Medicare Reimbursement for CPT 23575

This page covers Medicare Physician Fee Schedule (PFS) estimates for CPT code 23575, a procedure code whose official descriptor is licensed by the AMA and not reproduced here. It shows the national PFS allowed amount for 2026, along with how the amount can vary by locality and by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$458.93	$379.10
ALASKA* (AK)	$533.51	$448.49
ALABAMA (AL)	$409.68	$339.83
ARKANSAS (AR)	$403.51	$334.94
ARIZONA (AZ)	$445.65	$368.29
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$574.79	$462.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$585.37	$470.26
OXNARD-THOUSAND OAKS-VENTURA (CA)	$504.83	$410.47
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$508.12	$413.68
NAPA (CA)	$545.97	$440.75
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$575.79	$463.23
VALLEJO (CA)	$544.53	$439.31
BAKERSFIELD (CA)	$478.08	$390.58
CHICO (CA)	$475.65	$388.16
FRESNO (CA)	$475.65	$388.16
HANFORD-CORCORAN (CA)	$475.65	$388.16
MADERA (CA)	$475.65	$388.16
MERCED (CA)	$475.65	$388.16
MODESTO (CA)	$475.65	$388.16
REDDING (CA)	$475.65	$388.16
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$485.11	$397.62
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$497.83	$404.99
SALINAS (CA)	$495.97	$403.45
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$589.46	$474.35
SANTA CRUZ-WATSONVILLE (CA)	$510.94	$413.95
SANTA ROSA-PETALUMA (CA)	$515.98	$417.95
STOCKTON (CA)	$475.65	$388.16
VISALIA (CA)	$475.65	$388.16
YUBA CITY (CA)	$475.65	$388.16
EL CENTRO (CA)	$475.80	$388.31
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$506.81	$411.34
SAN LUIS OBISPO-PASO ROBLES (CA)	$488.21	$397.28
SANTA MARIA-SANTA BARBARA (CA)	$497.60	$404.52
REST OF CALIFORNIA (CA)	$475.65	$388.16
COLORADO (CO)	$472.83	$387.89
CONNECTICUT (CT)	$490.33	$404.36
DC + MD/VA SUBURBS (DC)	$521.64	$427.61
DELAWARE (DE)	$453.14	$374.27
FORT LAUDERDALE (FL)	$486.47	$405.61
MIAMI (FL)	$515.84	$432.74
REST OF FLORIDA (FL)	$460.87	$384.55
ATLANTA (GA)	$469.92	$388.81
REST OF GEORGIA (GA)	$433.04	$361.84
HAWAII, GUAM (HI)	$486.55	$395.78
IOWA (IA)	$416.39	$343.35
IDAHO (ID)	$420.08	$346.64
EAST ST. LOUIS (IL)	$465.38	$391.94
SUBURBAN CHICAGO (IL)	$490.46	$408.48
CHICAGO (IL)	$499.41	$419.19
REST OF ILLINOIS (IL)	$450.08	$377.20
INDIANA (IN)	$422.51	$348.51
KANSAS (KS)	$416.32	$344.16
KENTUCKY (KY)	$424.03	$353.06
NEW ORLEANS (LA)	$445.70	$370.58
REST OF LOUISIANA (LA)	$424.12	$353.47
METROPOLITAN BOSTON (MA)	$517.97	$422.66
REST OF MASSACHUSETTS (MA)	$470.64	$386.58
BALTIMORE/SURR. CNTYS (MD)	$489.41	$403.75
REST OF MARYLAND (MD)	$461.40	$380.61
SOUTHERN MAINE (ME)	$445.46	$366.35
REST OF MAINE (ME)	$424.46	$351.02
DETROIT (MI)	$468.87	$391.84
REST OF MICHIGAN (MI)	$437.32	$364.44
MINNESOTA (MN)	$446.70	$364.56
METROPOLITAN ST. LOUIS (MO)	$444.97	$368.98
METROPOLITAN KANSAS CITY (MO)	$440.44	$365.49
REST OF MISSOURI (MO)	$417.88	$349.07
MISSISSIPPI (MS)	$410.68	$341.95
MONTANA** (MT)	$458.87	$379.04
NORTH CAROLINA (NC)	$428.76	$354.28
NORTH DAKOTA** (ND)	$441.47	$361.64
NEBRASKA (NE)	$418.17	$344.49
NEW HAMPSHIRE (NH)	$467.22	$384.12
