's share?

No. The figure represents the full Medicare-allowed amount before cost-sharing; under standard Part B rules, Medicare generally pays 80% after the deductible, with the remainder owed by the patient or secondary payer.

Can modifiers change the amount paid for this code?

Yes. Modifiers indicating reduced services, bilateral procedures, or other circumstances 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.