Medicare Reimbursement for CPT 23430

This page covers CPT code 23430, a physician procedure code reported to Medicare. It shows the Medicare Physician Fee Schedule (PFS) allowed amount, both at the national level and adjusted for local cost differences, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$696.41	$696.41
ALASKA* (AK)	$851.64	$851.64
ALABAMA (AL)	$630.24	$630.24
ARKANSAS (AR)	$622.07	$622.07
ARIZONA (AZ)	$677.58	$677.58
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$812.09	$812.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$824.76	$824.76
OXNARD-THOUSAND OAKS-VENTURA (CA)	$734.97	$734.97
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$742.30	$742.30
NAPA (CA)	$779.54	$779.54
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$814.35	$814.35
VALLEJO (CA)	$776.28	$776.28
BAKERSFIELD (CA)	$705.38	$705.38
CHICO (CA)	$699.87	$699.87
FRESNO (CA)	$699.87	$699.87
HANFORD-CORCORAN (CA)	$699.87	$699.87
MADERA (CA)	$699.87	$699.87
MERCED (CA)	$699.87	$699.87
MODESTO (CA)	$699.87	$699.87
REDDING (CA)	$699.87	$699.87
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$721.27	$721.27
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$726.17	$726.17
SALINAS (CA)	$723.32	$723.32
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$834.00	$834.00
SANTA CRUZ-WATSONVILLE (CA)	$736.73	$736.73
SANTA ROSA-PETALUMA (CA)	$743.59	$743.59
STOCKTON (CA)	$699.87	$699.87
VISALIA (CA)	$699.87	$699.87
YUBA CITY (CA)	$699.87	$699.87
EL CENTRO (CA)	$700.20	$700.20
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$734.43	$734.43
SAN LUIS OBISPO-PASO ROBLES (CA)	$712.71	$712.71
SANTA MARIA-SANTA BARBARA (CA)	$724.41	$724.41
REST OF CALIFORNIA (CA)	$699.87	$699.87
COLORADO (CO)	$704.94	$704.94
CONNECTICUT (CT)	$739.99	$739.99
DC + MD/VA SUBURBS (DC)	$774.96	$774.96
DELAWARE (DE)	$687.77	$687.77
FORT LAUDERDALE (FL)	$754.00	$754.00
MIAMI (FL)	$810.28	$810.28
REST OF FLORIDA (FL)	$716.70	$716.70
ATLANTA (GA)	$715.54	$715.54
REST OF GEORGIA (GA)	$676.92	$676.92
HAWAII, GUAM (HI)	$709.33	$709.33
IOWA (IA)	$630.95	$630.95
IDAHO (ID)	$637.49	$637.49
EAST ST. LOUIS (IL)	$739.92	$739.92
SUBURBAN CHICAGO (IL)	$758.10	$758.10
CHICAGO (IL)	$786.30	$786.30
REST OF ILLINOIS (IL)	$707.85	$707.85
INDIANA (IN)	$640.45	$640.45
KANSAS (KS)	$634.77	$634.77
KENTUCKY (KY)	$657.61	$657.61
NEW ORLEANS (LA)	$687.83	$687.83
REST OF LOUISIANA (LA)	$659.28	$659.28
METROPOLITAN BOSTON (MA)	$760.61	$760.61
REST OF MASSACHUSETTS (MA)	$704.04	$704.04
BALTIMORE/SURR. CNTYS (MD)	$739.26	$739.26
REST OF MARYLAND (MD)	$697.86	$697.86
SOUTHERN MAINE (ME)	$669.19	$669.19
REST OF MAINE (ME)	$647.40	$647.40
DETROIT (MI)	$731.55	$731.55
REST OF MICHIGAN (MI)	$679.00	$679.00
MINNESOTA (MN)	$658.27	$658.27
METROPOLITAN ST. LOUIS (MO)	$682.21	$682.21
METROPOLITAN KANSAS CITY (MO)	$676.67	$676.67
REST OF MISSOURI (MO)	$653.47	$653.47
MISSISSIPPI (MS)	$637.55	$637.55
MONTANA** (MT)	$696.28	$696.28
NORTH CAROLINA (NC)	$652.41	$652.41
NORTH DAKOTA** (ND)	$656.93	$656.93
NEBRASKA (NE)	$632.07	$632.07
NEW HAMPSHIRE (NH)	$700.34	$700.34
NORTHERN NJ (NJ)	$769.58	$769.58
REST OF NEW JERSEY (NJ)	$743.58	$743.58
NEW MEXICO (NM)	$684.98	$684.98
NEVADA** (NV)	$685.61	$685.61
MANHATTAN (NY)	$804.94	$804.94
NYC SUBURBS/LONG ISLAND (NY)	$831.01	$831.01
POUGHKPSIE/N NYC SUBURBS (NY)	$753.64	$753.64
QUEENS (NY)	$801.34	$801.34
REST OF NEW YORK (NY)	$661.74	$661.74
OHIO (OH)	$670.96	$670.96
OKLAHOMA (OK)	$649.64	$649.64
PORTLAND (OR)	$717.84	$717.84
REST OF OREGON (OR)	$675.47	$675.47
METROPOLITAN PHILADELPHIA (PA)	$727.44	$727.44
REST OF PENNSYLVANIA (PA)	$668.27	$668.27
PUERTO RICO (PR)	$698.70	$698.70
RHODE ISLAND (RI)	$705.38	$705.38
SOUTH CAROLINA (SC)	$663.74	$663.74
SOUTH DAKOTA** (SD)	$652.27	$652.27
TENNESSEE (TN)	$638.46	$638.46
BRAZORIA (TX)	$681.75	$681.75
DALLAS (TX)	$688.76	$688.76
GALVESTON (TX)	$685.54	$685.54
HOUSTON (TX)	$721.96	$721.96
BEAUMONT (TX)	$664.82	$664.82
FORT WORTH (TX)	$686.64	$686.64
AUSTIN (TX)	$706.81	$706.81
REST OF TEXAS (TX)	$674.73	$674.73
UTAH (UT)	$671.71	$671.71
VIRGINIA (VA)	$671.79	$671.79
VIRGIN ISLANDS (VI)	$698.70	$698.70
VERMONT (VT)	$660.59	$660.59
SEATTLE (KING CNTY) (WA)	$768.60	$768.60
REST OF WASHINGTON (WA)	$700.66	$700.66
WISCONSIN (WI)	$637.87	$637.87
WEST VIRGINIA (WV)	$685.94	$685.94
WYOMING** (WY)	$679.13	$679.13

