Medicare Reimbursement for CPT 23474

This page covers CPT code 23474, a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). It shows the estimated Medicare-allowed payment amount nationally and by locality, with separate figures for non-facility and facility settings. Because CPT descriptors are proprietary to the AMA, this code is referred to generically rather than described in detail.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1552.14	$1552.14
ALASKA* (AK)	$1946.13	$1946.13
ALABAMA (AL)	$1413.36	$1413.36
ARKANSAS (AR)	$1396.42	$1396.42
ARIZONA (AZ)	$1511.19	$1511.19
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1732.39	$1732.39
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1756.21	$1756.21
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1597.72	$1597.72
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1617.09	$1617.09
NAPA (CA)	$1674.20	$1674.20
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1738.50	$1738.50
VALLEJO (CA)	$1665.40	$1665.40
BAKERSFIELD (CA)	$1545.40	$1545.40
CHICO (CA)	$1530.51	$1530.51
FRESNO (CA)	$1530.51	$1530.51
HANFORD-CORCORAN (CA)	$1530.51	$1530.51
MADERA (CA)	$1530.51	$1530.51
MERCED (CA)	$1530.51	$1530.51
MODESTO (CA)	$1530.51	$1530.51
REDDING (CA)	$1530.51	$1530.51
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1588.36	$1588.36
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1579.93	$1579.93
SALINAS (CA)	$1573.55	$1573.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1781.19	$1781.19
SANTA CRUZ-WATSONVILLE (CA)	$1591.93	$1591.93
SANTA ROSA-PETALUMA (CA)	$1606.22	$1606.22
STOCKTON (CA)	$1530.51	$1530.51
VISALIA (CA)	$1530.51	$1530.51
YUBA CITY (CA)	$1530.51	$1530.51
EL CENTRO (CA)	$1531.41	$1531.41
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1591.74	$1591.74
SAN LUIS OBISPO-PASO ROBLES (CA)	$1551.42	$1551.42
SANTA MARIA-SANTA BARBARA (CA)	$1574.30	$1574.30
REST OF CALIFORNIA (CA)	$1530.51	$1530.51
COLORADO (CO)	$1554.54	$1554.54
CONNECTICUT (CT)	$1645.05	$1645.05
DC + MD/VA SUBURBS (DC)	$1706.86	$1706.86
DELAWARE (DE)	$1532.59	$1532.59
FORT LAUDERDALE (FL)	$1703.66	$1703.66
MIAMI (FL)	$1846.84	$1846.84
REST OF FLORIDA (FL)	$1621.13	$1621.13
ATLANTA (GA)	$1598.70	$1598.70
REST OF GEORGIA (GA)	$1534.12	$1534.12
HAWAII, GUAM (HI)	$1543.11	$1543.11
IOWA (IA)	$1402.45	$1402.45
IDAHO (ID)	$1418.53	$1418.53
EAST ST. LOUIS (IL)	$1695.45	$1695.45
SUBURBAN CHICAGO (IL)	$1710.20	$1710.20
CHICAGO (IL)	$1793.48	$1793.48
REST OF ILLINOIS (IL)	$1611.00	$1611.00
INDIANA (IN)	$1424.27	$1424.27
KANSAS (KS)	$1416.32	$1416.32
KENTUCKY (KY)	$1482.88	$1482.88
NEW ORLEANS (LA)	$1547.89	$1547.89
REST OF LOUISIANA (LA)	$1488.67	$1488.67
METROPOLITAN BOSTON (MA)	$1663.05	$1663.05
REST OF MASSACHUSETTS (MA)	$1555.61	$1555.61
BALTIMORE/SURR. CNTYS (MD)	$1644.41	$1644.41
REST OF MARYLAND (MD)	$1552.10	$1552.10
SOUTHERN MAINE (ME)	$1481.45	$1481.45
REST OF MAINE (ME)	$1445.31	$1445.31
DETROIT (MI)	$1658.39	$1658.39
REST OF MICHIGAN (MI)	$1533.01	$1533.01
MINNESOTA (MN)	$1439.74	$1439.74
METROPOLITAN ST. LOUIS (MO)	$1529.16	$1529.16
METROPOLITAN KANSAS CITY (MO)	$1518.34	$1518.34
REST OF MISSOURI (MO)	$1480.36	$1480.36
MISSISSIPPI (MS)	$1437.64	$1437.64
MONTANA** (MT)	$1551.78	$1551.78
NORTH CAROLINA (NC)	$1454.69	$1454.69
NORTH DAKOTA** (ND)	$1445.40	$1445.40
