Medicare Reimbursement for CPT 23172

CPT 23172 is a surgical procedure code; the exact clinical description is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and, where available, by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$545.77	$545.77
ALASKA* (AK)	$659.09	$659.09
ALABAMA (AL)	$491.84	$491.84
ARKANSAS (AR)	$485.16	$485.16
ARIZONA (AZ)	$530.57	$530.57
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$645.17	$645.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$655.58	$655.58
OXNARD-THOUSAND OAKS-VENTURA (CA)	$580.42	$580.42
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$585.83	$585.83
NAPA (CA)	$618.02	$618.02
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$646.87	$646.87
VALLEJO (CA)	$615.56	$615.56
BAKERSFIELD (CA)	$555.43	$555.43
CHICO (CA)	$551.29	$551.29
FRESNO (CA)	$551.29	$551.29
HANFORD-CORCORAN (CA)	$551.29	$551.29
MADERA (CA)	$551.29	$551.29
MERCED (CA)	$551.29	$551.29
MODESTO (CA)	$551.29	$551.29
REDDING (CA)	$551.29	$551.29
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$567.41	$567.41
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$573.07	$573.07
SALINAS (CA)	$570.85	$570.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$662.54	$662.54
SANTA CRUZ-WATSONVILLE (CA)	$582.89	$582.89
SANTA ROSA-PETALUMA (CA)	$588.38	$588.38
STOCKTON (CA)	$551.29	$551.29
VISALIA (CA)	$551.29	$551.29
YUBA CITY (CA)	$551.29	$551.29
EL CENTRO (CA)	$551.54	$551.54
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$580.44	$580.44
SAN LUIS OBISPO-PASO ROBLES (CA)	$562.37	$562.37
SANTA MARIA-SANTA BARBARA (CA)	$571.94	$571.94
REST OF CALIFORNIA (CA)	$551.29	$551.29
COLORADO (CO)	$554.14	$554.14
CONNECTICUT (CT)	$580.88	$580.88
DC + MD/VA SUBURBS (DC)	$610.13	$610.13
DELAWARE (DE)	$538.81	$538.81
FORT LAUDERDALE (FL)	$589.60	$589.60
MIAMI (FL)	$632.93	$632.93
REST OF FLORIDA (FL)	$559.64	$559.64
ATLANTA (GA)	$560.68	$560.68
REST OF GEORGIA (GA)	$527.58	$527.58
HAWAII, GUAM (HI)	$559.96	$559.96
IOWA (IA)	$493.67	$493.67
IDAHO (ID)	$498.77	$498.77
EAST ST. LOUIS (IL)	$575.97	$575.97
SUBURBAN CHICAGO (IL)	$593.07	$593.07
CHICAGO (IL)	$613.61	$613.61
REST OF ILLINOIS (IL)	$551.57	$551.57
INDIANA (IN)	$501.22	$501.22
KANSAS (KS)	$496.20	$496.20
KENTUCKY (KY)	$512.93	$512.93
NEW ORLEANS (LA)	$537.39	$537.39
REST OF LOUISIANA (LA)	$514.05	$514.05
METROPOLITAN BOSTON (MA)	$599.98	$599.98
REST OF MASSACHUSETTS (MA)	$553.06	$553.06
BALTIMORE/SURR. CNTYS (MD)	$580.25	$580.25
REST OF MARYLAND (MD)	$547.13	$547.13
SOUTHERN MAINE (ME)	$524.97	$524.97
REST OF MAINE (ME)	$506.23	$506.23
DETROIT (MI)	$571.13	$571.13
REST OF MICHIGAN (MI)	$529.83	$529.83
MINNESOTA (MN)	$517.97	$517.97
METROPOLITAN ST. LOUIS (MO)	$533.51	$533.51
METROPOLITAN KANSAS CITY (MO)	$528.91	$528.91
REST OF MISSOURI (MO)	$508.93	$508.93
MISSISSIPPI (MS)	$496.90	$496.90
MONTANA** (MT)	$545.67	$545.67
NORTH CAROLINA (NC)	$510.43	$510.43
NORTH DAKOTA** (ND)	$516.01	$516.01
NEBRASKA (NE)	$494.78	$494.78
NEW HAMPSHIRE (NH)	$550.07	$550.07
NORTHERN NJ (NJ)	$605.38	$605.38
REST OF NEW JERSEY (NJ)	$583.85	$583.85
NEW MEXICO (NM)	$534.47	$534.47
NEVADA** (NV)	$537.66	$537.66
MANHATTAN (NY)	$632.09	$632.09
NYC SUBURBS/LONG ISLAND (NY)	$652.62	$652.62
POUGHKPSIE/N NYC SUBURBS (NY)	$591.47	$591.47
QUEENS (NY)	$630.03	$630.03
REST OF NEW YORK (NY)	$518.01	$518.01
OHIO (OH)	$523.77	$523.77
OKLAHOMA (OK)	$507.04	$507.04
PORTLAND (OR)	$565.34	$565.34
REST OF OREGON (OR)	$529.86	$529.86
METROPOLITAN PHILADELPHIA (PA)	$570.29	$570.29
REST OF PENNSYLVANIA (PA)	$521.90	$521.90
PUERTO RICO (PR)	$547.85	$547.85
RHODE ISLAND (RI)	$553.38	$553.38
SOUTH CAROLINA (SC)	$518.68	$518.68
SOUTH DAKOTA** (SD)	$512.50	$512.50
TENNESSEE (TN)	$499.14	$499.14
BRAZORIA (TX)	$534.34	$534.34
DALLAS (TX)	$539.77	$539.77
GALVESTON (TX)	$537.26	$537.26
HOUSTON (TX)	$564.71	$564.71
BEAUMONT (TX)	$519.04	$519.04
FORT WORTH (TX)	$537.85	$537.85
AUSTIN (TX)	$555.47	$555.47
REST OF TEXAS (TX)	$527.78	$527.78
UTAH (UT)	$525.21	$525.21
VIRGINIA (VA)	$526.66	$526.66
VIRGIN ISLANDS (VI)	$547.85	$547.85
VERMONT (VT)	$518.45	$518.45
SEATTLE (KING CNTY) (WA)	$606.97	$606.97
REST OF WASHINGTON (WA)	$550.54	$550.54
WISCONSIN (WI)	$500.28	$500.28
WEST VIRGINIA (WV)	$533.63	$533.63
WYOMING** (WY)	$532.74	$532.74

