Medicare Reimbursement for CPT 23552

This page covers CPT code 23552, a physician procedure code billed under Medicare Part B. It shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and, where available, adjusted by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$612.24	$612.24
ALASKA* (AK)	$747.97	$747.97
ALABAMA (AL)	$554.17	$554.17
ARKANSAS (AR)	$547.00	$547.00
ARIZONA (AZ)	$595.79	$595.79
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$717.17	$717.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$728.49	$728.49
OXNARD-THOUSAND OAKS-VENTURA (CA)	$647.88	$647.88
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$654.19	$654.19
NAPA (CA)	$687.96	$687.96
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$719.09	$719.09
VALLEJO (CA)	$685.19	$685.19
BAKERSFIELD (CA)	$621.41	$621.41
CHICO (CA)	$616.71	$616.71
FRESNO (CA)	$616.71	$616.71
HANFORD-CORCORAN (CA)	$616.71	$616.71
MADERA (CA)	$616.71	$616.71
MERCED (CA)	$616.71	$616.71
MODESTO (CA)	$616.71	$616.71
REDDING (CA)	$616.71	$616.71
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$634.89	$634.89
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$640.16	$640.16
SALINAS (CA)	$637.65	$637.65
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$736.34	$736.34
SANTA CRUZ-WATSONVILLE (CA)	$649.82	$649.82
SANTA ROSA-PETALUMA (CA)	$655.89	$655.89
STOCKTON (CA)	$616.71	$616.71
VISALIA (CA)	$616.71	$616.71
YUBA CITY (CA)	$616.71	$616.71
EL CENTRO (CA)	$616.99	$616.99
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$647.64	$647.64
SAN LUIS OBISPO-PASO ROBLES (CA)	$628.26	$628.26
SANTA MARIA-SANTA BARBARA (CA)	$638.67	$638.67
REST OF CALIFORNIA (CA)	$616.71	$616.71
COLORADO (CO)	$620.51	$620.51
CONNECTICUT (CT)	$650.52	$650.52
DC + MD/VA SUBURBS (DC)	$681.93	$681.93
DELAWARE (DE)	$604.75	$604.75
FORT LAUDERDALE (FL)	$661.34	$661.34
MIAMI (FL)	$709.56	$709.56
REST OF FLORIDA (FL)	$628.82	$628.82
ATLANTA (GA)	$628.74	$628.74
REST OF GEORGIA (GA)	$594.07	$594.07
HAWAII, GUAM (HI)	$625.26	$625.26
IOWA (IA)	$555.37	$555.37
IDAHO (ID)	$561.01	$561.01
EAST ST. LOUIS (IL)	$647.99	$647.99
SUBURBAN CHICAGO (IL)	$665.08	$665.08
CHICAGO (IL)	$688.69	$688.69
REST OF ILLINOIS (IL)	$620.66	$620.66
INDIANA (IN)	$563.62	$563.62
KANSAS (KS)	$558.46	$558.46
KENTUCKY (KY)	$577.63	$577.63
NEW ORLEANS (LA)	$604.07	$604.07
REST OF LOUISIANA (LA)	$578.99	$578.99
METROPOLITAN BOSTON (MA)	$669.90	$669.90
REST OF MASSACHUSETTS (MA)	$619.61	$619.61
BALTIMORE/SURR. CNTYS (MD)	$649.82	$649.82
REST OF MARYLAND (MD)	$613.70	$613.70
SOUTHERN MAINE (ME)	$588.99	$588.99
REST OF MAINE (ME)	$569.42	$569.42
DETROIT (MI)	$641.56	$641.56
REST OF MICHIGAN (MI)	$596.16	$596.16
MINNESOTA (MN)	$580.29	$580.29
METROPOLITAN ST. LOUIS (MO)	$599.46	$599.46
METROPOLITAN KANSAS CITY (MO)	$594.56	$594.56
REST OF MISSOURI (MO)	$573.71	$573.71
MISSISSIPPI (MS)	$560.18	$560.18
MONTANA** (MT)	$612.13	$612.13
NORTH CAROLINA (NC)	$573.87	$573.87
NORTH DAKOTA** (ND)	$578.71	$578.71
NEBRASKA (NE)	$556.45	$556.45
NEW HAMPSHIRE (NH)	$616.19	$616.19
NORTHERN NJ (NJ)	$677.14	$677.14
REST OF NEW JERSEY (NJ)	$653.91	$653.91
NEW MEXICO (NM)	$601.30	$601.30
NEVADA** (NV)	$603.08	$603.08
MANHATTAN (NY)	$707.20	$707.20
NYC SUBURBS/LONG ISLAND (NY)	$729.75	$729.75
POUGHKPSIE/N NYC SUBURBS (NY)	$662.53	$662.53
QUEENS (NY)	$704.45	$704.45
REST OF NEW YORK (NY)	$582.05	$582.05
OHIO (OH)	$589.33	$589.33
OKLAHOMA (OK)	$570.92	$570.92
PORTLAND (OR)	$632.19	$632.19
REST OF OREGON (OR)	$594.40	$594.40
METROPOLITAN PHILADELPHIA (PA)	$639.31	$639.31
REST OF PENNSYLVANIA (PA)	$587.11	$587.11
PUERTO RICO (PR)	$614.35	$614.35
RHODE ISLAND (RI)	$620.46	$620.46
SOUTH CAROLINA (SC)	$583.36	$583.36
SOUTH DAKOTA** (SD)	$574.76	$574.76
TENNESSEE (TN)	$561.67	$561.67
BRAZORIA (TX)	$599.70	$599.70
DALLAS (TX)	$605.73	$605.73
GALVESTON (TX)	$602.95	$602.95
HOUSTON (TX)	$633.88	$633.88
BEAUMONT (TX)	$584.06	$584.06
FORT WORTH (TX)	$603.78	$603.78
AUSTIN (TX)	$621.95	$621.95
REST OF TEXAS (TX)	$593.07	$593.07
UTAH (UT)	$590.37	$590.37
VIRGINIA (VA)	$591.08	$591.08
VIRGIN ISLANDS (VI)	$614.35	$614.35
VERMONT (VT)	$581.67	$581.67
SEATTLE (KING CNTY) (WA)	$677.23	$677.23
REST OF WASHINGTON (WA)	$616.71	$616.71
WISCONSIN (WI)	$561.90	$561.90
WEST VIRGINIA (WV)	$601.39	$601.39
WYOMING** (WY)	$597.56	$597.56

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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 the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often use different practice-expense RVUs because overhead costs differ, though for some codes these values are the same.

RVUs — work 8.6, practice expense 8.04 (non-facility) / 8.04 (facility), malpractice 1.69 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount 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, place-of-service codes, multiple-procedure reductions, and sequestration can change the final paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts can change year to year.
Always verify current rates and local adjustments with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why might the facility and non-facility amounts be the same for this code?

When the practice-expense RVUs are identical for both settings, the calculated allowed amounts will match. This usually happens when Medicare assigns the same overhead cost assumptions regardless of where the service is performed.

Does this amount reflect what my practice will actually be paid?

No. It's a national or locality-adjusted estimate based on standard RVUs and the conversion factor. Your actual payment depends on your specific locality GPCIs, any applicable modifiers, and Medicare Administrative Contractor (MAC) processing rules.

How often do these amounts change?

The conversion factor and RVUs are typically updated annually, and the amounts can also change mid-year due to legislative or budget-neutrality adjustments.

Why isn't the CPT code description shown here?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so we reference the code generically rather than reproducing the official descriptor.

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.