Medicare Reimbursement for CPT 23465

CPT code 23465 is a surgical procedure code; the full descriptive text is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both nationally and adjustable by locality, with separate non-facility and facility rates.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1024.74	$1024.74
ALASKA* (AK)	$1264.19	$1264.19
ALABAMA (AL)	$928.11	$928.11
ARKANSAS (AR)	$916.25	$916.25
ARIZONA (AZ)	$996.67	$996.67
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1166.50	$1166.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1183.49	$1183.49
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1066.40	$1066.40
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1078.31	$1078.31
NAPA (CA)	$1123.82	$1123.82
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1170.34	$1170.34
VALLEJO (CA)	$1118.29	$1118.29
BAKERSFIELD (CA)	$1027.27	$1027.27
CHICO (CA)	$1017.96	$1017.96
FRESNO (CA)	$1017.96	$1017.96
HANFORD-CORCORAN (CA)	$1017.96	$1017.96
MADERA (CA)	$1017.96	$1017.96
MERCED (CA)	$1017.96	$1017.96
MODESTO (CA)	$1017.96	$1017.96
REDDING (CA)	$1017.96	$1017.96
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1054.28	$1054.28
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1053.58	$1053.58
SALINAS (CA)	$1049.40	$1049.40
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1199.19	$1199.19
SANTA CRUZ-WATSONVILLE (CA)	$1065.44	$1065.44
SANTA ROSA-PETALUMA (CA)	$1075.17	$1075.17
STOCKTON (CA)	$1017.96	$1017.96
VISALIA (CA)	$1017.96	$1017.96
YUBA CITY (CA)	$1017.96	$1017.96
EL CENTRO (CA)	$1018.53	$1018.53
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1063.65	$1063.65
SAN LUIS OBISPO-PASO ROBLES (CA)	$1034.35	$1034.35
SANTA MARIA-SANTA BARBARA (CA)	$1050.48	$1050.48
REST OF CALIFORNIA (CA)	$1017.96	$1017.96
COLORADO (CO)	$1030.78	$1030.78
CONNECTICUT (CT)	$1088.41	$1088.41
DC + MD/VA SUBURBS (DC)	$1133.99	$1133.99
DELAWARE (DE)	$1011.42	$1011.42
FORT LAUDERDALE (FL)	$1120.91	$1120.91
MIAMI (FL)	$1212.98	$1212.98
REST OF FLORIDA (FL)	$1064.76	$1064.76
ATLANTA (GA)	$1055.12	$1055.12
REST OF GEORGIA (GA)	$1005.26	$1005.26
HAWAII, GUAM (HI)	$1029.42	$1029.42
IOWA (IA)	$924.27	$924.27
IDAHO (ID)	$934.76	$934.76
EAST ST. LOUIS (IL)	$1108.73	$1108.73
SUBURBAN CHICAGO (IL)	$1125.90	$1125.90
CHICAGO (IL)	$1176.56	$1176.56
REST OF ILLINOIS (IL)	$1055.14	$1055.14
INDIANA (IN)	$938.89	$938.89
KANSAS (KS)	$932.16	$932.16
KENTUCKY (KY)	$972.84	$972.84
NEW ORLEANS (LA)	$1017.61	$1017.61
REST OF LOUISIANA (LA)	$976.17	$976.17
METROPOLITAN BOSTON (MA)	$1108.02	$1108.02
REST OF MASSACHUSETTS (MA)	$1030.51	$1030.51
BALTIMORE/SURR. CNTYS (MD)	$1087.81	$1087.81
REST OF MARYLAND (MD)	$1025.36	$1025.36
SOUTHERN MAINE (ME)	$979.65	$979.65
REST OF MAINE (ME)	$951.58	$951.58
DETROIT (MI)	$1088.85	$1088.85
REST OF MICHIGAN (MI)	$1006.15	$1006.15
MINNESOTA (MN)	$956.31	$956.31
METROPOLITAN ST. LOUIS (MO)	$1006.67	$1006.67
METROPOLITAN KANSAS CITY (MO)	$998.90	$998.90
REST OF MISSOURI (MO)	$969.21	$969.21
MISSISSIPPI (MS)	$942.30	$942.30
MONTANA** (MT)	$1024.51	$1024.51
NORTH CAROLINA (NC)	$958.45	$958.45
NORTH DAKOTA** (ND)	$957.68	$957.68
NEBRASKA (NE)	$925.17	$925.17
NEW HAMPSHIRE (NH)	$1026.25	$1026.25
NORTHERN NJ (NJ)	$1126.83	$1126.83
REST OF NEW JERSEY (NJ)	$1091.98	$1091.98
NEW MEXICO (NM)	$1015.80	$1015.80
NEVADA** (NV)	$1006.27	$1006.27
MANHATTAN (NY)	$1186.60	$1186.60
NYC SUBURBS/LONG ISLAND (NY)	$1227.49	$1227.49
POUGHKPSIE/N NYC SUBURBS (NY)	$1108.54	$1108.54
QUEENS (NY)	$1177.97	$1177.97
REST OF NEW YORK (NY)	$972.15	$972.15
OHIO (OH)	$992.49	$992.49
OKLAHOMA (OK)	$958.79	$958.79
PORTLAND (OR)	$1046.63	$1046.63
REST OF OREGON (OR)	$989.69	$989.69
METROPOLITAN PHILADELPHIA (PA)	$1071.71	$1071.71
REST OF PENNSYLVANIA (PA)	$987.28	$987.28
PUERTO RICO (PR)	$1027.24	$1027.24
RHODE ISLAND (RI)	$1035.21	$1035.21
SOUTH CAROLINA (SC)	$978.84	$978.84
SOUTH DAKOTA** (SD)	$949.78	$949.78
TENNESSEE (TN)	$937.79	$937.79
BRAZORIA (TX)	$1000.72	$1000.72
DALLAS (TX)	$1011.96	$1011.96
GALVESTON (TX)	$1006.90	$1006.90
HOUSTON (TX)	$1068.77	$1068.77
BEAUMONT (TX)	$982.42	$982.42
FORT WORTH (TX)	$1009.62	$1009.62
AUSTIN (TX)	$1035.04	$1035.04
REST OF TEXAS (TX)	$994.35	$994.35
UTAH (UT)	$990.36	$990.36
VIRGINIA (VA)	$985.07	$985.07
VIRGIN ISLANDS (VI)	$1027.24	$1027.24
VERMONT (VT)	$965.16	$965.16
SEATTLE (KING CNTY) (WA)	$1117.13	$1117.13
REST OF WASHINGTON (WA)	$1024.86	$1024.86
WISCONSIN (WI)	$930.61	$930.61
WEST VIRGINIA (WV)	$1023.47	$1023.47
WYOMING** (WY)	$995.39	$995.39

