Medicare Reimbursement for CPT 23605

CPT 23605 is a physician procedure code reported under Medicare's Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code at the national level and adjusted by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$534.75	$440.89
ALASKA* (AK)	$622.60	$522.64
ALABAMA (AL)	$477.34	$395.22
ARKANSAS (AR)	$470.16	$389.53
ARIZONA (AZ)	$519.20	$428.25
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$666.59	$534.26
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$678.74	$543.40
OXNARD-THOUSAND OAKS-VENTURA (CA)	$586.55	$475.61
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$590.50	$479.47
NAPA (CA)	$633.59	$509.89
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$667.82	$535.48
VALLEJO (CA)	$631.82	$508.12
BAKERSFIELD (CA)	$555.84	$452.97
CHICO (CA)	$552.87	$450.01
FRESNO (CA)	$552.87	$450.01
HANFORD-CORCORAN (CA)	$552.87	$450.01
MADERA (CA)	$552.87	$450.01
MERCED (CA)	$552.87	$450.01
MODESTO (CA)	$552.87	$450.01
REDDING (CA)	$552.87	$450.01
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$564.47	$461.61
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$578.38	$469.23
SALINAS (CA)	$576.22	$467.44
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$683.76	$548.41
SANTA CRUZ-WATSONVILLE (CA)	$593.28	$479.24
SANTA ROSA-PETALUMA (CA)	$599.10	$483.85
STOCKTON (CA)	$552.87	$450.01
VISALIA (CA)	$552.87	$450.01
YUBA CITY (CA)	$552.87	$450.01
EL CENTRO (CA)	$553.06	$450.19
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$588.63	$476.38
SAN LUIS OBISPO-PASO ROBLES (CA)	$567.24	$460.33
SANTA MARIA-SANTA BARBARA (CA)	$578.07	$468.63
REST OF CALIFORNIA (CA)	$552.87	$450.01
COLORADO (CO)	$550.20	$450.34
CONNECTICUT (CT)	$571.34	$470.25
DC + MD/VA SUBURBS (DC)	$607.17	$496.61
DELAWARE (DE)	$527.92	$435.19
FORT LAUDERDALE (FL)	$568.24	$473.16
MIAMI (FL)	$603.60	$505.89
REST OF FLORIDA (FL)	$538.20	$448.47
ATLANTA (GA)	$547.84	$452.48
REST OF GEORGIA (GA)	$505.60	$421.88
HAWAII, GUAM (HI)	$565.32	$458.61
IOWA (IA)	$484.61	$398.73
IDAHO (ID)	$489.02	$402.67
EAST ST. LOUIS (IL)	$544.61	$458.26
SUBURBAN CHICAGO (IL)	$572.77	$476.38
CHICAGO (IL)	$584.29	$489.96
REST OF ILLINOIS (IL)	$526.00	$440.31
INDIANA (IN)	$491.82	$404.82
KANSAS (KS)	$484.79	$399.95
KENTUCKY (KY)	$494.61	$411.17
NEW ORLEANS (LA)	$519.95	$431.63
REST OF LOUISIANA (LA)	$494.82	$411.76
METROPOLITAN BOSTON (MA)	$602.33	$490.26
REST OF MASSACHUSETTS (MA)	$547.76	$448.93
BALTIMORE/SURR. CNTYS (MD)	$570.32	$469.61
REST OF MARYLAND (MD)	$537.45	$442.46
SOUTHERN MAINE (ME)	$518.43	$425.42
REST OF MAINE (ME)	$494.39	$408.04
DETROIT (MI)	$547.80	$457.23
REST OF MICHIGAN (MI)	$510.34	$424.65
MINNESOTA (MN)	$519.04	$422.46
METROPOLITAN ST. LOUIS (MO)	$518.79	$429.44
METROPOLITAN KANSAS CITY (MO)	$513.54	$425.41
REST OF MISSOURI (MO)	$487.72	$406.81
MISSISSIPPI (MS)	$478.91	$398.10
MONTANA** (MT)	$534.68	$440.82
NORTH CAROLINA (NC)	$499.35	$411.78
NORTH DAKOTA** (ND)	$513.32	$419.46
NEBRASKA (NE)	$486.59	$399.96
NEW HAMPSHIRE (NH)	$543.93	$446.23
NORTHERN NJ (NJ)	$601.02	$492.14
REST OF NEW JERSEY (NJ)	$575.56	$473.07
NEW MEXICO (NM)	$514.28	$428.21
NEVADA** (NV)	$529.06	$435.11
MANHATTAN (NY)	$620.54	$511.47
NYC SUBURBS/LONG ISLAND (NY)	$639.33	$527.73
POUGHKPSIE/N NYC SUBURBS (NY)	$581.46	$478.69
QUEENS (NY)	$622.02	$511.08
REST OF NEW YORK (NY)	$507.33	$418.17
OHIO (OH)	$505.98	$420.29
OKLAHOMA (OK)	$490.97	$407.15
PORTLAND (OR)	$565.22	$460.95
REST OF OREGON (OR)	$522.70	$429.22
METROPOLITAN PHILADELPHIA (PA)	$558.37	$460.66
REST OF PENNSYLVANIA (PA)	$505.38	$419.22
PUERTO RICO (PR)	$537.88	$442.99
RHODE ISLAND (RI)	$545.00	$448.05
SOUTH CAROLINA (SC)	$503.95	$417.23
SOUTH DAKOTA** (SD)	$510.80	$416.94
TENNESSEE (TN)	$487.65	$402.34
BRAZORIA (TX)	$525.12	$432.11
DALLAS (TX)	$529.77	$436.29
GALVESTON (TX)	$527.52	$434.32
HOUSTON (TX)	$547.29	$454.09
BEAUMONT (TX)	$502.13	$416.72
FORT WORTH (TX)	$526.90	$434.36
AUSTIN (TX)	$550.34	$451.04
REST OF TEXAS (TX)	$514.21	$425.15
UTAH (UT)	$511.03	$422.80
VIRGINIA (VA)	$518.46	$426.20
VIRGIN ISLANDS (VI)	$537.88	$442.99
VERMONT (VT)	$513.59	$420.67
SEATTLE (KING CNTY) (WA)	$612.20	$497.04
REST OF WASHINGTON (WA)	$545.97	$447.14
WISCONSIN (WI)	$495.76	$405.84
WEST VIRGINIA (WV)	$506.54	$424.98
WYOMING** (WY)	$525.37	$431.51

