Medicare Reimbursement for CPT Code 23078

This page explains the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code. It shows the national estimate as well as locality-adjusted estimates, broken out by non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1325.68	$1325.68
ALASKA* (AK)	$1645.17	$1645.17
ALABAMA (AL)	$1199.97	$1199.97
ARKANSAS (AR)	$1184.64	$1184.64
ARIZONA (AZ)	$1288.41	$1288.41
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1472.69	$1472.69
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1492.57	$1492.57
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1360.12	$1360.12
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1376.96	$1376.96
NAPA (CA)	$1424.14	$1424.14
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1478.39	$1478.39
VALLEJO (CA)	$1415.92	$1415.92
BAKERSFIELD (CA)	$1314.74	$1314.74
CHICO (CA)	$1301.03	$1301.03
FRESNO (CA)	$1301.03	$1301.03
HANFORD-CORCORAN (CA)	$1301.03	$1301.03
MADERA (CA)	$1301.03	$1301.03
MERCED (CA)	$1301.03	$1301.03
MODESTO (CA)	$1301.03	$1301.03
REDDING (CA)	$1301.03	$1301.03
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1354.91	$1354.91
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1343.36	$1343.36
SALINAS (CA)	$1337.99	$1337.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1515.87	$1515.87
SANTA CRUZ-WATSONVILLE (CA)	$1354.36	$1354.36
SANTA ROSA-PETALUMA (CA)	$1366.48	$1366.48
STOCKTON (CA)	$1301.03	$1301.03
VISALIA (CA)	$1301.03	$1301.03
YUBA CITY (CA)	$1301.03	$1301.03
EL CENTRO (CA)	$1301.86	$1301.86
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1353.93	$1353.93
SAN LUIS OBISPO-PASO ROBLES (CA)	$1319.24	$1319.24
SANTA MARIA-SANTA BARBARA (CA)	$1338.75	$1338.75
REST OF CALIFORNIA (CA)	$1301.03	$1301.03
COLORADO (CO)	$1324.88	$1324.88
CONNECTICUT (CT)	$1408.19	$1408.19
DC + MD/VA SUBURBS (DC)	$1459.68	$1459.68
DELAWARE (DE)	$1307.34	$1307.34
FORT LAUDERDALE (FL)	$1466.67	$1466.67
MIAMI (FL)	$1599.42	$1599.42
REST OF FLORIDA (FL)	$1391.39	$1391.39
ATLANTA (GA)	$1368.36	$1368.36
REST OF GEORGIA (GA)	$1312.13	$1312.13
HAWAII, GUAM (HI)	$1313.11	$1313.11
IOWA (IA)	$1188.58	$1188.58
IDAHO (ID)	$1203.44	$1203.44
EAST ST. LOUIS (IL)	$1461.82	$1461.82
SUBURBAN CHICAGO (IL)	$1471.70	$1471.70
CHICAGO (IL)	$1550.08	$1550.08
REST OF ILLINOIS (IL)	$1383.23	$1383.23
INDIANA (IN)	$1208.58	$1208.58
KANSAS (KS)	$1201.86	$1201.86
KENTUCKY (KY)	$1264.42	$1264.42
NEW ORLEANS (LA)	$1323.50	$1323.50
REST OF LOUISIANA (LA)	$1269.93	$1269.93
METROPOLITAN BOSTON (MA)	$1419.52	$1419.52
REST OF MASSACHUSETTS (MA)	$1325.84	$1325.84
BALTIMORE/SURR. CNTYS (MD)	$1408.09	$1408.09
REST OF MARYLAND (MD)	$1324.36	$1324.36
SOUTHERN MAINE (ME)	$1260.00	$1260.00
REST OF MAINE (ME)	$1228.42	$1228.42
DETROIT (MI)	$1425.88	$1425.88
REST OF MICHIGAN (MI)	$1310.46	$1310.46
MINNESOTA (MN)	$1219.92	$1219.92
METROPOLITAN ST. LOUIS (MO)	$1305.69	$1305.69
METROPOLITAN KANSAS CITY (MO)	$1295.99	$1295.99
REST OF MISSOURI (MO)	$1262.88	$1262.88
MISSISSIPPI (MS)	$1223.05	$1223.05
MONTANA** (MT)	$1325.35	$1325.35
NORTH CAROLINA (NC)	$1236.78	$1236.78
NORTH DAKOTA** (ND)	$1226.08	$1226.08
NEBRASKA (NE)	$1188.78	$1188.78
NEW HAMPSHIRE (NH)	$1322.09	$1322.09
NORTHERN NJ (NJ)	$1451.12	$1451.12
REST OF NEW JERSEY (NJ)	$1410.29	$1410.29
NEW MEXICO (NM)	$1324.23	$1324.23
NEVADA** (NV)	$1298.10	$1298.10
MANHATTAN (NY)	$1539.56	$1539.56
NYC SUBURBS/LONG ISLAND (NY)	$1596.43	$1596.43
POUGHKPSIE/N NYC SUBURBS (NY)	$1434.18	$1434.18
QUEENS (NY)	$1523.88	$1523.88
REST OF NEW YORK (NY)	$1254.71	$1254.71
OHIO (OH)	$1290.18	$1290.18
OKLAHOMA (OK)	$1242.97	$1242.97
PORTLAND (OR)	$1341.52	$1341.52
REST OF OREGON (OR)	$1274.19	$1274.19
METROPOLITAN PHILADELPHIA (PA)	$1388.63	$1388.63
REST OF PENNSYLVANIA (PA)	$1281.73	$1281.73
PUERTO RICO (PR)	$1327.83	$1327.83
RHODE ISLAND (RI)	$1335.50	$1335.50
SOUTH CAROLINA (SC)	$1268.34	$1268.34
SOUTH DAKOTA** (SD)	$1214.35	$1214.35
TENNESSEE (TN)	$1209.51	$1209.51
BRAZORIA (TX)	$1290.86	$1290.86
DALLAS (TX)	$1306.79	$1306.79
GALVESTON (TX)	$1299.75	$1299.75
HOUSTON (TX)	$1391.64	$1391.64
BEAUMONT (TX)	$1275.66	$1275.66
FORT WORTH (TX)	$1304.73	$1304.73
AUSTIN (TX)	$1332.60	$1332.60
REST OF TEXAS (TX)	$1287.82	$1287.82
UTAH (UT)	$1283.17	$1283.17
VIRGINIA (VA)	$1269.19	$1269.19
VIRGIN ISLANDS (VI)	$1327.83	$1327.83
VERMONT (VT)	$1238.62	$1238.62
SEATTLE (KING CNTY) (WA)	$1427.86	$1427.86
REST OF WASHINGTON (WA)	$1317.60	$1317.60
WISCONSIN (WI)	$1191.86	$1191.86
WEST VIRGINIA (WV)	$1342.47	$1342.47
WYOMING** (WY)	$1282.09	$1282.09