NEBRASKA (NE)	$1402.92	$1402.92
NEW HAMPSHIRE (NH)	$1549.62	$1549.62
NORTHERN NJ (NJ)	$1698.00	$1698.00
REST OF NEW JERSEY (NJ)	$1649.76	$1649.76
NEW MEXICO (NM)	$1547.89	$1547.89
NEVADA** (NV)	$1522.62	$1522.62
MANHATTAN (NY)	$1792.94	$1792.94
NYC SUBURBS/LONG ISLAND (NY)	$1854.77	$1854.77
POUGHKPSIE/N NYC SUBURBS (NY)	$1675.95	$1675.95
QUEENS (NY)	$1776.79	$1776.79
REST OF NEW YORK (NY)	$1474.45	$1474.45
OHIO (OH)	$1511.27	$1511.27
OKLAHOMA (OK)	$1460.03	$1460.03
PORTLAND (OR)	$1574.30	$1574.30
REST OF OREGON (OR)	$1496.82	$1496.82
METROPOLITAN PHILADELPHIA (PA)	$1622.71	$1622.71
REST OF PENNSYLVANIA (PA)	$1502.38	$1502.38
PUERTO RICO (PR)	$1554.79	$1554.79
RHODE ISLAND (RI)	$1565.62	$1565.62
SOUTH CAROLINA (SC)	$1488.23	$1488.23
SOUTH DAKOTA** (SD)	$1432.82	$1432.82
TENNESSEE (TN)	$1424.69	$1424.69
BRAZORIA (TX)	$1515.32	$1515.32
DALLAS (TX)	$1532.65	$1532.65
GALVESTON (TX)	$1524.92	$1524.92
HOUSTON (TX)	$1623.39	$1623.39
BEAUMONT (TX)	$1495.61	$1495.61
FORT WORTH (TX)	$1530.13	$1530.13
AUSTIN (TX)	$1561.63	$1561.63
REST OF TEXAS (TX)	$1509.91	$1509.91
UTAH (UT)	$1504.63	$1504.63
VIRGINIA (VA)	$1491.04	$1491.04
VIRGIN ISLANDS (VI)	$1554.79	$1554.79
VERMONT (VT)	$1458.51	$1458.51
SEATTLE (KING CNTY) (WA)	$1673.96	$1673.96
REST OF WASHINGTON (WA)	$1546.49	$1546.49
WISCONSIN (WI)	$1407.36	$1407.36
WEST VIRGINIA (WV)	$1565.88	$1565.88
WYOMING** (WY)	$1505.42	$1505.42

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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 amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs, which can result in different payment amounts for the same code depending on where the service is performed.

RVUs — work 26.53, practice expense 14.56 (non-facility) / 14.56 (facility), malpractice 5.38 — × 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 their deductible; the patient or secondary insurer is responsible for the rest.
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 reimbursed.
Always verify current-year rates and locality-specific amounts directly with your MAC before billing or appealing a claim.

Frequently asked

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

The practice-expense RVU component is typically lower in a facility setting because the facility itself (e.g., hospital) bears many overhead costs, while non-facility settings like a physician's office include higher practice-expense RVUs to cover those costs directly.

Why might the amount I see here differ from what I was actually paid?

Actual payments can vary due to locality-specific GPCIs, applied modifiers, secondary payer adjustments, sequestration, and annual updates to the conversion factor or RVUs that may occur after this estimate was generated.

Does this amount reflect what the patient will owe?

No. This is the Medicare-allowed amount before cost-sharing. Patients are generally responsible for 20% coinsurance after meeting the Part B deductible, unless they have supplemental coverage.

Where can I find the official description for CPT 23474?

CPT code descriptors are copyrighted by the American Medical Association. Refer to your AMA CPT codebook or licensed coding software for the official language.

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.