Medicare Reimbursement for CPT 23100

CPT code 23100 is a physician procedure code; because CPT descriptors are licensed by the AMA, this page refers to it generically as 'this procedure code.' The page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount nationally and lets you compare non-facility and facility settings, with adjustments available by locality.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$491.33	$491.33
ALASKA* (AK)	$589.02	$589.02
ALABAMA (AL)	$441.86	$441.86
ARKANSAS (AR)	$435.72	$435.72
ARIZONA (AZ)	$477.49	$477.49
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$586.68	$586.68
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$596.38	$596.38
OXNARD-THOUSAND OAKS-VENTURA (CA)	$525.54	$525.54
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$530.18	$530.18
NAPA (CA)	$561.14	$561.14
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$588.14	$588.14
VALLEJO (CA)	$559.03	$559.03
BAKERSFIELD (CA)	$501.95	$501.95
CHICO (CA)	$498.40	$498.40
FRESNO (CA)	$498.40	$498.40
HANFORD-CORCORAN (CA)	$498.40	$498.40
MADERA (CA)	$498.40	$498.40
MERCED (CA)	$498.40	$498.40
MODESTO (CA)	$498.40	$498.40
REDDING (CA)	$498.40	$498.40
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$512.26	$512.26
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$518.73	$518.73
SALINAS (CA)	$516.74	$516.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$602.37	$602.37
SANTA CRUZ-WATSONVILLE (CA)	$528.50	$528.50
SANTA ROSA-PETALUMA (CA)	$533.52	$533.52
STOCKTON (CA)	$498.40	$498.40
VISALIA (CA)	$498.40	$498.40
YUBA CITY (CA)	$498.40	$498.40
EL CENTRO (CA)	$498.62	$498.62
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$525.90	$525.90
SAN LUIS OBISPO-PASO ROBLES (CA)	$508.99	$508.99
SANTA MARIA-SANTA BARBARA (CA)	$517.86	$517.86
REST OF CALIFORNIA (CA)	$498.40	$498.40
COLORADO (CO)	$500.07	$500.07
CONNECTICUT (CT)	$523.37	$523.37
DC + MD/VA SUBURBS (DC)	$550.93	$550.93
DELAWARE (DE)	$485.03	$485.03
FORT LAUDERDALE (FL)	$529.34	$529.34
MIAMI (FL)	$567.30	$567.30
REST OF FLORIDA (FL)	$502.17	$502.17
ATLANTA (GA)	$504.53	$504.53
REST OF GEORGIA (GA)	$473.01	$473.01
HAWAII, GUAM (HI)	$506.91	$506.91
IOWA (IA)	$444.42	$444.42
IDAHO (ID)	$448.93	$448.93
EAST ST. LOUIS (IL)	$515.32	$515.32
SUBURBAN CHICAGO (IL)	$532.65	$532.65
CHICAGO (IL)	$549.77	$549.77
REST OF ILLINOIS (IL)	$494.17	$494.17
INDIANA (IN)	$451.21	$451.21
KANSAS (KS)	$446.32	$446.32
KENTUCKY (KY)	$460.34	$460.34
NEW ORLEANS (LA)	$482.66	$482.66
REST OF LOUISIANA (LA)	$461.21	$461.21
METROPOLITAN BOSTON (MA)	$542.63	$542.63
REST OF MASSACHUSETTS (MA)	$498.86	$498.86
BALTIMORE/SURR. CNTYS (MD)	$522.74	$522.74
REST OF MARYLAND (MD)	$492.77	$492.77
SOUTHERN MAINE (ME)	$473.21	$473.21
REST OF MAINE (ME)	$455.35	$455.35
DETROIT (MI)	$512.27	$512.27
REST OF MICHIGAN (MI)	$475.47	$475.47
MINNESOTA (MN)	$468.13	$468.13
METROPOLITAN ST. LOUIS (MO)	$479.60	$479.60
METROPOLITAN KANSAS CITY (MO)	$475.32	$475.32
REST OF MISSOURI (MO)	$456.24	$456.24
MISSISSIPPI (MS)	$445.86	$445.86
MONTANA** (MT)	$491.24	$491.24
NORTH CAROLINA (NC)	$459.28	$459.28
NORTH DAKOTA** (ND)	$465.73	$465.73
NEBRASKA (NE)	$445.57	$445.57
NEW HAMPSHIRE (NH)	$496.03	$496.03
