Medicare Reimbursement for CPT 23491

CPT 23491 is a surgical procedure code; because CPT descriptors are proprietary to the AMA, this page refers to it generically as 'this procedure code.' The page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$937.56	$937.56
ALASKA* (AK)	$1152.68	$1152.68
ALABAMA (AL)	$848.40	$848.40
ARKANSAS (AR)	$837.45	$837.45
ARIZONA (AZ)	$911.78	$911.78
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1073.41	$1073.41
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1089.31	$1089.31
OXNARD-THOUSAND OAKS-VENTURA (CA)	$978.87	$978.87
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$989.53	$989.53
NAPA (CA)	$1033.23	$1033.23
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1076.84	$1076.84
VALLEJO (CA)	$1028.29	$1028.29
BAKERSFIELD (CA)	$941.98	$941.98
CHICO (CA)	$933.67	$933.67
FRESNO (CA)	$933.67	$933.67
HANFORD-CORCORAN (CA)	$933.67	$933.67
MADERA (CA)	$933.67	$933.67
MERCED (CA)	$933.67	$933.67
MODESTO (CA)	$933.67	$933.67
REDDING (CA)	$933.67	$933.67
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$966.12	$966.12
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$966.99	$966.99
SALINAS (CA)	$963.17	$963.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1103.33	$1103.33
SANTA CRUZ-WATSONVILLE (CA)	$978.76	$978.76
SANTA ROSA-PETALUMA (CA)	$987.75	$987.75
STOCKTON (CA)	$933.67	$933.67
VISALIA (CA)	$933.67	$933.67
YUBA CITY (CA)	$933.67	$933.67
EL CENTRO (CA)	$934.17	$934.17
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$976.73	$976.73
SAN LUIS OBISPO-PASO ROBLES (CA)	$949.28	$949.28
SANTA MARIA-SANTA BARBARA (CA)	$964.29	$964.29
REST OF CALIFORNIA (CA)	$933.67	$933.67
COLORADO (CO)	$944.39	$944.39
CONNECTICUT (CT)	$996.17	$996.17
DC + MD/VA SUBURBS (DC)	$1039.16	$1039.16
DELAWARE (DE)	$925.39	$925.39
FORT LAUDERDALE (FL)	$1023.79	$1023.79
MIAMI (FL)	$1106.68	$1106.68
REST OF FLORIDA (FL)	$972.33	$972.33
ATLANTA (GA)	$965.07	$965.07
REST OF GEORGIA (GA)	$917.72	$917.72
HAWAII, GUAM (HI)	$944.84	$944.84
IOWA (IA)	$845.88	$845.88
IDAHO (ID)	$855.36	$855.36
EAST ST. LOUIS (IL)	$1010.80	$1010.80
SUBURBAN CHICAGO (IL)	$1028.55	$1028.55
CHICAGO (IL)	$1073.32	$1073.32
REST OF ILLINOIS (IL)	$962.77	$962.77
INDIANA (IN)	$859.21	$859.21
KANSAS (KS)	$852.68	$852.68
KENTUCKY (KY)	$888.69	$888.69
NEW ORLEANS (LA)	$929.86	$929.86
REST OF LOUISIANA (LA)	$891.57	$891.57
METROPOLITAN BOSTON (MA)	$1016.32	$1016.32
REST OF MASSACHUSETTS (MA)	$943.91	$943.91
BALTIMORE/SURR. CNTYS (MD)	$995.55	$995.55
REST OF MARYLAND (MD)	$938.38	$938.38
SOUTHERN MAINE (ME)	$897.07	$897.07
REST OF MAINE (ME)	$870.39	$870.39
DETROIT (MI)	$994.05	$994.05
REST OF MICHIGAN (MI)	$918.99	$918.99
MINNESOTA (MN)	$877.08	$877.08
METROPOLITAN ST. LOUIS (MO)	$920.34	$920.34
METROPOLITAN KANSAS CITY (MO)	$913.10	$913.10
REST OF MISSOURI (MO)	$884.84	$884.84
MISSISSIPPI (MS)	$860.77	$860.77
MONTANA** (MT)	$937.36	$937.36
NORTH CAROLINA (NC)	$876.82	$876.82
NORTH DAKOTA** (ND)	$877.65	$877.65
NEBRASKA (NE)	$846.87	$846.87
NEW HAMPSHIRE (NH)	$939.84	$939.84
NORTHERN NJ (NJ)	$1032.35	$1032.35
REST OF NEW JERSEY (NJ)	$999.69	$999.69
NEW MEXICO (NM)	$927.70	$927.70
NEVADA** (NV)	$921.08	$921.08
MANHATTAN (NY)	$1085.80	$1085.80
NYC SUBURBS/LONG ISLAND (NY)	$1122.94	$1122.94
POUGHKPSIE/N NYC SUBURBS (NY)	$1014.55	$1014.55
QUEENS (NY)	$1078.54	$1078.54
REST OF NEW YORK (NY)	$889.45	$889.45
OHIO (OH)	$906.78	$906.78
OKLAHOMA (OK)	$876.22	$876.22
PORTLAND (OR)	$959.62	$959.62
REST OF OREGON (OR)	$906.15	$906.15
METROPOLITAN PHILADELPHIA (PA)	$980.44	$980.44
REST OF PENNSYLVANIA (PA)	$902.24	$902.24
PUERTO RICO (PR)	$940.04	$940.04
RHODE ISLAND (RI)	$947.65	$947.65
SOUTH CAROLINA (SC)	$894.84	$894.84
SOUTH DAKOTA** (SD)	$870.59	$870.59
TENNESSEE (TN)	$857.82	$857.82
BRAZORIA (TX)	$915.89	$915.89
DALLAS (TX)	$926.05	$926.05
GALVESTON (TX)	$921.46	$921.46
HOUSTON (TX)	$976.74	$976.74
BEAUMONT (TX)	$897.73	$897.73
FORT WORTH (TX)	$923.73	$923.73
AUSTIN (TX)	$948.07	$948.07
REST OF TEXAS (TX)	$909.26	$909.26
UTAH (UT)	$905.49	$905.49
VIRGINIA (VA)	$901.74	$901.74
VIRGIN ISLANDS (VI)	$940.04	$940.04
VERMONT (VT)	$884.10	$884.10
SEATTLE (KING CNTY) (WA)	$1025.20	$1025.20
REST OF WASHINGTON (WA)	$938.85	$938.85
WISCONSIN (WI)	$852.51	$852.51
WEST VIRGINIA (WV)	$933.48	$933.48
WYOMING** (WY)	$911.34	$911.34

