Medicare Reimbursement for CPT 23125

CPT 23125 is a surgical procedure code; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$669.02	$669.02
ALASKA* (AK)	$814.75	$814.75
ALABAMA (AL)	$604.00	$604.00
ARKANSAS (AR)	$595.98	$595.98
ARIZONA (AZ)	$650.46	$650.46
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$778.62	$778.62
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$790.68	$790.68
OXNARD-THOUSAND OAKS-VENTURA (CA)	$705.09	$705.09
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$712.20	$712.20
NAPA (CA)	$747.60	$747.60
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$780.89	$780.89
VALLEJO (CA)	$744.32	$744.32
BAKERSFIELD (CA)	$676.54	$676.54
CHICO (CA)	$671.03	$671.03
FRESNO (CA)	$671.03	$671.03
HANFORD-CORCORAN (CA)	$671.03	$671.03
MADERA (CA)	$671.03	$671.03
MERCED (CA)	$671.03	$671.03
MODESTO (CA)	$671.03	$671.03
REDDING (CA)	$671.03	$671.03
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$692.52	$692.52
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$696.31	$696.31
SALINAS (CA)	$693.59	$693.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$799.97	$799.97
SANTA CRUZ-WATSONVILLE (CA)	$706.59	$706.59
SANTA ROSA-PETALUMA (CA)	$713.16	$713.16
STOCKTON (CA)	$671.03	$671.03
VISALIA (CA)	$671.03	$671.03
YUBA CITY (CA)	$671.03	$671.03
EL CENTRO (CA)	$671.37	$671.37
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$704.34	$704.34
SAN LUIS OBISPO-PASO ROBLES (CA)	$683.43	$683.43
SANTA MARIA-SANTA BARBARA (CA)	$694.66	$694.66
REST OF CALIFORNIA (CA)	$671.03	$671.03
COLORADO (CO)	$676.61	$676.61
CONNECTICUT (CT)	$711.52	$711.52
DC + MD/VA SUBURBS (DC)	$744.83	$744.83
DELAWARE (DE)	$660.38	$660.38
FORT LAUDERDALE (FL)	$726.74	$726.74
MIAMI (FL)	$782.98	$782.98
REST OF FLORIDA (FL)	$689.94	$689.94
ATLANTA (GA)	$688.00	$688.00
REST OF GEORGIA (GA)	$650.71	$650.71
HAWAII, GUAM (HI)	$680.39	$680.39
IOWA (IA)	$604.24	$604.24
IDAHO (ID)	$610.76	$610.76
EAST ST. LOUIS (IL)	$713.70	$713.70
SUBURBAN CHICAGO (IL)	$730.57	$730.57
CHICAGO (IL)	$759.17	$759.17
REST OF ILLINOIS (IL)	$681.55	$681.55
INDIANA (IN)	$613.64	$613.64
KANSAS (KS)	$608.21	$608.21
KENTUCKY (KY)	$631.35	$631.35
NEW ORLEANS (LA)	$661.10	$661.10
REST OF LOUISIANA (LA)	$633.07	$633.07
METROPOLITAN BOSTON (MA)	$730.46	$730.46
REST OF MASSACHUSETTS (MA)	$675.76	$675.76
BALTIMORE/SURR. CNTYS (MD)	$710.92	$710.92
REST OF MARYLAND (MD)	$670.14	$670.14
SOUTHERN MAINE (ME)	$641.78	$641.78
REST OF MAINE (ME)	$620.71	$620.71
DETROIT (MI)	$704.76	$704.76
REST OF MICHIGAN (MI)	$652.56	$652.56
MINNESOTA (MN)	$630.35	$630.35
METROPOLITAN ST. LOUIS (MO)	$655.32	$655.32
METROPOLITAN KANSAS CITY (MO)	$649.90	$649.90
REST OF MISSOURI (MO)	$627.50	$627.50
MISSISSIPPI (MS)	$611.52	$611.52
MONTANA** (MT)	$668.89	$668.89
NORTH CAROLINA (NC)	$625.59	$625.59
NORTH DAKOTA** (ND)	$629.34	$629.34
NEBRASKA (NE)	$605.27	$605.27
NEW HAMPSHIRE (NH)	$672.49	$672.49
NORTHERN NJ (NJ)	$739.46	$739.46
REST OF NEW JERSEY (NJ)	$714.58	$714.58
NEW MEXICO (NM)	$658.52	$658.52
NEVADA** (NV)	$658.15	$658.15
MANHATTAN (NY)	$774.96	$774.96
NYC SUBURBS/LONG ISLAND (NY)	$800.84	$800.84
POUGHKPSIE/N NYC SUBURBS (NY)	$724.56	$724.56
QUEENS (NY)	$771.10	$771.10
REST OF NEW YORK (NY)	$634.77	$634.77
OHIO (OH)	$644.48	$644.48
OKLAHOMA (OK)	$623.28	$623.28
PORTLAND (OR)	$688.94	$688.94
REST OF OREGON (OR)	$648.03	$648.03
METROPOLITAN PHILADELPHIA (PA)	$699.38	$699.38
REST OF PENNSYLVANIA (PA)	$641.71	$641.71
PUERTO RICO (PR)	$671.19	$671.19
RHODE ISLAND (RI)	$677.28	$677.28
SOUTH CAROLINA (SC)	$637.09	$637.09
SOUTH DAKOTA** (SD)	$624.66	$624.66
TENNESSEE (TN)	$611.86	$611.86
BRAZORIA (TX)	$654.24	$654.24
DALLAS (TX)	$661.21	$661.21
GALVESTON (TX)	$658.02	$658.02
HOUSTON (TX)	$694.63	$694.63
BEAUMONT (TX)	$638.33	$638.33
FORT WORTH (TX)	$659.19	$659.19
AUSTIN (TX)	$678.75	$678.75
REST OF TEXAS (TX)	$647.84	$647.84
UTAH (UT)	$644.91	$644.91
VIRGINIA (VA)	$644.48	$644.48
VIRGIN ISLANDS (VI)	$671.19	$671.19
VERMONT (VT)	$633.14	$633.14
SEATTLE (KING CNTY) (WA)	$737.93	$737.93
REST OF WASHINGTON (WA)	$672.41	$672.41
WISCONSIN (WI)	$610.69	$610.69
WEST VIRGINIA (WV)	$660.05	$660.05
WYOMING** (WY)	$651.65	$651.65

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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs because the resources and overhead assumed differ by site of service. The national rate shown reflects a standardized GPCI baseline, while locality-specific rates reflect actual geographic cost adjustments. These are the same core mechanics used across all PFS-priced codes, regardless of specialty or code type.

RVUs — work 9.4, practice expense 8.63 (non-facility) / 8.63 (facility), malpractice 2 — × 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 Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount?

Facility and non-facility rates can differ because the practice-expense RVU assumes different overhead costs depending on whether the service is performed in a facility (e.g., hospital) versus a non-facility setting (e.g., physician office).

Why might the rate differ in my locality compared to the national figure?

Locality-specific Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs to reflect regional cost differences, which can raise or lower the final allowed amount compared to the national baseline.

Does this page tell me what the code actually describes?

No. Because this is a CPT code, the official descriptor is copyrighted by the AMA and is not reproduced here. Consult your CPT codebook or EHR system for the full description.

Will modifiers change this amount?

Yes, many modifiers (e.g., bilateral, multiple procedure, assistant surgeon) can increase or decrease the allowed amount; this page reflects the unmodified base rate only.

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.