Medicare Reimbursement for CPT Code 23455

CPT code 23455 is a physician procedure code used for billing Medicare Part B services. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for a specific locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$880.45	$880.45
ALASKA* (AK)	$1098.58	$1098.58
ALABAMA (AL)	$801.92	$801.92
ARKANSAS (AR)	$792.28	$792.28
ARIZONA (AZ)	$857.66	$857.66
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1001.16	$1001.16
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1015.74	$1015.74
OXNARD-THOUSAND OAKS-VENTURA (CA)	$916.16	$916.16
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$926.42	$926.42
NAPA (CA)	$964.77	$964.77
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1004.26	$1004.26
VALLEJO (CA)	$960.31	$960.31
BAKERSFIELD (CA)	$883.79	$883.79
CHICO (CA)	$876.17	$876.17
FRESNO (CA)	$876.17	$876.17
HANFORD-CORCORAN (CA)	$876.17	$876.17
MADERA (CA)	$876.17	$876.17
MERCED (CA)	$876.17	$876.17
MODESTO (CA)	$876.17	$876.17
REDDING (CA)	$876.17	$876.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$905.56	$905.56
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$906.13	$906.13
SALINAS (CA)	$902.49	$902.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1028.42	$1028.42
SANTA CRUZ-WATSONVILLE (CA)	$915.17	$915.17
SANTA ROSA-PETALUMA (CA)	$923.52	$923.52
STOCKTON (CA)	$876.17	$876.17
VISALIA (CA)	$876.17	$876.17
YUBA CITY (CA)	$876.17	$876.17
EL CENTRO (CA)	$876.63	$876.63
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$914.09	$914.09
SAN LUIS OBISPO-PASO ROBLES (CA)	$889.57	$889.57
SANTA MARIA-SANTA BARBARA (CA)	$903.24	$903.24
REST OF CALIFORNIA (CA)	$876.17	$876.17
COLORADO (CO)	$886.15	$886.15
CONNECTICUT (CT)	$933.14	$933.14
DC + MD/VA SUBURBS (DC)	$972.01	$972.01
DELAWARE (DE)	$869.89	$869.89
FORT LAUDERDALE (FL)	$958.18	$958.18
MIAMI (FL)	$1032.65	$1032.65
REST OF FLORIDA (FL)	$912.60	$912.60
ATLANTA (GA)	$905.19	$905.19
REST OF GEORGIA (GA)	$864.30	$864.30
HAWAII, GUAM (HI)	$884.75	$884.75
IOWA (IA)	$798.97	$798.97
IDAHO (ID)	$807.46	$807.46
EAST ST. LOUIS (IL)	$947.98	$947.98
SUBURBAN CHICAGO (IL)	$962.60	$962.60
CHICAGO (IL)	$1003.43	$1003.43
REST OF ILLINOIS (IL)	$904.67	$904.67
INDIANA (IN)	$810.83	$810.83
KANSAS (KS)	$805.30	$805.30
KENTUCKY (KY)	$838.11	$838.11
NEW ORLEANS (LA)	$874.46	$874.46
REST OF LOUISIANA (LA)	$840.78	$840.78
METROPOLITAN BOSTON (MA)	$950.46	$950.46
REST OF MASSACHUSETTS (MA)	$886.10	$886.10
BALTIMORE/SURR. CNTYS (MD)	$932.45	$932.45
REST OF MARYLAND (MD)	$881.49	$881.49
SOUTHERN MAINE (ME)	$844.00	$844.00
REST OF MAINE (ME)	$821.05	$821.05
DETROIT (MI)	$932.09	$932.09
REST OF MICHIGAN (MI)	$865.10	$865.10
MINNESOTA (MN)	$825.29	$825.29
METROPOLITAN ST. LOUIS (MO)	$865.67	$865.67
METROPOLITAN KANSAS CITY (MO)	$859.34	$859.34
REST OF MISSOURI (MO)	$835.07	$835.07
MISSISSIPPI (MS)	$813.33	$813.33
MONTANA** (MT)	$880.27	$880.27
NORTH CAROLINA (NC)	$826.65	$826.65
NORTH DAKOTA** (ND)	$826.28	$826.28
NEBRASKA (NE)	$799.74	$799.74
NEW HAMPSHIRE (NH)	$881.83	$881.83
NORTHERN NJ (NJ)	$966.60	$966.60
REST OF NEW JERSEY (NJ)	$937.07	$937.07
NEW MEXICO (NM)	$872.91	$872.91
NEVADA** (NV)	$865.53	$865.53
MANHATTAN (NY)	$1014.93	$1014.93
NYC SUBURBS/LONG ISLAND (NY)	$1048.06	$1048.06
POUGHKPSIE/N NYC SUBURBS (NY)	$950.69	$950.69
QUEENS (NY)	$1008.04	$1008.04
REST OF NEW YORK (NY)	$837.78	$837.78
OHIO (OH)	$854.07	$854.07
OKLAHOMA (OK)	$826.77	$826.77
PORTLAND (OR)	$899.34	$899.34
REST OF OREGON (OR)	$852.12	$852.12
METROPOLITAN PHILADELPHIA (PA)	$919.42	$919.42
REST OF PENNSYLVANIA (PA)	$849.88	$849.88
PUERTO RICO (PR)	$882.51	$882.51
RHODE ISLAND (RI)	$889.96	$889.96
SOUTH CAROLINA (SC)	$843.09	$843.09
SOUTH DAKOTA** (SD)	$819.90	$819.90
TENNESSEE (TN)	$809.87	$809.87
BRAZORIA (TX)	$861.40	$861.40
DALLAS (TX)	$870.55	$870.55
GALVESTON (TX)	$866.40	$866.40
HOUSTON (TX)	$916.37	$916.37
BEAUMONT (TX)	$845.93	$845.93
FORT WORTH (TX)	$868.62	$868.62
AUSTIN (TX)	$889.08	$889.08
REST OF TEXAS (TX)	$855.71	$855.71
UTAH (UT)	$852.45	$852.45
VIRGINIA (VA)	$848.34	$848.34
VIRGIN ISLANDS (VI)	$882.51	$882.51
VERMONT (VT)	$832.29	$832.29
SEATTLE (KING CNTY) (WA)	$958.38	$958.38
REST OF WASHINGTON (WA)	$881.38	$881.38
WISCONSIN (WI)	$804.26	$804.26
WEST VIRGINIA (WV)	$878.92	$878.92
WYOMING** (WY)	$856.74	$856.74