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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) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility and facility rates can differ because the practice-expense RVU often varies depending on whether the service is performed in a physician's office versus a hospital or facility setting; for this code the facility and non-facility PE RVUs are the same, so the two amounts align.

RVUs — work 14.18, practice expense 10.87 (non-facility) / 10.87 (facility), malpractice 3.02 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates based on the national PFS formula and may not reflect the exact amount paid.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, assistant-surgeon rules, sequestration, and annual budget-neutrality adjustments can change the final payment.
Locality-specific GPCIs mean actual payment will differ from the national average shown here.
Always confirm final allowed amounts and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The practice-expense RVU assigned to this code is identical for both settings, so the calculated PFS amount does not differ between non-facility and facility place-of-service.

Does this amount reflect what my specific MAC or locality will pay?

No. This is a national estimate; your MAC applies locality-specific GPCIs to the same RVUs, which can raise or lower the actual allowed amount.

Will the patient's coinsurance come out of this allowed amount?

Yes. Medicare generally pays 80% of the allowed amount after the Part B deductible, leaving the remaining 20% as patient or secondary-payer responsibility.

Can modifiers change this estimate?

Yes. Modifiers such as those for bilateral procedures, multiple procedures, or reduced services can adjust the final payment above or below the base PFS estimate shown here.

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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.