Medicare Reimbursement for CPT 23106
CPT 23106 is a physician procedure code reported under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $487.99 | $487.99 |
| ALASKA* (AK) | $584.62 | $584.62 |
| ALABAMA (AL) | $438.75 | $438.75 |
| ARKANSAS (AR) | $432.64 | $432.64 |
| ARIZONA (AZ) | $474.22 | $474.22 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $583.03 | $583.03 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $592.69 | $592.69 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $522.14 | $522.14 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $526.74 | $526.74 |
| NAPA (CA) | $557.60 | $557.60 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $584.49 | $584.49 |
| VALLEJO (CA) | $555.51 | $555.51 |
| BAKERSFIELD (CA) | $498.63 | $498.63 |
| CHICO (CA) | $495.11 | $495.11 |
| FRESNO (CA) | $495.11 | $495.11 |
| HANFORD-CORCORAN (CA) | $495.11 | $495.11 |
| MADERA (CA) | $495.11 | $495.11 |
| MERCED (CA) | $495.11 | $495.11 |
| MODESTO (CA) | $495.11 | $495.11 |
| REDDING (CA) | $495.11 | $495.11 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $508.87 | $508.87 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $515.36 | $515.36 |
| SALINAS (CA) | $513.38 | $513.38 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $598.63 | $598.63 |
| SANTA CRUZ-WATSONVILLE (CA) | $525.13 | $525.13 |
| SANTA ROSA-PETALUMA (CA) | $530.12 | $530.12 |
| STOCKTON (CA) | $495.11 | $495.11 |
| VISALIA (CA) | $495.11 | $495.11 |
| YUBA CITY (CA) | $495.11 | $495.11 |
| EL CENTRO (CA) | $495.33 | $495.33 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $522.52 | $522.52 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $505.67 | $505.67 |
| SANTA MARIA-SANTA BARBARA (CA) | $514.49 | $514.49 |
| REST OF CALIFORNIA (CA) | $495.11 | $495.11 |
| COLORADO (CO) | $496.73 | $496.73 |
| CONNECTICUT (CT) | $519.86 | $519.86 |
| DC + MD/VA SUBURBS (DC) | $547.30 | $547.30 |
| DELAWARE (DE) | $481.72 | $481.72 |
| FORT LAUDERDALE (FL) | $525.72 | $525.72 |
| MIAMI (FL) | $563.42 | $563.42 |
| REST OF FLORIDA (FL) | $498.69 | $498.69 |
| ATLANTA (GA) | $501.11 | $501.11 |
| REST OF GEORGIA (GA) | $469.68 | $469.68 |
| HAWAII, GUAM (HI) | $503.62 | $503.62 |
| IOWA (IA) | $441.34 | $441.34 |
| IDAHO (ID) | $445.82 | $445.82 |
| EAST ST. LOUIS (IL) | $511.70 | $511.70 |
| SUBURBAN CHICAGO (IL) | $529.02 | $529.02 |
| CHICAGO (IL) | $545.98 | $545.98 |
| REST OF ILLINOIS (IL) | $490.70 | $490.70 |
| INDIANA (IN) | $448.09 | $448.09 |
| KANSAS (KS) | $443.21 | $443.21 |
| KENTUCKY (KY) | $457.10 | $457.10 |
| NEW ORLEANS (LA) | $479.32 | $479.32 |
| REST OF LOUISIANA (LA) | $457.96 | $457.96 |
| METROPOLITAN BOSTON (MA) | $539.10 | $539.10 |
| REST OF MASSACHUSETTS (MA) | $495.52 | $495.52 |
| BALTIMORE/SURR. CNTYS (MD) | $519.24 | $519.24 |
| REST OF MARYLAND (MD) | $489.42 | $489.42 |
| SOUTHERN MAINE (ME) | $470.00 | $470.00 |
| REST OF MAINE (ME) | $452.19 | $452.19 |
| DETROIT (MI) | $508.72 | $508.72 |
| REST OF MICHIGAN (MI) | $472.14 | $472.14 |
| MINNESOTA (MN) | $465.01 | $465.01 |
| METROPOLITAN ST. LOUIS (MO) | $476.29 | $476.29 |
| METROPOLITAN KANSAS CITY (MO) | $472.03 | $472.03 |
| REST OF MISSOURI (MO) | $453.00 | $453.00 |
| MISSISSIPPI (MS) | $442.70 | $442.70 |
| MONTANA** (MT) | $487.90 | $487.90 |
| NORTH CAROLINA (NC) | $456.10 | $456.10 |
| NORTH DAKOTA** (ND) | $462.59 | $462.59 |
| NEBRASKA (NE) | $442.49 | $442.49 |
| NEW HAMPSHIRE (NH) | $492.71 | $492.71 |
| NORTHERN NJ (NJ) | $542.76 | $542.76 |
| REST OF NEW JERSEY (NJ) | $522.71 | $522.71 |
| NEW MEXICO (NM) | $476.20 | $476.20 |
