Medicare Reimbursement for CPT 23500

CPT 23500 is a procedure code defined by the AMA; its official descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$258.19	$245.16
ALASKA* (AK)	$298.48	$284.61
ALABAMA (AL)	$230.25	$218.85
ARKANSAS (AR)	$226.74	$215.55
ARIZONA (AZ)	$250.71	$238.09
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$326.62	$308.25
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$332.76	$313.98
OXNARD-THOUSAND OAKS-VENTURA (CA)	$285.72	$270.32
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$287.44	$272.03
NAPA (CA)	$309.81	$292.64
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$327.13	$308.76
VALLEJO (CA)	$309.07	$291.90
BAKERSFIELD (CA)	$270.13	$255.85
CHICO (CA)	$268.88	$254.61
FRESNO (CA)	$268.88	$254.61
HANFORD-CORCORAN (CA)	$268.88	$254.61
MADERA (CA)	$268.88	$254.61
MERCED (CA)	$268.88	$254.61
MODESTO (CA)	$268.88	$254.61
REDDING (CA)	$268.88	$254.61
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$273.72	$259.44
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$281.73	$266.58
SALINAS (CA)	$280.69	$265.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$334.85	$316.07
SANTA CRUZ-WATSONVILLE (CA)	$289.56	$273.74
SANTA ROSA-PETALUMA (CA)	$292.44	$276.44
STOCKTON (CA)	$268.88	$254.61
VISALIA (CA)	$268.88	$254.61
YUBA CITY (CA)	$268.88	$254.61
EL CENTRO (CA)	$268.96	$254.68
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$287.04	$271.46
SAN LUIS OBISPO-PASO ROBLES (CA)	$276.25	$261.42
SANTA MARIA-SANTA BARBARA (CA)	$281.67	$266.48
REST OF CALIFORNIA (CA)	$268.88	$254.61
COLORADO (CO)	$266.73	$252.87
CONNECTICUT (CT)	$275.98	$261.95
DC + MD/VA SUBURBS (DC)	$294.26	$278.92
DELAWARE (DE)	$254.97	$242.10
FORT LAUDERDALE (FL)	$272.56	$259.37
MIAMI (FL)	$288.20	$274.64
REST OF FLORIDA (FL)	$258.21	$245.76
ATLANTA (GA)	$264.17	$250.93
REST OF GEORGIA (GA)	$242.57	$230.95
HAWAII, GUAM (HI)	$275.34	$260.52
IOWA (IA)	$234.56	$222.64
IDAHO (ID)	$236.56	$224.58
EAST ST. LOUIS (IL)	$259.72	$247.74
SUBURBAN CHICAGO (IL)	$274.92	$261.54
CHICAGO (IL)	$279.01	$265.92
REST OF ILLINOIS (IL)	$251.74	$239.85
INDIANA (IN)	$237.96	$225.88
KANSAS (KS)	$234.28	$222.51
KENTUCKY (KY)	$237.89	$226.31
NEW ORLEANS (LA)	$250.12	$237.87
REST OF LOUISIANA (LA)	$237.85	$226.32
METROPOLITAN BOSTON (MA)	$292.72	$277.17
REST OF MASSACHUSETTS (MA)	$265.37	$251.65
BALTIMORE/SURR. CNTYS (MD)	$275.41	$261.43
REST OF MARYLAND (MD)	$259.73	$246.55
SOUTHERN MAINE (ME)	$251.10	$238.19
REST OF MAINE (ME)	$238.80	$226.82
DETROIT (MI)	$262.50	$249.93
REST OF MICHIGAN (MI)	$245.22	$233.33
MINNESOTA (MN)	$252.58	$239.17
METROPOLITAN ST. LOUIS (MO)	$249.99	$237.59
METROPOLITAN KANSAS CITY (MO)	$247.39	$235.16
REST OF MISSOURI (MO)	$234.15	$222.92
MISSISSIPPI (MS)	$230.45	$219.23
MONTANA** (MT)	$258.16	$245.13
NORTH CAROLINA (NC)	$241.28	$229.13
NORTH DAKOTA** (ND)	$249.26	$236.23
NEBRASKA (NE)	$235.65	$223.62
NEW HAMPSHIRE (NH)	$263.34	$249.77
NORTHERN NJ (NJ)	$291.15	$276.04
REST OF NEW JERSEY (NJ)	$278.28	$264.06
NEW MEXICO (NM)	$246.99	$235.04
NEVADA** (NV)	$255.85	$242.81
MANHATTAN (NY)	$299.35	$284.21
NYC SUBURBS/LONG ISLAND (NY)	$308.05	$292.56
POUGHKPSIE/N NYC SUBURBS (NY)	$280.85	$266.59
QUEENS (NY)	$300.61	$285.22
REST OF NEW YORK (NY)	$245.16	$232.78
OHIO (OH)	$243.40	$231.51
OKLAHOMA (OK)	$236.50	$224.87
PORTLAND (OR)	$274.51	$260.04
REST OF OREGON (OR)	$253.04	$240.07
METROPOLITAN PHILADELPHIA (PA)	$269.41	$255.85
REST OF PENNSYLVANIA (PA)	$243.31	$231.35
PUERTO RICO (PR)	$259.85	$246.68
RHODE ISLAND (RI)	$263.58	$250.13
SOUTH CAROLINA (SC)	$242.91	$230.88
SOUTH DAKOTA** (SD)	$248.21	$235.18
TENNESSEE (TN)	$235.64	$223.80
BRAZORIA (TX)	$253.91	$241.01
DALLAS (TX)	$256.02	$243.04
GALVESTON (TX)	$254.98	$242.04
HOUSTON (TX)	$263.22	$250.28
BEAUMONT (TX)	$241.70	$229.85
FORT WORTH (TX)	$254.50	$241.65
AUSTIN (TX)	$266.56	$252.78
REST OF TEXAS (TX)	$247.99	$235.63
UTAH (UT)	$246.38	$234.13
VIRGINIA (VA)	$250.86	$238.05
VIRGIN ISLANDS (VI)	$259.85	$246.68
VERMONT (VT)	$249.05	$236.15
SEATTLE (KING CNTY) (WA)	$297.92	$281.94
REST OF WASHINGTON (WA)	$264.61	$250.89
WISCONSIN (WI)	$240.59	$228.11
WEST VIRGINIA (WV)	$242.22	$230.90
WYOMING** (WY)	$254.28	$241.25

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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) — work, practice expense (PE), and malpractice (MP) — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because the PE RVU is lower when the service is performed in a facility (e.g., hospital), since the facility itself bears some of the overhead costs. These calculations are updated annually and can shift due to policy changes, even if the RVUs themselves stay the same.

RVUs — work 2.15, practice expense 5.13 (non-facility) / 4.74 (facility), malpractice 0.45 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility rate different from the non-facility rate for CPT 23500?

The facility rate uses a lower practice expense RVU because overhead costs (equipment, supplies, staff) are assumed to be covered by the facility rather than the billing provider's own practice.

Does this amount reflect what Medicare will actually pay?

No. It reflects the full PFS allowed amount estimate. Medicare generally reimburses 80% of this amount after the deductible, and local adjustments or modifiers can change the final payment.

Why does the amount change by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs) for work, practice expense, and malpractice, which adjust the RVUs to reflect regional cost-of-living and practice cost differences.

Can this fee change during the year?

The conversion factor and RVUs are typically set annually, but mid-year legislative or regulatory changes, along with budget-neutrality adjustments, can occasionally affect the final allowed amount.

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.