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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

Each CPT code is assigned three Relative Value Units (RVUs) — for physician work, practice expense, and malpractice risk. These RVUs are each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (e.g., equipment, staff) are assumed to be lower when a service is performed in a facility such as a hospital. The work and malpractice RVU components generally stay the same across settings, while the practice-expense component drives most of the difference between non-facility and facility payment.

RVUs — work 4.93, practice expense 10 (non-facility) / 7.19 (facility), malpractice 1.08 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment can differ based on your specific Medicare Administrative Contractor (MAC), claim modifiers, and beneficiary-specific factors.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Amounts shown are subject to sequestration reductions, annual budget-neutrality adjustments, and mid-year CMS corrections.
Always verify current rates and any applicable modifiers or edits with your local MAC before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 23605?

The practice-expense RVU is lower in the facility setting because Medicare assumes the facility (not the physician's office) bears certain overhead costs, such as equipment and supplies.

Does this amount reflect what the patient will owe?

No. This figure is the Medicare-allowed amount before cost-sharing. The patient (or secondary insurance) is typically responsible for 20% after the deductible is met.

Why might my MAC's actual payment differ from this estimate?

Local GPCI values, sequestration, claim-specific modifiers, and annual CMS rule updates can all cause the final paid amount to differ from this general estimate.

Is the conversion factor the same every year?

No. CMS updates the conversion factor annually, and it can also be adjusted mid-year due to legislative or budget-neutrality changes.

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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.