| NEVADA** (NV) | $481.09 | $481.09 |
| MANHATTAN (NY) | $565.59 | $565.59 |
| NYC SUBURBS/LONG ISLAND (NY) | $583.81 | $583.81 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $529.28 | $529.28 |
| QUEENS (NY) | $564.35 | $564.35 |
| REST OF NEW YORK (NY) | $463.01 | $463.01 |
| OHIO (OH) | $466.97 | $466.97 |
| OKLAHOMA (OK) | $452.19 | $452.19 |
| PORTLAND (OR) | $507.49 | $507.49 |
| REST OF OREGON (OR) | $474.31 | $474.31 |
| METROPOLITAN PHILADELPHIA (PA) | $509.90 | $509.90 |
| REST OF PENNSYLVANIA (PA) | $465.51 | $465.51 |
| PUERTO RICO (PR) | $490.05 | $490.05 |
| RHODE ISLAND (RI) | $495.27 | $495.27 |
| SOUTH CAROLINA (SC) | $462.92 | $462.92 |
| SOUTH DAKOTA** (SD) | $459.60 | $459.60 |
| TENNESSEE (TN) | $445.85 | $445.85 |
| BRAZORIA (TX) | $477.97 | $477.97 |
| DALLAS (TX) | $482.73 | $482.73 |
| GALVESTON (TX) | $480.51 | $480.51 |
| HOUSTON (TX) | $503.94 | $503.94 |
| BEAUMONT (TX) | $462.86 | $462.86 |
| FORT WORTH (TX) | $480.83 | $480.83 |
| AUSTIN (TX) | $497.75 | $497.75 |
| REST OF TEXAS (TX) | $471.32 | $471.32 |
| UTAH (UT) | $468.90 | $468.90 |
| VIRGINIA (VA) | $471.24 | $471.24 |
| VIRGIN ISLANDS (VI) | $490.05 | $490.05 |
| VERMONT (VT) | $464.41 | $464.41 |
| SEATTLE (KING CNTY) (WA) | $545.88 | $545.88 |
| REST OF WASHINGTON (WA) | $493.38 | $493.38 |
| WISCONSIN (WI) | $448.09 | $448.09 |
| WEST VIRGINIA (WV) | $474.25 | $474.25 |
| WYOMING** (WY) | $476.87 | $476.87 |
Look up another code or locality →
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 fee schedule 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, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital, ASC) settings because overhead costs differ, though for some codes the two values are the same. The result is a national estimate that CMS further adjusts locality-by-locality.
RVUs — work 5.98, practice expense 7.35 (non-facility) / 7.35 (facility), malpractice 1.28 — × 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 rest.
- Actual payment can vary by locality, applicable modifiers, place of service, sequestration reductions, and yearly budget-neutrality adjustments.
- Always confirm final amounts with your Medicare Administrative Contractor (MAC) or official CMS fee schedule files.
- This page does not reflect commercial payer rates, which may differ significantly from Medicare's PFS.
Frequently asked
Why is there a difference between facility and non-facility amounts?
Practice-expense RVUs account for overhead costs, which are typically higher when the physician's office bears the expense (non-facility) versus when the service is performed in a hospital or ambulatory surgical center that bills separately for overhead (facility). For some codes these RVUs are equal, resulting in the same estimated amount in both settings.
Does this amount include the patient's share?
No. The figure shown is the total Medicare-allowed amount. Medicare generally pays 80% after the deductible, with the remaining 20% owed by the patient or a secondary payer.
Why might my MAC's actual payment differ from this estimate?
Locality-specific GPCIs, applied modifiers, sequestration, and annual budget-neutrality adjustments can all cause the actual paid amount to differ from this national or locality estimate.
Can I use this figure for CPT code 23106 to predict reimbursement for other codes?
No. Each CPT/HCPCS code has its own set of work, practice-expense, and malpractice RVUs, so estimates must be calculated separately for each 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.
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