Medicare Reimbursement for CPT 23397
CPT 23397 is a physician procedure code reported to Medicare for payment under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings. Actual payment depends on where the service is performed and the patient's specific locality.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $1042.78 | $1042.78 |
| ALASKA* (AK) | $1288.22 | $1288.22 |
| ALABAMA (AL) | $944.73 | $944.73 |
| ARKANSAS (AR) | $932.71 | $932.71 |
| ARIZONA (AZ) | $1014.23 | $1014.23 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1183.90 | $1183.90 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1201.02 | $1201.02 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1083.54 | $1083.54 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1095.78 | $1095.78 |
| NAPA (CA) | $1141.06 | $1141.06 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1187.86 | $1187.86 |
| VALLEJO (CA) | $1135.36 | $1135.36 |
| BAKERSFIELD (CA) | $1044.25 | $1044.25 |
| CHICO (CA) | $1034.68 | $1034.68 |
| FRESNO (CA) | $1034.68 | $1034.68 |
| HANFORD-CORCORAN (CA) | $1034.68 | $1034.68 |
| MADERA (CA) | $1034.68 | $1034.68 |
| MERCED (CA) | $1034.68 | $1034.68 |
| MODESTO (CA) | $1034.68 | $1034.68 |
| REDDING (CA) | $1034.68 | $1034.68 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $1072.07 | $1072.07 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1070.56 | $1070.56 |
| SALINAS (CA) | $1066.30 | $1066.30 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1217.18 | $1217.18 |
| SANTA CRUZ-WATSONVILLE (CA) | $1082.17 | $1082.17 |
| SANTA ROSA-PETALUMA (CA) | $1092.03 | $1092.03 |
| STOCKTON (CA) | $1034.68 | $1034.68 |
| VISALIA (CA) | $1034.68 | $1034.68 |
| YUBA CITY (CA) | $1034.68 | $1034.68 |
| EL CENTRO (CA) | $1035.26 | $1035.26 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1080.54 | $1080.54 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $1051.05 | $1051.05 |
| SANTA MARIA-SANTA BARBARA (CA) | $1067.33 | $1067.33 |
| REST OF CALIFORNIA (CA) | $1034.68 | $1034.68 |
| COLORADO (CO) | $1048.24 | $1048.24 |
| CONNECTICUT (CT) | $1107.42 | $1107.42 |
| DC + MD/VA SUBURBS (DC) | $1153.16 | $1153.16 |
| DELAWARE (DE) | $1029.20 | $1029.20 |
| FORT LAUDERDALE (FL) | $1141.64 | $1141.64 |
| MIAMI (FL) | $1236.11 | $1236.11 |
| REST OF FLORIDA (FL) | $1084.49 | $1084.49 |
| ATLANTA (GA) | $1073.87 | $1073.87 |
| REST OF GEORGIA (GA) | $1023.97 | $1023.97 |
| HAWAII, GUAM (HI) | $1046.01 | $1046.01 |
| IOWA (IA) | $940.32 | $940.32 |
| IDAHO (ID) | $951.06 | $951.06 |
| EAST ST. LOUIS (IL) | $1130.18 | $1130.18 |
| SUBURBAN CHICAGO (IL) | $1146.61 | $1146.61 |
| CHICAGO (IL) | $1199.02 | $1199.02 |
| REST OF ILLINOIS (IL) | $1075.09 | $1075.09 |
| INDIANA (IN) | $955.24 | $955.24 |
| KANSAS (KS) | $948.57 | $948.57 |
| KENTUCKY (KY) | $990.63 | $990.63 |
| NEW ORLEANS (LA) | $1036.12 | $1036.12 |
| REST OF LOUISIANA (LA) | $994.11 | $994.11 |
| METROPOLITAN BOSTON (MA) | $1126.24 | $1126.24 |
| REST OF MASSACHUSETTS (MA) | $1048.09 | $1048.09 |
| BALTIMORE/SURR. CNTYS (MD) | $1106.85 | $1106.85 |
| REST OF MARYLAND (MD) | $1043.27 | $1043.27 |
| SOUTHERN MAINE (ME) | $996.46 | $996.46 |
| REST OF MAINE (ME) | $968.38 | $968.38 |
| DETROIT (MI) | $1109.19 | $1109.19 |
| REST OF MICHIGAN (MI) | $1024.64 | $1024.64 |
| MINNESOTA (MN) | $971.99 | $971.99 |
| METROPOLITAN ST. LOUIS (MO) | $1024.73 | $1024.73 |
| METROPOLITAN KANSAS CITY (MO) | $1016.88 | $1016.88 |
| REST OF MISSOURI (MO) | $987.21 | $987.21 |
| MISSISSIPPI (MS) | $959.51 | $959.51 |
| MONTANA** (MT) | $1042.54 | $1042.54 |
| NORTH CAROLINA (NC) | $975.30 | $975.30 |
| NORTH DAKOTA** (ND) | $973.73 | $973.73 |
| NEBRASKA (NE) | $941.16 | $941.16 |
| NEW HAMPSHIRE (NH) | $1043.86 | $1043.86 |
| NORTHERN NJ (NJ) | $1145.99 | $1145.99 |
| REST OF NEW JERSEY (NJ) | $1110.91 | $1110.91 |
