Medicare Reimbursement for CPT 23195

CPT 23195 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$709.77	$709.77
ALASKA* (AK)	$865.74	$865.74
ALABAMA (AL)	$641.03	$641.03
ARKANSAS (AR)	$632.55	$632.55
ARIZONA (AZ)	$690.11	$690.11
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$823.77	$823.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$836.44	$836.44
OXNARD-THOUSAND OAKS-VENTURA (CA)	$746.85	$746.85
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$754.48	$754.48
NAPA (CA)	$791.28	$791.28
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$826.22	$826.22
VALLEJO (CA)	$787.77	$787.77
BAKERSFIELD (CA)	$716.96	$716.96
CHICO (CA)	$711.04	$711.04
FRESNO (CA)	$711.04	$711.04
HANFORD-CORCORAN (CA)	$711.04	$711.04
MADERA (CA)	$711.04	$711.04
MERCED (CA)	$711.04	$711.04
MODESTO (CA)	$711.04	$711.04
REDDING (CA)	$711.04	$711.04
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$734.14	$734.14
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$737.59	$737.59
SALINAS (CA)	$734.70	$734.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$846.43	$846.43
SANTA CRUZ-WATSONVILLE (CA)	$748.16	$748.16
SANTA ROSA-PETALUMA (CA)	$755.11	$755.11
STOCKTON (CA)	$711.04	$711.04
VISALIA (CA)	$711.04	$711.04
YUBA CITY (CA)	$711.04	$711.04
EL CENTRO (CA)	$711.40	$711.40
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$745.92	$745.92
SAN LUIS OBISPO-PASO ROBLES (CA)	$723.97	$723.97
SANTA MARIA-SANTA BARBARA (CA)	$735.80	$735.80
REST OF CALIFORNIA (CA)	$711.04	$711.04
COLORADO (CO)	$717.33	$717.33
CONNECTICUT (CT)	$754.74	$754.74
DC + MD/VA SUBURBS (DC)	$789.61	$789.61
DELAWARE (DE)	$700.60	$700.60
FORT LAUDERDALE (FL)	$771.70	$771.70
MIAMI (FL)	$831.89	$831.89
REST OF FLORIDA (FL)	$732.66	$732.66
ATLANTA (GA)	$730.03	$730.03
REST OF GEORGIA (GA)	$691.09	$691.09
HAWAII, GUAM (HI)	$720.72	$720.72
IOWA (IA)	$640.91	$640.91
IDAHO (ID)	$647.88	$647.88
EAST ST. LOUIS (IL)	$758.54	$758.54
SUBURBAN CHICAGO (IL)	$775.69	$775.69
CHICAGO (IL)	$806.63	$806.63
REST OF ILLINOIS (IL)	$724.05	$724.05
INDIANA (IN)	$650.91	$650.91
KANSAS (KS)	$645.29	$645.29
KENTUCKY (KY)	$670.30	$670.30
NEW ORLEANS (LA)	$701.80	$701.80
REST OF LOUISIANA (LA)	$672.18	$672.18
METROPOLITAN BOSTON (MA)	$774.02	$774.02
REST OF MASSACHUSETTS (MA)	$716.52	$716.52
BALTIMORE/SURR. CNTYS (MD)	$754.13	$754.13
REST OF MARYLAND (MD)	$710.86	$710.86
SOUTHERN MAINE (ME)	$680.57	$680.57
REST OF MAINE (ME)	$658.58	$658.58
DETROIT (MI)	$748.51	$748.51
REST OF MICHIGAN (MI)	$692.88	$692.88
MINNESOTA (MN)	$667.93	$667.93
METROPOLITAN ST. LOUIS (MO)	$695.48	$695.48
METROPOLITAN KANSAS CITY (MO)	$689.78	$689.78
REST OF MISSOURI (MO)	$666.42	$666.42
MISSISSIPPI (MS)	$649.24	$649.24
MONTANA** (MT)	$709.63	$709.63
NORTH CAROLINA (NC)	$663.70	$663.70
NORTH DAKOTA** (ND)	$667.11	$667.11
NEBRASKA (NE)	$641.96	$641.96
NEW HAMPSHIRE (NH)	$713.12	$713.12
NORTHERN NJ (NJ)	$784.00	$784.00
REST OF NEW JERSEY (NJ)	$757.88	$757.88
NEW MEXICO (NM)	$699.25	$699.25
NEVADA** (NV)	$698.08	$698.08
MANHATTAN (NY)	$822.14	$822.14
NYC SUBURBS/LONG ISLAND (NY)	$849.72	$849.72
POUGHKPSIE/N NYC SUBURBS (NY)	$768.59	$768.59
QUEENS (NY)	$817.81	$817.81
REST OF NEW YORK (NY)	$673.41	$673.41
OHIO (OH)	$684.19	$684.19
OKLAHOMA (OK)	$661.59	$661.59
PORTLAND (OR)	$730.15	$730.15
REST OF OREGON (OR)	$687.24	$687.24
METROPOLITAN PHILADELPHIA (PA)	$742.03	$742.03
REST OF PENNSYLVANIA (PA)	$681.17	$681.17
PUERTO RICO (PR)	$712.00	$712.00
RHODE ISLAND (RI)	$718.34	$718.34
SOUTH CAROLINA (SC)	$676.15	$676.15
SOUTH DAKOTA** (SD)	$662.09	$662.09
TENNESSEE (TN)	$649.16	$649.16
BRAZORIA (TX)	$693.96	$693.96
DALLAS (TX)	$701.41	$701.41
GALVESTON (TX)	$698.01	$698.01
HOUSTON (TX)	$737.36	$737.36
BEAUMONT (TX)	$677.62	$677.62
FORT WORTH (TX)	$699.33	$699.33
AUSTIN (TX)	$719.69	$719.69
REST OF TEXAS (TX)	$687.47	$687.47
UTAH (UT)	$684.41	$684.41
VIRGINIA (VA)	$683.55	$683.55
VIRGIN ISLANDS (VI)	$712.00	$712.00
VERMONT (VT)	$671.29	$671.29
SEATTLE (KING CNTY) (WA)	$781.73	$781.73
REST OF WASHINGTON (WA)	$712.92	$712.92
WISCONSIN (WI)	$647.45	$647.45
WEST VIRGINIA (WV)	$701.34	$701.34
WYOMING** (WY)	$691.10	$691.10

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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 regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital, ASC) settings because overhead costs differ, which can make the allowed amount vary by place of service.

RVUs — work 10.1, practice expense 9 (non-facility) / 9 (facility), malpractice 2.15 — × 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 the annual deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts shown are national/locality PFS estimates and may not reflect your specific Medicare Administrative Contractor (MAC) or final remittance.
Always verify current rates and coverage policy with your MAC before billing or appealing a claim.

Frequently asked

Why does the amount differ between non-facility and facility settings?

The practice-expense RVU component is calculated differently depending on where the service is performed, since office-based practices typically bear more overhead costs than hospital-based settings.

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

Each locality has its own Geographic Practice Cost Index (GPCI) values, which adjust the work, practice-expense, and malpractice RVUs to reflect local cost-of-living and practice-cost differences.

Does this page show what I will actually be paid?

No. This page shows an estimated PFS allowed amount. Actual payment can be affected by modifiers, secondary payers, deductible status, sequestration, and other claim-specific factors.

Where can I find the official rate for my area?

Contact your Medicare Administrative Contractor (MAC) or consult the CMS Physician Fee Schedule Look-Up Tool for the most current, locality-specific rate.

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.