Medicare Reimbursement for CPT 23220

CPT 23220 is a surgical procedure code reported to Medicare and other payers; the full code description is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level, with notes on how amounts can vary by locality and by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1737.51	$1737.51
ALASKA* (AK)	$2170.87	$2170.87
ALABAMA (AL)	$1578.67	$1578.67
ARKANSAS (AR)	$1559.29	$1559.29
ARIZONA (AZ)	$1690.52	$1690.52
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1934.09	$1934.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1960.42	$1960.42
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1785.38	$1785.38
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1807.28	$1807.28
NAPA (CA)	$1869.85	$1869.85
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1941.20	$1941.20
VALLEJO (CA)	$1859.60	$1859.60
BAKERSFIELD (CA)	$1726.75	$1726.75
CHICO (CA)	$1709.52	$1709.52
FRESNO (CA)	$1709.52	$1709.52
HANFORD-CORCORAN (CA)	$1709.52	$1709.52
MADERA (CA)	$1709.52	$1709.52
MERCED (CA)	$1709.52	$1709.52
MODESTO (CA)	$1709.52	$1709.52
REDDING (CA)	$1709.52	$1709.52
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1776.78	$1776.78
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1764.71	$1764.71
SALINAS (CA)	$1757.61	$1757.61
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1989.49	$1989.49
SANTA CRUZ-WATSONVILLE (CA)	$1778.28	$1778.28
SANTA ROSA-PETALUMA (CA)	$1794.21	$1794.21
STOCKTON (CA)	$1709.52	$1709.52
VISALIA (CA)	$1709.52	$1709.52
YUBA CITY (CA)	$1709.52	$1709.52
EL CENTRO (CA)	$1710.56	$1710.56
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1778.04	$1778.04
SAN LUIS OBISPO-PASO ROBLES (CA)	$1732.94	$1732.94
SANTA MARIA-SANTA BARBARA (CA)	$1758.47	$1758.47
REST OF CALIFORNIA (CA)	$1709.52	$1709.52
COLORADO (CO)	$1738.39	$1738.39
CONNECTICUT (CT)	$1843.04	$1843.04
DC + MD/VA SUBURBS (DC)	$1911.23	$1911.23
DELAWARE (DE)	$1714.78	$1714.78
FORT LAUDERDALE (FL)	$1913.54	$1913.54
MIAMI (FL)	$2079.55	$2079.55
REST OF FLORIDA (FL)	$1818.72	$1818.72
ATLANTA (GA)	$1791.21	$1791.21
REST OF GEORGIA (GA)	$1718.83	$1718.83
HAWAII, GUAM (HI)	$1724.12	$1724.12
IOWA (IA)	$1565.13	$1565.13
IDAHO (ID)	$1583.74	$1583.74
EAST ST. LOUIS (IL)	$1905.95	$1905.95
SUBURBAN CHICAGO (IL)	$1920.53	$1920.53
CHICAGO (IL)	$2017.90	$2017.90
REST OF ILLINOIS (IL)	$1807.84	$1807.84
INDIANA (IN)	$1590.27	$1590.27
KANSAS (KS)	$1581.51	$1581.51
KENTUCKY (KY)	$1659.27	$1659.27
NEW ORLEANS (LA)	$1733.81	$1733.81
REST OF LOUISIANA (LA)	$1666.08	$1666.08
METROPOLITAN BOSTON (MA)	$1860.53	$1860.53
REST OF MASSACHUSETTS (MA)	$1739.68	$1739.68
BALTIMORE/SURR. CNTYS (MD)	$1842.58	$1842.58
REST OF MARYLAND (MD)	$1736.74	$1736.74
SOUTHERN MAINE (ME)	$1655.46	$1655.46
REST OF MAINE (ME)	$1614.90	$1614.90
DETROIT (MI)	$1861.88	$1861.88
REST OF MICHIGAN (MI)	$1717.09	$1717.09
MINNESOTA (MN)	$1606.11	$1606.11
METROPOLITAN ST. LOUIS (MO)	$1711.78	$1711.78
METROPOLITAN KANSAS CITY (MO)	$1699.47	$1699.47
REST OF MISSOURI (MO)	$1656.90	$1656.90
MISSISSIPPI (MS)	$1607.22	$1607.22
MONTANA** (MT)	$1737.10	$1737.10
NORTH CAROLINA (NC)	$1625.53	$1625.53
NORTH DAKOTA** (ND)	$1613.32	$1613.32