| NEW MEXICO (NM) | $1034.54 | $1034.54 |
| NEVADA** (NV) | $1023.75 | $1023.75 |
| MANHATTAN (NY) | $1207.50 | $1207.50 |
| NYC SUBURBS/LONG ISLAND (NY) | $1249.28 | $1249.28 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1127.92 | $1127.92 |
| QUEENS (NY) | $1198.38 | $1198.38 |
| REST OF NEW YORK (NY) | $989.22 | $989.22 |
| OHIO (OH) | $1010.58 | $1010.58 |
| OKLAHOMA (OK) | $976.11 | $976.11 |
| PORTLAND (OR) | $1064.02 | $1064.02 |
| REST OF OREGON (OR) | $1006.73 | $1006.73 |
| METROPOLITAN PHILADELPHIA (PA) | $1090.64 | $1090.64 |
| REST OF PENNSYLVANIA (PA) | $1005.16 | $1005.16 |
| PUERTO RICO (PR) | $1045.22 | $1045.22 |
| RHODE ISLAND (RI) | $1053.16 | $1053.16 |
| SOUTH CAROLINA (SC) | $996.40 | $996.40 |
| SOUTH DAKOTA** (SD) | $965.60 | $965.60 |
| TENNESSEE (TN) | $954.31 | $954.31 |
| BRAZORIA (TX) | $1018.14 | $1018.14 |
| DALLAS (TX) | $1029.66 | $1029.66 |
| GALVESTON (TX) | $1024.48 | $1024.48 |
| HOUSTON (TX) | $1088.18 | $1088.18 |
| BEAUMONT (TX) | $1000.25 | $1000.25 |
| FORT WORTH (TX) | $1027.36 | $1027.36 |
| AUSTIN (TX) | $1052.70 | $1052.70 |
| REST OF TEXAS (TX) | $1012.08 | $1012.08 |
| UTAH (UT) | $1008.07 | $1008.07 |
| VIRGINIA (VA) | $1002.13 | $1002.13 |
| VIRGIN ISLANDS (VI) | $1045.22 | $1045.22 |
| VERMONT (VT) | $981.55 | $981.55 |
| SEATTLE (KING CNTY) (WA) | $1135.23 | $1135.23 |
| REST OF WASHINGTON (WA) | $1042.27 | $1042.27 |
| WISCONSIN (WI) | $946.35 | $946.35 |
| WEST VIRGINIA (WV) | $1042.99 | $1042.99 |
| WYOMING** (WY) | $1012.55 | $1012.55 |
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: 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 Physician Fee Schedule 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 Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting local cost-of-living and practice cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates can differ because the practice-expense RVU is typically higher in non-facility (e.g., office) settings, where the provider bears more overhead costs directly.
RVUs — work 16.34, practice expense 11.4 (non-facility) / 11.4 (facility), malpractice 3.48 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only, based on national and locality-adjusted PFS inputs — not a guarantee of payment.
- Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary insurer is responsible for the remainder.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
- Rates are updated annually and can vary by locality; always confirm current rates with your Medicare Administrative Contractor (MAC).
- This page does not reflect facility-specific contracts, secondary payer rules, or state Medicaid crossover adjustments.
Frequently asked
Why do the non-facility and facility amounts differ for this code?
The practice-expense RVU often varies between settings because non-facility (e.g., office) billing includes the provider's overhead costs, while facility billing assumes the hospital or ASC absorbs those costs separately.
Does this amount reflect what Medicare will actually pay?
No — it's an estimate based on standard PFS formulas. Actual payment depends on your specific locality, any applicable modifiers, sequestration, and other adjustments determined by your MAC.
Why do rates change year to year?
CMS updates the conversion factor and RVUs annually, often due to legislative changes, relative value recalibrations, and budget-neutrality requirements across the fee schedule.
How is the locality-specific amount calculated from the national figure?
Each RVU component (work, practice expense, malpractice) is multiplied by its corresponding locality GPCI before being summed and multiplied by the conversion factor, which produces a locality-adjusted allowed amount.
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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