NORTHERN NJ (NJ)	$516.30	$423.70
REST OF NEW JERSEY (NJ)	$494.14	$406.97
NEW MEXICO (NM)	$440.61	$367.40
NEVADA** (NV)	$454.31	$374.40
MANHATTAN (NY)	$532.25	$439.49
NYC SUBURBS/LONG ISLAND (NY)	$548.10	$453.18
POUGHKPSIE/N NYC SUBURBS (NY)	$499.03	$411.61
QUEENS (NY)	$533.86	$439.50
REST OF NEW YORK (NY)	$435.60	$359.77
OHIO (OH)	$433.77	$360.88
OKLAHOMA (OK)	$421.14	$349.85
PORTLAND (OR)	$486.01	$397.32
REST OF OREGON (OR)	$449.03	$369.52
METROPOLITAN PHILADELPHIA (PA)	$479.05	$395.95
REST OF PENNSYLVANIA (PA)	$433.37	$360.09
PUERTO RICO (PR)	$461.70	$380.99
RHODE ISLAND (RI)	$468.00	$385.54
SOUTH CAROLINA (SC)	$432.33	$358.57
SOUTH DAKOTA** (SD)	$439.41	$359.58
TENNESSEE (TN)	$418.75	$346.19
BRAZORIA (TX)	$450.94	$371.83
DALLAS (TX)	$454.83	$375.32
GALVESTON (TX)	$452.93	$373.66
HOUSTON (TX)	$469.04	$389.77
BEAUMONT (TX)	$430.57	$357.92
FORT WORTH (TX)	$452.29	$373.58
AUSTIN (TX)	$472.78	$388.33
REST OF TEXAS (TX)	$441.19	$365.43
UTAH (UT)	$438.41	$363.38
VIRGINIA (VA)	$445.32	$366.85
VIRGIN ISLANDS (VI)	$461.70	$380.99
VERMONT (VT)	$441.49	$362.46
SEATTLE (KING CNTY) (WA)	$526.70	$428.75
REST OF WASHINGTON (WA)	$469.16	$385.11
WISCONSIN (WI)	$426.33	$349.85
WEST VIRGINIA (WV)	$433.35	$363.98
WYOMING** (WY)	$451.29	$371.46

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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 using Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a national dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility and facility settings use different practice-expense RVUs — non-facility is generally higher because it assumes the provider bears more overhead (e.g., office-based costs), while facility rates assume the overhead is borne by a hospital or ASC.

RVUs — work 4.12, practice expense 8.74 (non-facility) / 6.35 (facility), malpractice 0.88 — × 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's deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary based on locality-specific GPCIs, applicable modifiers, 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 does the amount differ between non-facility and facility settings?

The practice-expense RVU component differs depending on whether the service is performed in a facility (e.g., hospital) or non-facility (e.g., physician office) setting, since overhead costs are allocated differently.

Why might my local Medicare payment differ from the national amount shown here?

Local Geographic Practice Cost Indices (GPCIs) adjust the RVUs to reflect regional cost-of-living and practice cost differences, so the final allowed amount varies by locality.

Does this amount reflect what the patient or secondary insurer will pay?

No — this figure is the total Medicare-allowed amount. Medicare generally pays 80% after the deductible, with the remaining 20% and any unmet deductible being the patient's or secondary payer's responsibility.

Can modifiers change this amount?

Yes. Modifiers (e.g., bilateral procedure, reduced services, assistant surgeon) can increase or decrease the final payment relative to the base PFS amount 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.