NORTHERN NJ (NJ)	$546.37	$546.37
REST OF NEW JERSEY (NJ)	$526.24	$526.24
NEW MEXICO (NM)	$479.56	$479.56
NEVADA** (NV)	$484.38	$484.38
MANHATTAN (NY)	$569.39	$569.39
NYC SUBURBS/LONG ISLAND (NY)	$587.71	$587.71
POUGHKPSIE/N NYC SUBURBS (NY)	$532.85	$532.85
QUEENS (NY)	$568.11	$568.11
REST OF NEW YORK (NY)	$466.22	$466.22
OHIO (OH)	$470.26	$470.26
OKLAHOMA (OK)	$455.38	$455.38
PORTLAND (OR)	$510.85	$510.85
REST OF OREGON (OR)	$477.55	$477.55
METROPOLITAN PHILADELPHIA (PA)	$513.37	$513.37
REST OF PENNSYLVANIA (PA)	$468.77	$468.77
PUERTO RICO (PR)	$493.39	$493.39
RHODE ISLAND (RI)	$498.64	$498.64
SOUTH CAROLINA (SC)	$466.16	$466.16
SOUTH DAKOTA** (SD)	$462.72	$462.72
TENNESSEE (TN)	$448.98	$448.98
BRAZORIA (TX)	$481.25	$481.25
DALLAS (TX)	$486.04	$486.04
GALVESTON (TX)	$483.81	$483.81
HOUSTON (TX)	$507.42	$507.42
BEAUMONT (TX)	$466.11	$466.11
FORT WORTH (TX)	$484.14	$484.14
AUSTIN (TX)	$501.10	$501.10
REST OF TEXAS (TX)	$474.59	$474.59
UTAH (UT)	$472.16	$472.16
VIRGINIA (VA)	$474.47	$474.47
VIRGIN ISLANDS (VI)	$493.39	$493.39
VERMONT (VT)	$467.58	$467.58
SEATTLE (KING CNTY) (WA)	$549.43	$549.43
REST OF WASHINGTON (WA)	$496.70	$496.70
WISCONSIN (WI)	$451.17	$451.17
WEST VIRGINIA (WV)	$477.65	$477.65
WYOMING** (WY)	$480.12	$480.12

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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 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 the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs (and therefore the total) can differ between non-facility (e.g., office) and facility (e.g., hospital) settings, though for this code the non-facility and facility PE RVUs are the same, so the amounts shown are equal.

RVUs — work 6.05, practice expense 7.37 (non-facility) / 7.37 (facility), malpractice 1.29 — × 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 payer is responsible for the remainder.
Actual payment can vary by locality GPCI, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always confirm the final allowed amount and any applicable modifiers with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the amount differ between localities?

The GPCI values used to adjust the work, practice expense, and malpractice RVUs vary by locality to reflect differences in local labor, rent, and liability insurance costs, which changes the final calculated amount.

Why are the non-facility and facility amounts the same for this code?

The amount depends on the practice-expense RVU assigned to each setting. When CMS assigns the same practice-expense RVU to both non-facility and facility settings for a code, the calculated allowed amounts come out equal.

Does this amount include what the patient owes?

No. The figure shown is the total Medicare-allowed amount. After the deductible is met, Medicare generally pays 80% of this amount, and the patient or secondary insurance is typically responsible for the remaining 20%.

Can modifiers change this amount?

Yes. Modifiers (such as those indicating bilateral procedures, reduced services, or multiple procedures) can increase or decrease the final payment relative to the base PFS amount 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.