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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) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates differ mainly in the practice-expense RVU, since overhead costs assumed for an office setting differ from those assumed when the service is performed in a facility (where the facility bears more of the overhead).

RVUs — work 21.99, practice expense 12.68 (non-facility) / 12.68 (facility), malpractice 5.02 — × 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 rest.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final payment.
Rates vary by locality based on GPCI adjustments; always confirm with your Medicare Administrative Contractor (MAC) for the applicable locality and year.
This page reflects Physician Fee Schedule amounts and may not apply to hospital outpatient (OPPS), ASC, or other payment systems.

Frequently asked

Why does this code show two different amounts — non-facility and facility?

The non-facility rate applies when the service is performed in a setting like a physician's office, where the billing provider bears the overhead costs. The facility rate applies when the service is performed in a hospital or ASC, where the facility bills separately for overhead, so the practice-expense RVU (and resulting payment) is typically lower.

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

Not necessarily. The national amount uses a GPCI value of 1.0 for all components, while actual payments in a specific locality are adjusted up or down based on that area's wage and cost indices.

Does this amount reflect what the patient will owe?

No. This is the Medicare-allowed amount before cost-sharing. After the deductible is met, Medicare generally pays 80% and the patient (or a supplemental payer) is responsible for the remaining 20%, subject to any applicable adjustments.

Why might my actual remittance differ from this estimate?

Differences can result from modifiers, bilateral or multiple-procedure payment rules, sequestration cuts, mid-year or annual rate updates, and budget-neutrality adjustments applied by CMS.

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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.