Medicare Reimbursement for CPT 23200
This page covers the Medicare Physician Fee Schedule (PFS) estimate for CPT code 23200, a procedure code defined by the American Medical Association. It shows the national PFS allowed amount as well as locality-adjusted figures, broken out by non-facility and facility settings where applicable.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $1365.43 | $1365.43 |
| ALASKA* (AK) | $1694.66 | $1694.66 |
| ALABAMA (AL) | $1238.37 | $1238.37 |
| ARKANSAS (AR) | $1222.82 | $1222.82 |
| ARIZONA (AZ) | $1328.17 | $1328.17 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1536.70 | $1536.70 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1558.34 | $1558.34 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1411.74 | $1411.74 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1428.30 | $1428.30 |
| NAPA (CA) | $1483.09 | $1483.09 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1542.07 | $1542.07 |
| VALLEJO (CA) | $1475.35 | $1475.35 |
| BAKERSFIELD (CA) | $1362.63 | $1362.63 |
| CHICO (CA) | $1349.62 | $1349.62 |
| FRESNO (CA) | $1349.62 | $1349.62 |
| HANFORD-CORCORAN (CA) | $1349.62 | $1349.62 |
| MADERA (CA) | $1349.62 | $1349.62 |
| MERCED (CA) | $1349.62 | $1349.62 |
| MODESTO (CA) | $1349.62 | $1349.62 |
| REDDING (CA) | $1349.62 | $1349.62 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $1400.44 | $1400.44 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1395.02 | $1395.02 |
| SALINAS (CA) | $1389.45 | $1389.45 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1580.30 | $1580.30 |
| SANTA CRUZ-WATSONVILLE (CA) | $1408.26 | $1408.26 |
| SANTA ROSA-PETALUMA (CA) | $1421.00 | $1421.00 |
| STOCKTON (CA) | $1349.62 | $1349.62 |
| VISALIA (CA) | $1349.62 | $1349.62 |
| YUBA CITY (CA) | $1349.62 | $1349.62 |
| EL CENTRO (CA) | $1350.41 | $1350.41 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1406.97 | $1406.97 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $1369.74 | $1369.74 |
| SANTA MARIA-SANTA BARBARA (CA) | $1390.51 | $1390.51 |
| REST OF CALIFORNIA (CA) | $1349.62 | $1349.62 |
| COLORADO (CO) | $1369.65 | $1369.65 |
| CONNECTICUT (CT) | $1449.43 | $1449.43 |
| DC + MD/VA SUBURBS (DC) | $1506.51 | $1506.51 |
| DELAWARE (DE) | $1347.55 | $1347.55 |
| FORT LAUDERDALE (FL) | $1499.16 | $1499.16 |
| MIAMI (FL) | $1626.18 | $1626.18 |
| REST OF FLORIDA (FL) | $1424.31 | $1424.31 |
| ATLANTA (GA) | $1406.89 | $1406.89 |
| REST OF GEORGIA (GA) | $1345.22 | $1345.22 |
| HAWAII, GUAM (HI) | $1363.03 | $1363.03 |
| IOWA (IA) | $1230.39 | $1230.39 |
| IDAHO (ID) | $1244.73 | $1244.73 |
| EAST ST. LOUIS (IL) | $1488.19 | $1488.19 |
| SUBURBAN CHICAGO (IL) | $1505.21 | $1505.21 |
| CHICAGO (IL) | $1577.54 | $1577.54 |
| REST OF ILLINOIS (IL) | $1413.66 | $1413.66 |
| INDIANA (IN) | $1250.06 | $1250.06 |
| KANSAS (KS) | $1242.14 | $1242.14 |
| KENTUCKY (KY) | $1300.06 | $1300.06 |
| NEW ORLEANS (LA) | $1359.31 | $1359.31 |
| REST OF LOUISIANA (LA) | $1304.98 | $1304.98 |
| METROPOLITAN BOSTON (MA) | $1469.15 | $1469.15 |
| REST OF MASSACHUSETTS (MA) | $1369.99 | $1369.99 |
| BALTIMORE/SURR. CNTYS (MD) | $1448.86 | $1448.86 |
| REST OF MARYLAND (MD) | $1365.48 | $1365.48 |
| SOUTHERN MAINE (ME) | $1302.92 | $1302.92 |
| REST OF MAINE (ME) | $1268.27 | $1268.27 |
| DETROIT (MI) | $1457.43 | $1457.43 |
| REST OF MICHIGAN (MI) | $1345.10 | $1345.10 |
| MINNESOTA (MN) | $1267.78 | $1267.78 |
| METROPOLITAN ST. LOUIS (MO) | $1343.28 | $1343.28 |
| METROPOLITAN KANSAS CITY (MO) | $1333.25 | $1333.25 |
| REST OF MISSOURI (MO) | $1296.74 | $1296.74 |
| MISSISSIPPI (MS) | $1259.15 | $1259.15 |