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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

The Medicare PFS amount is built from three Relative Value Units (RVUs) assigned to the code — physician work, practice expense, and malpractice — which are each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility rates generally apply when the service is performed in a physician's office, while facility rates apply in hospitals or ambulatory surgical centers, reflecting different practice-expense assumptions; for this code, the practice-expense RVU and resulting amounts are the same in both settings. Because GPCIs vary by region, the final payment can differ meaningfully from the national average shown here.

RVUs — work 15.89, practice expense 11.41 (non-facility) / 11.41 (facility), malpractice 3.38 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on the national conversion factor and standard RVUs — actual payment depends on your specific Medicare Administrative Contractor (MAC) and locality GPCIs.
Medicare typically pays 80% of the allowed amount after the patient's Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Modifiers (e.g., bilateral, multiple procedure, assistant surgeon), sequestration, and annual budget-neutrality adjustments can increase or decrease the final paid amount.
Always verify current-year figures and locality-specific pricing directly with your MAC or the CMS Physician Fee Schedule Look-Up Tool before billing or appealing a denial.

Frequently asked

Why does the amount shown differ from what my MAC actually paid?

Local GPCIs, applied modifiers, site-of-service differentials, and annual budget-neutrality adjustments can all change the final payment from the national average shown here.

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

For CPT 23465, the practice-expense RVU used in the formula is identical for non-facility and facility settings, so both calculations currently produce the same allowed amount.

Does this amount reflect what the patient owes?

No. This figure represents the full Medicare-allowed amount before cost-sharing; after the deductible, Medicare generally pays 80%, leaving the remaining 20% as coinsurance unless covered by a secondary payer.

Can this figure be used to dispute a claim denial?

It can serve as a reference point, but any appeal should be based on the exact RVUs, GPCIs, and conversion factor in effect for the date of service and locality, as confirmed with your MAC.

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.