Medicare Reimbursement for CPT 23395

CPT 23395 is a procedure code billed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and adjusted by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1177.72	$1177.72
ALASKA* (AK)	$1453.09	$1453.09
ALABAMA (AL)	$1067.59	$1067.59
ARKANSAS (AR)	$1054.06	$1054.06
ARIZONA (AZ)	$1145.89	$1145.89
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1347.97	$1347.97
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1367.93	$1367.93
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1229.60	$1229.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1243.00	$1243.00
NAPA (CA)	$1297.59	$1297.59
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1352.19	$1352.19
VALLEJO (CA)	$1291.51	$1291.51
BAKERSFIELD (CA)	$1183.77	$1183.77
CHICO (CA)	$1173.49	$1173.49
FRESNO (CA)	$1173.49	$1173.49
HANFORD-CORCORAN (CA)	$1173.49	$1173.49
MADERA (CA)	$1173.49	$1173.49
MERCED (CA)	$1173.49	$1173.49
MODESTO (CA)	$1173.49	$1173.49
REDDING (CA)	$1173.49	$1173.49
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1213.48	$1213.48
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1215.08	$1215.08
SALINAS (CA)	$1210.27	$1210.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1385.20	$1385.20
SANTA CRUZ-WATSONVILLE (CA)	$1229.40	$1229.40
SANTA ROSA-PETALUMA (CA)	$1240.68	$1240.68
STOCKTON (CA)	$1173.49	$1173.49
VISALIA (CA)	$1173.49	$1173.49
YUBA CITY (CA)	$1173.49	$1173.49
EL CENTRO (CA)	$1174.11	$1174.11
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1227.04	$1227.04
SAN LUIS OBISPO-PASO ROBLES (CA)	$1192.82	$1192.82
SANTA MARIA-SANTA BARBARA (CA)	$1211.60	$1211.60
REST OF CALIFORNIA (CA)	$1173.49	$1173.49
COLORADO (CO)	$1186.52	$1186.52
CONNECTICUT (CT)	$1250.50	$1250.50
DC + MD/VA SUBURBS (DC)	$1304.39	$1304.39
DELAWARE (DE)	$1162.79	$1162.79
FORT LAUDERDALE (FL)	$1283.96	$1283.96
MIAMI (FL)	$1386.13	$1386.13
REST OF FLORIDA (FL)	$1220.43	$1220.43
ATLANTA (GA)	$1211.70	$1211.70
REST OF GEORGIA (GA)	$1153.02	$1153.02
HAWAII, GUAM (HI)	$1187.00	$1187.00
IOWA (IA)	$1064.58	$1064.58
IDAHO (ID)	$1076.27	$1076.27
EAST ST. LOUIS (IL)	$1267.74	$1267.74
SUBURBAN CHICAGO (IL)	$1290.00	$1290.00
CHICAGO (IL)	$1345.10	$1345.10
REST OF ILLINOIS (IL)	$1208.56	$1208.56
INDIANA (IN)	$1081.03	$1081.03
KANSAS (KS)	$1072.93	$1072.93
KENTUCKY (KY)	$1117.25	$1117.25
NEW ORLEANS (LA)	$1168.09	$1168.09
REST OF LOUISIANA (LA)	$1120.80	$1120.80
METROPOLITAN BOSTON (MA)	$1276.03	$1276.03
REST OF MASSACHUSETTS (MA)	$1185.98	$1185.98
BALTIMORE/SURR. CNTYS (MD)	$1249.64	$1249.64
REST OF MARYLAND (MD)	$1178.96	$1178.96
SOUTHERN MAINE (ME)	$1127.82	$1127.82
REST OF MAINE (ME)	$1094.78	$1094.78
DETROIT (MI)	$1247.22	$1247.22
REST OF MICHIGAN (MI)	$1154.63	$1154.63
MINNESOTA (MN)	$1103.28	$1103.28
METROPOLITAN ST. LOUIS (MO)	$1156.38	$1156.38
METROPOLITAN KANSAS CITY (MO)	$1147.43	$1147.43
REST OF MISSOURI (MO)	$1112.44	$1112.44
MISSISSIPPI (MS)	$1082.80	$1082.80
MONTANA** (MT)	$1177.47	$1177.47
NORTH CAROLINA (NC)	$1102.74	$1102.74
NORTH DAKOTA** (ND)	$1103.91	$1103.91
NEBRASKA (NE)	$1065.81	$1065.81
NEW HAMPSHIRE (NH)	$1180.62	$1180.62
NORTHERN NJ (NJ)	$1296.14	$1296.14
REST OF NEW JERSEY (NJ)	$1255.28	$1255.28
NEW MEXICO (NM)	$1165.38	$1165.38
NEVADA** (NV)	$1157.42	$1157.42
MANHATTAN (NY)	$1362.01	$1362.01
NYC SUBURBS/LONG ISLAND (NY)	$1407.82	$1407.82
POUGHKPSIE/N NYC SUBURBS (NY)	$1273.69	$1273.69
QUEENS (NY)	$1353.11	$1353.11
REST OF NEW YORK (NY)	$1118.33	$1118.33
OHIO (OH)	$1139.60	$1139.60
OKLAHOMA (OK)	$1101.90	$1101.90
PORTLAND (OR)	$1205.47	$1205.47
REST OF OREGON (OR)	$1139.01	$1139.01
METROPOLITAN PHILADELPHIA (PA)	$1231.00	$1231.00
REST OF PENNSYLVANIA (PA)	$1134.02	$1134.02
PUERTO RICO (PR)	$1180.80	$1180.80
RHODE ISLAND (RI)	$1190.61	$1190.61
SOUTH CAROLINA (SC)	$1124.91	$1124.91
SOUTH DAKOTA** (SD)	$1095.21	$1095.21
TENNESSEE (TN)	$1079.28	$1079.28
BRAZORIA (TX)	$1151.17	$1151.17
DALLAS (TX)	$1163.71	$1163.71
GALVESTON (TX)	$1158.03	$1158.03
HOUSTON (TX)	$1226.12	$1226.12
BEAUMONT (TX)	$1128.43	$1128.43
FORT WORTH (TX)	$1160.83	$1160.83
AUSTIN (TX)	$1190.83	$1190.83
REST OF TEXAS (TX)	$1142.73	$1142.73
UTAH (UT)	$1138.07	$1138.07
VIRGINIA (VA)	$1133.54	$1133.54
VIRGIN ISLANDS (VI)	$1180.80	$1180.80
VERMONT (VT)	$1111.84	$1111.84
SEATTLE (KING CNTY) (WA)	$1287.23	$1287.23
REST OF WASHINGTON (WA)	$1179.70	$1179.70
WISCONSIN (WI)	$1072.85	$1072.85
WEST VIRGINIA (WV)	$1172.37	$1172.37
WYOMING** (WY)	$1145.41	$1145.41

