Medicare Reimbursement for CPT 23105

CPT 23105 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for your locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$605.22	$605.22
ALASKA* (AK)	$735.19	$735.19
ALABAMA (AL)	$546.35	$546.35
ARKANSAS (AR)	$539.07	$539.07
ARIZONA (AZ)	$588.53	$588.53
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$709.77	$709.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$720.99	$720.99
OXNARD-THOUSAND OAKS-VENTURA (CA)	$640.72	$640.72
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$646.94	$646.94
NAPA (CA)	$680.71	$680.71
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$711.72	$711.72
VALLEJO (CA)	$677.90	$677.90
BAKERSFIELD (CA)	$614.08	$614.08
CHICO (CA)	$609.33	$609.33
FRESNO (CA)	$609.33	$609.33
HANFORD-CORCORAN (CA)	$609.33	$609.33
MADERA (CA)	$609.33	$609.33
MERCED (CA)	$609.33	$609.33
MODESTO (CA)	$609.33	$609.33
REDDING (CA)	$609.33	$609.33
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$627.82	$627.82
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$632.77	$632.77
SALINAS (CA)	$630.31	$630.31
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$728.98	$728.98
SANTA CRUZ-WATSONVILLE (CA)	$642.75	$642.75
SANTA ROSA-PETALUMA (CA)	$648.77	$648.77
STOCKTON (CA)	$609.33	$609.33
VISALIA (CA)	$609.33	$609.33
YUBA CITY (CA)	$609.33	$609.33
EL CENTRO (CA)	$609.62	$609.62
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$640.42	$640.42
SAN LUIS OBISPO-PASO ROBLES (CA)	$621.01	$621.01
SANTA MARIA-SANTA BARBARA (CA)	$631.38	$631.38
REST OF CALIFORNIA (CA)	$609.33	$609.33
COLORADO (CO)	$613.34	$613.34
CONNECTICUT (CT)	$643.72	$643.72
DC + MD/VA SUBURBS (DC)	$674.97	$674.97
DELAWARE (DE)	$597.54	$597.54
FORT LAUDERDALE (FL)	$655.17	$655.17
MIAMI (FL)	$704.20	$704.20
REST OF FLORIDA (FL)	$622.17	$622.17
ATLANTA (GA)	$621.95	$621.95
REST OF GEORGIA (GA)	$586.93	$586.93
HAWAII, GUAM (HI)	$618.24	$618.24
IOWA (IA)	$547.50	$547.50
IDAHO (ID)	$553.22	$553.22
EAST ST. LOUIS (IL)	$641.75	$641.75
SUBURBAN CHICAGO (IL)	$658.84	$658.84
CHICAGO (IL)	$682.91	$682.91
REST OF ILLINOIS (IL)	$613.94	$613.94
INDIANA (IN)	$555.87	$555.87
KANSAS (KS)	$550.66	$550.66
KENTUCKY (KY)	$570.20	$570.20
NEW ORLEANS (LA)	$597.02	$597.02
REST OF LOUISIANA (LA)	$571.58	$571.58
METROPOLITAN BOSTON (MA)	$662.91	$662.91
REST OF MASSACHUSETTS (MA)	$612.37	$612.37
BALTIMORE/SURR. CNTYS (MD)	$643.08	$643.08
REST OF MARYLAND (MD)	$606.53	$606.53
SOUTHERN MAINE (ME)	$581.58	$581.58
REST OF MAINE (ME)	$561.78	$561.78
DETROIT (MI)	$635.13	$635.13
REST OF MICHIGAN (MI)	$589.01	$589.01
MINNESOTA (MN)	$572.65	$572.65
METROPOLITAN ST. LOUIS (MO)	$592.30	$592.30
METROPOLITAN KANSAS CITY (MO)	$587.34	$587.34
REST OF MISSOURI (MO)	$566.26	$566.26
MISSISSIPPI (MS)	$552.48	$552.48
MONTANA** (MT)	$605.11	$605.11
NORTH CAROLINA (NC)	$566.29	$566.29
NORTH DAKOTA** (ND)	$571.10	$571.10
NEBRASKA (NE)	$548.58	$548.58
NEW HAMPSHIRE (NH)	$609.18	$609.18
NORTHERN NJ (NJ)	$669.98	$669.98
REST OF NEW JERSEY (NJ)	$646.83	$646.83
NEW MEXICO (NM)	$594.23	$594.23
NEVADA** (NV)	$595.90	$595.90
MANHATTAN (NY)	$700.56	$700.56
NYC SUBURBS/LONG ISLAND (NY)	$723.46	$723.46
POUGHKPSIE/N NYC SUBURBS (NY)	$655.52	$655.52
QUEENS (NY)	$697.72	$697.72
REST OF NEW YORK (NY)	$574.58	$574.58
OHIO (OH)	$582.06	$582.06
OKLAHOMA (OK)	$563.36	$563.36
PORTLAND (OR)	$625.08	$625.08
REST OF OREGON (OR)	$587.08	$587.08
METROPOLITAN PHILADELPHIA (PA)	$632.42	$632.42
REST OF PENNSYLVANIA (PA)	$579.80	$579.80
PUERTO RICO (PR)	$607.35	$607.35
RHODE ISLAND (RI)	$613.23	$613.23
SOUTH CAROLINA (SC)	$575.97	$575.97
SOUTH DAKOTA** (SD)	$567.08	$567.08
TENNESSEE (TN)	$553.91	$553.91
BRAZORIA (TX)	$592.35	$592.35
DALLAS (TX)	$598.47	$598.47
GALVESTON (TX)	$595.65	$595.65
HOUSTON (TX)	$627.13	$627.13
BEAUMONT (TX)	$576.71	$576.71
FORT WORTH (TX)	$596.50	$596.50
AUSTIN (TX)	$614.98	$614.98
REST OF TEXAS (TX)	$585.80	$585.80
UTAH (UT)	$583.07	$583.07
VIRGINIA (VA)	$583.72	$583.72
VIRGIN ISLANDS (VI)	$607.35	$607.35
VERMONT (VT)	$574.13	$574.13
SEATTLE (KING CNTY) (WA)	$670.16	$670.16
REST OF WASHINGTON (WA)	$609.48	$609.48
WISCONSIN (WI)	$554.06	$554.06
WEST VIRGINIA (WV)	$594.41	$594.41
WYOMING** (WY)	$590.29	$590.29