| MONTANA** (MT) | $1365.11 | $1365.11 |
| NORTH CAROLINA (NC) | $1277.04 | $1277.04 |
| NORTH DAKOTA** (ND) | $1271.58 | $1271.58 |
| NEBRASKA (NE) | $1231.13 | $1231.13 |
| NEW HAMPSHIRE (NH) | $1364.87 | $1364.87 |
| NORTHERN NJ (NJ) | $1497.63 | $1497.63 |
| REST OF NEW JERSEY (NJ) | $1453.38 | $1453.38 |
| NEW MEXICO (NM) | $1358.34 | $1358.34 |
| NEVADA** (NV) | $1339.51 | $1339.51 |
| MANHATTAN (NY) | $1581.14 | $1581.14 |
| NYC SUBURBS/LONG ISLAND (NY) | $1636.59 | $1636.59 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1476.34 | $1476.34 |
| QUEENS (NY) | $1567.75 | $1567.75 |
| REST OF NEW YORK (NY) | $1295.11 | $1295.11 |
| OHIO (OH) | $1325.98 | $1325.98 |
| OKLAHOMA (OK) | $1280.13 | $1280.13 |
| PORTLAND (OR) | $1388.76 | $1388.76 |
| REST OF OREGON (OR) | $1316.64 | $1316.64 |
| METROPOLITAN PHILADELPHIA (PA) | $1428.42 | $1428.42 |
| REST OF PENNSYLVANIA (PA) | $1318.37 | $1318.37 |
| PUERTO RICO (PR) | $1368.21 | $1368.21 |
| RHODE ISLAND (RI) | $1377.86 | $1377.86 |
| SOUTH CAROLINA (SC) | $1306.17 | $1306.17 |
| SOUTH DAKOTA** (SD) | $1260.53 | $1260.53 |
| TENNESSEE (TN) | $1249.70 | $1249.70 |
| BRAZORIA (TX) | $1332.38 | $1332.38 |
| DALLAS (TX) | $1347.78 | $1347.78 |
| GALVESTON (TX) | $1340.90 | $1340.90 |
| HOUSTON (TX) | $1427.47 | $1427.47 |
| BEAUMONT (TX) | $1312.10 | $1312.10 |
| FORT WORTH (TX) | $1345.15 | $1345.15 |
| AUSTIN (TX) | $1376.04 | $1376.04 |
| REST OF TEXAS (TX) | $1326.24 | $1326.24 |
| UTAH (UT) | $1321.24 | $1321.24 |
| VIRGINIA (VA) | $1311.03 | $1311.03 |
| VIRGIN ISLANDS (VI) | $1368.21 | $1368.21 |
| VERMONT (VT) | $1282.70 | $1282.70 |
| SEATTLE (KING CNTY) (WA) | $1479.72 | $1479.72 |
| REST OF WASHINGTON (WA) | $1362.08 | $1362.08 |
| WISCONSIN (WI) | $1236.45 | $1236.45 |
| WEST VIRGINIA (WV) | $1372.22 | $1372.22 |
| WYOMING** (WY) | $1324.35 | $1324.35 |
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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
The Medicare 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) for the specific locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can use different practice-expense RVUs, which is why payment can differ by place of service, though for this code both figures may align or differ slightly based on CMS data.
RVUs — work 22.14, practice expense 14.01 (non-facility) / 14.01 (facility), malpractice 4.73 — × 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 insurer is responsible for the remainder.
- Actual payment varies by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the Medicare fee for this code differ by locality?
Each locality has its own Geographic Practice Cost Index (GPCI) values for work, practice expense, and malpractice, which adjust the base RVUs to reflect local cost-of-living and practice cost differences.
Why are the non-facility and facility amounts the same for this code?
When the practice-expense RVU is identical in both non-facility and facility settings, as shown in the data here, the resulting PFS allowed amount will also be the same regardless of place of service.
Does this amount reflect what Medicare will actually pay me?
No. This figure is the total allowed amount before the patient's deductible and coinsurance are applied. Medicare generally reimburses 80% of the allowed amount once the deductible is met.
Can modifiers change this estimate?
Yes. Modifiers such as bilateral procedure, multiple procedure, or assistant-at-surgery indicators can increase or decrease the final payment relative to the base PFS amount shown here.
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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