Medicare Reimbursement for CPT 23525

CPT 23525 is a physician procedure code reported to Medicare for payment purposes; the full descriptor is AMA-licensed and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, nationally and adjustable by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$446.24	$367.08
ALASKA* (AK)	$515.44	$431.13
ALABAMA (AL)	$397.75	$328.49
ARKANSAS (AR)	$391.66	$323.67
ARIZONA (AZ)	$433.25	$356.55
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$564.27	$452.66
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$574.87	$460.72
OXNARD-THOUSAND OAKS-VENTURA (CA)	$493.67	$400.10
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$496.65	$403.01
NAPA (CA)	$535.25	$430.92
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$565.17	$453.55
VALLEJO (CA)	$533.96	$429.63
BAKERSFIELD (CA)	$466.71	$379.95
CHICO (CA)	$464.54	$377.78
FRESNO (CA)	$464.54	$377.78
HANFORD-CORCORAN (CA)	$464.54	$377.78
MADERA (CA)	$464.54	$377.78
MERCED (CA)	$464.54	$377.78
MODESTO (CA)	$464.54	$377.78
REDDING (CA)	$464.54	$377.78
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$473.02	$386.26
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$486.73	$394.67
SALINAS (CA)	$484.93	$393.18
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$578.54	$464.39
SANTA CRUZ-WATSONVILLE (CA)	$500.29	$404.11
SANTA ROSA-PETALUMA (CA)	$505.25	$408.04
STOCKTON (CA)	$464.54	$377.78
VISALIA (CA)	$464.54	$377.78
YUBA CITY (CA)	$464.54	$377.78
EL CENTRO (CA)	$464.67	$377.91
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$495.93	$401.25
SAN LUIS OBISPO-PASO ROBLES (CA)	$477.27	$387.11
SANTA MARIA-SANTA BARBARA (CA)	$486.63	$394.33
REST OF CALIFORNIA (CA)	$464.54	$377.78
COLORADO (CO)	$460.90	$376.67
CONNECTICUT (CT)	$477.06	$391.81
DC + MD/VA SUBURBS (DC)	$508.63	$415.38
DELAWARE (DE)	$440.63	$362.42
FORT LAUDERDALE (FL)	$471.41	$391.22
MIAMI (FL)	$498.73	$416.32
REST OF FLORIDA (FL)	$446.47	$370.80
ATLANTA (GA)	$456.65	$376.22
REST OF GEORGIA (GA)	$419.31	$348.69
HAWAII, GUAM (HI)	$475.72	$385.71
IOWA (IA)	$405.14	$332.71
IDAHO (ID)	$408.63	$335.80
EAST ST. LOUIS (IL)	$449.29	$376.46
SUBURBAN CHICAGO (IL)	$475.47	$394.17
CHICAGO (IL)	$482.75	$403.20
REST OF ILLINOIS (IL)	$435.32	$363.04
INDIANA (IN)	$411.05	$337.66
KANSAS (KS)	$404.71	$333.15
KENTUCKY (KY)	$411.11	$340.73
NEW ORLEANS (LA)	$432.34	$357.86
REST OF LOUISIANA (LA)	$411.06	$341.00
METROPOLITAN BOSTON (MA)	$505.88	$411.36
REST OF MASSACHUSETTS (MA)	$458.56	$375.20
BALTIMORE/SURR. CNTYS (MD)	$476.09	$391.16
REST OF MARYLAND (MD)	$448.86	$368.75
SOUTHERN MAINE (ME)	$433.83	$355.39
REST OF MAINE (ME)	$412.56	$339.73
DETROIT (MI)	$453.97	$377.58
REST OF MICHIGAN (MI)	$423.86	$351.59
MINNESOTA (MN)	$436.25	$354.80
METROPOLITAN ST. LOUIS (MO)	$432.07	$356.71
METROPOLITAN KANSAS CITY (MO)	$427.56	$353.23
REST OF MISSOURI (MO)	$404.67	$336.43
MISSISSIPPI (MS)	$398.17	$330.01
MONTANA** (MT)	$446.18	$367.02
NORTH CAROLINA (NC)	$416.86	$343.00
NORTH DAKOTA** (ND)	$430.56	$351.40
NEBRASKA (NE)	$407.01	$333.95
NEW HAMPSHIRE (NH)	$455.08	$372.68
NORTHERN NJ (NJ)	$503.22	$411.39
REST OF NEW JERSEY (NJ)	$481.00	$394.55
NEW MEXICO (NM)	$426.95	$354.36
NEVADA** (NV)	$442.13	$362.89
MANHATTAN (NY)	$517.60	$425.62
NYC SUBURBS/LONG ISLAND (NY)	$532.75	$438.63
POUGHKPSIE/N NYC SUBURBS (NY)	$485.48	$398.80
QUEENS (NY)	$519.73	$426.16
REST OF NEW YORK (NY)	$423.59	$348.38
OHIO (OH)	$420.67	$348.40
OKLAHOMA (OK)	$408.65	$337.96
PORTLAND (OR)	$474.34	$386.40
REST OF OREGON (OR)	$437.21	$358.37
METROPOLITAN PHILADELPHIA (PA)	$465.70	$383.29
REST OF PENNSYLVANIA (PA)	$420.49	$347.82
PUERTO RICO (PR)	$449.10	$369.07
RHODE ISLAND (RI)	$455.51	$373.74
SOUTH CAROLINA (SC)	$419.76	$346.62
SOUTH DAKOTA** (SD)	$428.72	$349.56
TENNESSEE (TN)	$407.06	$335.10
BRAZORIA (TX)	$438.75	$360.31
DALLAS (TX)	$442.42	$363.57
GALVESTON (TX)	$440.61	$362.01
HOUSTON (TX)	$455.07	$376.47
BEAUMONT (TX)	$417.70	$345.66
FORT WORTH (TX)	$439.80	$361.74
AUSTIN (TX)	$460.66	$376.91
REST OF TEXAS (TX)	$428.57	$353.44
UTAH (UT)	$425.77	$351.36
VIRGINIA (VA)	$433.44	$355.63
VIRGIN ISLANDS (VI)	$449.10	$369.07
VERMONT (VT)	$430.24	$351.87
SEATTLE (KING CNTY) (WA)	$514.84	$417.71
REST OF WASHINGTON (WA)	$457.24	$373.88
WISCONSIN (WI)	$415.53	$339.70
WEST VIRGINIA (WV)	$418.80	$350.01
WYOMING** (WY)	$439.38	$360.22