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

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 local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs (and therefore the total) can differ between non-facility (e.g., office) and facility (e.g., hospital) settings, though for some codes the two amounts are the same, as reflected here. Because GPCIs and RVUs are updated annually, allowed amounts change from year to year.

RVUs — work 18.08, practice expense 13.46 (non-facility) / 13.46 (facility), malpractice 3.72 — × 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 payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the real allowed amount can differ from the national figure shown.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why do non-facility and facility amounts sometimes match for a code like 23395?

When the practice-expense RVU is the same in both settings, the calculated allowed amount comes out equal, even though facility and non-facility PE RVUs are generally priced separately.

Why might the amount I'm actually paid differ from the figure shown here?

Your locality's GPCIs, applicable modifiers, secondary payer coordination, sequestration, and any mid-year or annual rule changes can all shift the final paid amount away from the national estimate.

Does this amount represent what Medicare pays, or the total allowed charge?

It represents the total Medicare-allowed amount before cost-sharing; Medicare generally pays 80% of this figure after the deductible, with the remaining 20% owed by the patient or a secondary payer.

Where can I find the official RVU and GPCI values used in this calculation?

CMS publishes the annual Physician Fee Schedule Relative Value Files and GPCI tables, which your MAC also uses to price claims for your specific locality.

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.