Medicare Reimbursement for CPT 23472

CPT 23472 is a surgical procedure code; the AMA-licensed descriptor is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1300.30	$1300.30
ALASKA* (AK)	$1623.51	$1623.51
ALABAMA (AL)	$1182.86	$1182.86
ARKANSAS (AR)	$1168.49	$1168.49
ARIZONA (AZ)	$1265.88	$1265.88
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1462.93	$1462.93
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1483.54	$1483.54
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1344.54	$1344.54
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1360.32	$1360.32
NAPA (CA)	$1412.03	$1412.03
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1467.88	$1467.88
VALLEJO (CA)	$1404.90	$1404.90
BAKERSFIELD (CA)	$1298.70	$1298.70
CHICO (CA)	$1286.63	$1286.63
FRESNO (CA)	$1286.63	$1286.63
HANFORD-CORCORAN (CA)	$1286.63	$1286.63
MADERA (CA)	$1286.63	$1286.63
MERCED (CA)	$1286.63	$1286.63
MODESTO (CA)	$1286.63	$1286.63
REDDING (CA)	$1286.63	$1286.63
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1333.52	$1333.52
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1329.40	$1329.40
SALINAS (CA)	$1324.06	$1324.06
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1503.79	$1503.79
SANTA CRUZ-WATSONVILLE (CA)	$1341.15	$1341.15
SANTA ROSA-PETALUMA (CA)	$1353.27	$1353.27
STOCKTON (CA)	$1286.63	$1286.63
VISALIA (CA)	$1286.63	$1286.63
YUBA CITY (CA)	$1286.63	$1286.63
EL CENTRO (CA)	$1287.36	$1287.36
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1340.26	$1340.26
SAN LUIS OBISPO-PASO ROBLES (CA)	$1305.29	$1305.29
SANTA MARIA-SANTA BARBARA (CA)	$1324.93	$1324.93
REST OF CALIFORNIA (CA)	$1286.63	$1286.63
COLORADO (CO)	$1304.82	$1304.82
CONNECTICUT (CT)	$1378.70	$1378.70
DC + MD/VA SUBURBS (DC)	$1432.91	$1432.91
DELAWARE (DE)	$1283.99	$1283.99
FORT LAUDERDALE (FL)	$1423.60	$1423.60
MIAMI (FL)	$1540.75	$1540.75
REST OF FLORIDA (FL)	$1354.46	$1354.46
ATLANTA (GA)	$1338.67	$1338.67
REST OF GEORGIA (GA)	$1281.40	$1281.40
HAWAII, GUAM (HI)	$1298.43	$1298.43
IOWA (IA)	$1175.60	$1175.60
IDAHO (ID)	$1188.84	$1188.84
EAST ST. LOUIS (IL)	$1413.25	$1413.25
SUBURBAN CHICAGO (IL)	$1429.48	$1429.48
CHICAGO (IL)	$1496.10	$1496.10
REST OF ILLINOIS (IL)	$1344.54	$1344.54
INDIANA (IN)	$1193.77	$1193.77
KANSAS (KS)	$1186.41	$1186.41
KENTUCKY (KY)	$1239.76	$1239.76
NEW ORLEANS (LA)	$1294.50	$1294.50
REST OF LOUISIANA (LA)	$1244.28	$1244.28
METROPOLITAN BOSTON (MA)	$1398.00	$1398.00
REST OF MASSACHUSETTS (MA)	$1305.26	$1305.26
BALTIMORE/SURR. CNTYS (MD)	$1378.02	$1378.02
REST OF MARYLAND (MD)	$1300.77	$1300.77
SOUTHERN MAINE (ME)	$1242.66	$1242.66
REST OF MAINE (ME)	$1210.54	$1210.54
DETROIT (MI)	$1385.01	$1385.01
REST OF MICHIGAN (MI)	$1281.34	$1281.34
MINNESOTA (MN)	$1210.36	$1210.36
METROPOLITAN ST. LOUIS (MO)	$1279.76	$1279.76
METROPOLITAN KANSAS CITY (MO)	$1270.48	$1270.48
REST OF MISSOURI (MO)	$1236.64	$1236.64
MISSISSIPPI (MS)	$1201.98	$1201.98
MONTANA** (MT)	$1300.01	$1300.01
NORTH CAROLINA (NC)	$1218.66	$1218.66
NORTH DAKOTA** (ND)	$1213.79	$1213.79
NEBRASKA (NE)	$1176.31	$1176.31
NEW HAMPSHIRE (NH)	$1299.88	$1299.88
NORTHERN NJ (NJ)	$1425.03	$1425.03
REST OF NEW JERSEY (NJ)	$1383.17	$1383.17
NEW MEXICO (NM)	$1293.56	$1293.56
NEVADA** (NV)	$1276.41	$1276.41
MANHATTAN (NY)	$1502.05	$1502.05
NYC SUBURBS/LONG ISLAND (NY)	$1553.23	$1553.23
POUGHKPSIE/N NYC SUBURBS (NY)	$1404.53	$1404.53
QUEENS (NY)	$1489.76	$1489.76
REST OF NEW YORK (NY)	$1235.35	$1235.35
OHIO (OH)	$1263.71	$1263.71
OKLAHOMA (OK)	$1221.40	$1221.40
PORTLAND (OR)	$1322.71	$1322.71
REST OF OREGON (OR)	$1255.31	$1255.31
METROPOLITAN PHILADELPHIA (PA)	$1359.17	$1359.17
REST OF PENNSYLVANIA (PA)	$1256.71	$1256.71
PUERTO RICO (PR)	$1302.89	$1302.89
RHODE ISLAND (RI)	$1312.58	$1312.58
SOUTH CAROLINA (SC)	$1245.48	$1245.48
SOUTH DAKOTA** (SD)	$1203.60	$1203.60
TENNESSEE (TN)	$1193.39	$1193.39
BRAZORIA (TX)	$1270.12	$1270.12
DALLAS (TX)	$1284.37	$1284.37
GALVESTON (TX)	$1277.98	$1277.98
HOUSTON (TX)	$1357.78	$1357.78
BEAUMONT (TX)	$1250.91	$1250.91
FORT WORTH (TX)	$1281.92	$1281.92
AUSTIN (TX)	$1310.30	$1310.30
REST OF TEXAS (TX)	$1264.04	$1264.04
UTAH (UT)	$1259.41	$1259.41
VIRGINIA (VA)	$1250.11	$1250.11
VIRGIN ISLANDS (VI)	$1302.89	$1302.89
VERMONT (VT)	$1224.02	$1224.02
SEATTLE (KING CNTY) (WA)	$1408.18	$1408.18
REST OF WASHINGTON (WA)	$1297.86	$1297.86
WISCONSIN (WI)	$1181.30	$1181.30
WEST VIRGINIA (WV)	$1306.22	$1306.22
WYOMING** (WY)	$1262.43	$1262.43