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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 fee schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each procedure code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Because practice expense costs differ depending on whether a service is performed in a facility (like a hospital) versus a non-facility setting (like an office), the practice-expense RVU — and therefore the final payment — can vary between these two settings for the same code.

RVUs — work 9.92, practice expense 8.94 (non-facility) / 8.94 (facility), malpractice 1.99 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the remaining 20% is patient responsibility or secondary coverage.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Local Medicare Administrative Contractor (MAC) policies and coverage determinations may affect whether and how this code is paid.
Figures shown reflect a specific year's fee schedule and may differ in prior or future years.

Frequently asked

Why is the facility amount different from the non-facility amount?

The practice-expense RVU component differs because non-facility settings (e.g., physician offices) bear more of the direct overhead costs, while facility settings (e.g., hospitals) absorb some of those costs separately, which is reflected in the payment calculation.

Does this amount apply the same way in every state?

No. The national amount is adjusted by locality-specific GPCIs, so the actual allowed amount can be higher or lower depending on where the service is furnished.

Is this the amount the patient or payer actually pays?

This is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% after the deductible, with the patient or secondary insurance responsible for the remainder, subject to any applicable adjustments.

Can modifiers change this fee?

Yes. Certain modifiers (e.g., bilateral, multiple procedure, or assistant-at-surgery modifiers) can increase or reduce the base fee schedule amount for this code.

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.