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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 — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is billed. The geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital, ASC) settings because overhead costs differ; for this code the practice-expense RVU is the same in both settings, so the non-facility and facility amounts shown are equal. The conversion factor and RVU values are updated annually and can shift the final amount even if the code itself doesn't change.

RVUs — work 7.13, practice expense 7.71 (non-facility) / 7.71 (facility), malpractice 1.5 — × 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 remainder.
Modifiers, place-of-service rules, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Local Medicare Administrative Contractor (MAC) policies and coverage determinations may affect whether and how this code is paid.
Always verify current-year rates and locality-specific figures with your MAC or the official Medicare Physician Fee Schedule lookup tool before billing or appealing a denial.

Frequently asked

Why does this code show the same amount for facility and non-facility settings?

The PFS amount depends partly on practice-expense RVUs, which can differ by setting to reflect overhead costs. For this code, the practice-expense RVU is identical in both settings, so the calculated allowed amounts match.

Why might my locality's amount differ from the national figure?

Medicare adjusts work, practice-expense, and malpractice RVUs using locality-specific GPCIs before applying the conversion factor, so allowed amounts vary across geographic areas even for the same code.

Does this amount reflect what the patient or secondary payer owes?

No. The figure shown is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% after the deductible, with the remaining 20% owed by the patient or a secondary payer.

Can modifiers change this amount?

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

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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.