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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 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. Non-facility (e.g., office) and facility (e.g., hospital) settings often use different practice-expense RVUs, since the resources a practice must supply differ between the two settings. For CPT 23105, the practice-expense RVU is the same in both settings, so the resulting non-facility and facility allowed amounts are equal.

RVUs — work 8.27, practice expense 8.13 (non-facility) / 8.13 (facility), malpractice 1.72 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national RVUs, GPCIs, and the current conversion factor — actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the beneficiary or secondary payer is responsible for the rest.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify current rates and local adjustments with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the allowed amount differ by locality for the same CPT code?

Medicare applies Geographic Practice Cost Indices (GPCIs) to the work, practice-expense, and malpractice RVUs to reflect regional differences in costs of living and practice. This causes the same code to have different allowed amounts in different localities.

Why are the non-facility and facility amounts the same for CPT 23105?

The practice-expense RVU used in the fee formula is identical for both settings for this code, so the calculated allowed amount does not change between non-facility and facility locations.

Does this amount represent what Medicare will actually pay?

No. It is an estimated allowed amount before patient cost-sharing. Medicare generally pays 80% after the deductible, and the actual payment can be affected by modifiers, sequestration, and other adjustments.

Where can I confirm the exact reimbursement for my claim?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules and can confirm the exact allowed and paid amounts for a given claim.

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.