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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. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly in the practice-expense RVU, reflecting whether overhead costs (like clinical staff and supplies) are borne by the physician's office or by a facility such as a hospital. The national figures shown use national GPCI values of 1.0, while locality-specific figures apply the actual GPCIs for that area.

RVUs — work 3.7, practice expense 8.87 (non-facility) / 6.5 (facility), malpractice 0.79 — × 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 patient meets the annual Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Rates vary by locality based on GPCI values; always confirm with your specific Medicare Administrative Contractor (MAC) and current fee schedule.
Figures are based on the 2026 conversion factor and RVUs, which CMS may revise during the year.

Frequently asked

Why does the facility rate differ from the non-facility rate for CPT 23525?

The practice-expense RVU is lower in the facility setting because overhead costs like staff and equipment are assumed to be covered by the facility rather than the physician's office.

Does this amount reflect what Medicare will actually pay?

No. It is an estimate based on national RVUs and the conversion factor. Actual payment depends on locality GPCIs, applicable modifiers, deductible status, and any sequestration or policy adjustments in effect at the time of service.

Can I use this figure to bill the patient directly?

No. Patient responsibility depends on their specific coverage, deductible status, and secondary insurance; this page is for informational and estimation purposes only.

Where can I find the exact rate for my locality?

Use the locality-specific GPCI values shown on this page, or consult your MAC's published fee schedule for the precise, current reimbursement 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.