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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 payment is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — 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 Medicare conversion factor to produce a dollar allowed amount. Because practice expense costs differ depending on where the procedure takes place, non-facility (e.g., office) and facility (e.g., hospital) settings can have different practice-expense RVU values, which may result in different allowed amounts. For this code, the non-facility and facility amounts shown reflect that underlying RVU structure for the selected year.

RVUs — work 21.58, practice expense 12.99 (non-facility) / 12.99 (facility), malpractice 4.36 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate based on the national Medicare Physician Fee Schedule; actual payment can vary by locality, contractor, and claim-specific factors.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the beneficiary or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final payment.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the amount differ between non-facility and facility settings?

The practice-expense component of the RVUs differs based on where the service is performed, since overhead costs differ between an office setting and a facility like a hospital.

Is this the amount my practice will actually be paid?

No. This is a national estimate adjusted by locality GPCIs; actual reimbursement depends on your specific locality, payer policies, applied modifiers, and other claim-specific adjustments.

Does this reflect what the patient owes?

No. This figure is the Medicare-allowed amount. The patient's responsibility depends on deductible status, coinsurance, and any secondary coverage.

Will this amount change during the year?

The conversion factor and RVUs are typically set annually, but mid-year adjustments, sequestration, or policy changes can still affect actual payments.

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.