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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 PFS formula combines three relative value units (RVUs) — physician work, practice expense, and malpractice — each adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is rendered. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice expense RVUs typically differ between non-facility and facility settings because the practice absorbs more overhead when a service is performed outside a facility. Work and malpractice RVU adjustments generally remain the same across settings. The resulting allowed amount represents the total payment before any patient cost-sharing is applied.

RVUs — work 14.3, practice expense 9.33 (non-facility) / 9.33 (facility), malpractice 2.73 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets the Part B 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.
Rates vary by locality due to differing GPCI values; always confirm with your Medicare Administrative Contractor (MAC) for the specific locality and date of service.
Conversion factors and RVUs are updated annually and may be revised mid-year by CMS.

Frequently asked

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

The two settings can have different practice expense RVUs, since the overhead a physician practice incurs is treated differently depending on whether the service is performed in an office versus a facility like a hospital.

What is a GPCI and why does it matter for billing?

The Geographic Practice Cost Index adjusts each RVU component to reflect regional differences in labor, rent, and malpractice costs, which is why the same code can have different allowed amounts across localities.

Does the amount shown include what the patient owes?

No. The figure represents the total Medicare-allowed amount; patient responsibility (typically 20% coinsurance after the deductible) is calculated separately and not shown here.

How often does CMS update these rates?

RVUs and the conversion factor are typically updated annually through CMS rulemaking, though mid-year adjustments can occur due to legislation or budget-neutrality corrections.

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.