NEBRASKA (NE)	$1565.51	$1565.51
NEW HAMPSHIRE (NH)	$1733.71	$1733.71
NORTHERN NJ (NJ)	$1900.87	$1900.87
REST OF NEW JERSEY (NJ)	$1847.26	$1847.26
NEW MEXICO (NM)	$1734.33	$1734.33
NEVADA** (NV)	$1703.14	$1703.14
MANHATTAN (NY)	$2011.25	$2011.25
NYC SUBURBS/LONG ISLAND (NY)	$2082.62	$2082.62
POUGHKPSIE/N NYC SUBURBS (NY)	$1877.44	$1877.44
QUEENS (NY)	$1992.03	$1992.03
REST OF NEW YORK (NY)	$1648.18	$1648.18
OHIO (OH)	$1691.79	$1691.79
OKLAHOMA (OK)	$1632.60	$1632.60
PORTLAND (OR)	$1760.20	$1760.20
REST OF OREGON (OR)	$1673.24	$1673.24
METROPOLITAN PHILADELPHIA (PA)	$1817.91	$1817.91
REST OF PENNSYLVANIA (PA)	$1681.34	$1681.34
PUERTO RICO (PR)	$1740.37	$1740.37
RHODE ISLAND (RI)	$1751.60	$1751.60
SOUTH CAROLINA (SC)	$1664.75	$1664.75
SOUTH DAKOTA** (SD)	$1598.68	$1598.68
TENNESSEE (TN)	$1591.13	$1591.13
BRAZORIA (TX)	$1694.48	$1694.48
DALLAS (TX)	$1714.50	$1714.50
GALVESTON (TX)	$1705.61	$1705.61
HOUSTON (TX)	$1820.19	$1820.19
BEAUMONT (TX)	$1673.64	$1673.64
FORT WORTH (TX)	$1711.77	$1711.77
AUSTIN (TX)	$1747.24	$1747.24
REST OF TEXAS (TX)	$1689.45	$1689.45
UTAH (UT)	$1683.50	$1683.50
VIRGINIA (VA)	$1666.78	$1666.78
VIRGIN ISLANDS (VI)	$1740.37	$1740.37
VERMONT (VT)	$1628.78	$1628.78
SEATTLE (KING CNTY) (WA)	$1872.10	$1872.10
REST OF WASHINGTON (WA)	$1729.20	$1729.20
WISCONSIN (WI)	$1569.94	$1569.94
WEST VIRGINIA (WV)	$1756.27	$1756.27
WYOMING** (WY)	$1683.15	$1683.15

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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 Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which can change the total payment even though work and malpractice RVUs stay the same. Because this code shows identical non-facility and facility PE RVUs, the national amounts shown here are the same for both settings, though locality adjustments still apply.

RVUs — work 29.45, practice expense 16.31 (non-facility) / 16.31 (facility), malpractice 6.26 — × 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, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify the current fee schedule amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the Medicare payment for this code differ by locality?

Medicare adjusts the work, practice expense, and malpractice RVUs using locality-specific GPCIs before applying the conversion factor, so the same code can price differently depending on where the service was performed.

Why are the non-facility and facility amounts the same for this code?

When the practice-expense RVU is identical for both settings, the calculated PFS amount is the same regardless of site of service, though locality adjustments can still cause variation across regions.

Does this amount reflect what I'll actually be paid?

No — this is a national PFS estimate. Actual reimbursement depends on your specific locality GPCIs, applicable modifiers, claim adjustments, and payer-specific policies.

How often does the conversion factor change?

The conversion factor is updated annually by CMS and can also be affected by legislative or budget-neutrality adjustments during the year.

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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.