Medicare Reimbursement for CPT 23616

CPT code 23616 is a physician procedure code; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted for your locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1121.60	$1121.60
ALASKA* (AK)	$1391.21	$1391.21
ALABAMA (AL)	$1017.99	$1017.99
ARKANSAS (AR)	$1005.29	$1005.29
ARIZONA (AZ)	$1091.41	$1091.41
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1271.29	$1271.29
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1289.60	$1289.60
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1164.53	$1164.53
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1177.77	$1177.77
NAPA (CA)	$1225.63	$1225.63
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1275.50	$1275.50
VALLEJO (CA)	$1219.57	$1219.57
BAKERSFIELD (CA)	$1123.03	$1123.03
CHICO (CA)	$1112.81	$1112.81
FRESNO (CA)	$1112.81	$1112.81
HANFORD-CORCORAN (CA)	$1112.81	$1112.81
MADERA (CA)	$1112.81	$1112.81
MERCED (CA)	$1112.81	$1112.81
MODESTO (CA)	$1112.81	$1112.81
REDDING (CA)	$1112.81	$1112.81
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1152.58	$1152.58
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1150.96	$1150.96
SALINAS (CA)	$1146.37	$1146.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1306.78	$1306.78
SANTA CRUZ-WATSONVILLE (CA)	$1162.78	$1162.78
SANTA ROSA-PETALUMA (CA)	$1173.36	$1173.36
STOCKTON (CA)	$1112.81	$1112.81
VISALIA (CA)	$1112.81	$1112.81
YUBA CITY (CA)	$1112.81	$1112.81
EL CENTRO (CA)	$1113.43	$1113.43
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1161.31	$1161.31
SAN LUIS OBISPO-PASO ROBLES (CA)	$1130.00	$1130.00
SANTA MARIA-SANTA BARBARA (CA)	$1147.38	$1147.38
REST OF CALIFORNIA (CA)	$1112.81	$1112.81
COLORADO (CO)	$1127.30	$1127.30
CONNECTICUT (CT)	$1190.30	$1190.30
DC + MD/VA SUBURBS (DC)	$1239.04	$1239.04
DELAWARE (DE)	$1107.31	$1107.31
FORT LAUDERDALE (FL)	$1226.66	$1226.66
MIAMI (FL)	$1326.95	$1326.95
REST OF FLORIDA (FL)	$1166.17	$1166.17
ATLANTA (GA)	$1154.63	$1154.63
REST OF GEORGIA (GA)	$1102.15	$1102.15
HAWAII, GUAM (HI)	$1124.35	$1124.35
IOWA (IA)	$1013.10	$1013.10
IDAHO (ID)	$1024.49	$1024.49
EAST ST. LOUIS (IL)	$1214.93	$1214.93
SUBURBAN CHICAGO (IL)	$1231.99	$1231.99
CHICAGO (IL)	$1287.83	$1287.83
REST OF ILLINOIS (IL)	$1156.40	$1156.40
INDIANA (IN)	$1028.89	$1028.89
KANSAS (KS)	$1021.92	$1021.92
KENTUCKY (KY)	$1066.72	$1066.72
NEW ORLEANS (LA)	$1114.82	$1114.82
REST OF LOUISIANA (LA)	$1070.43	$1070.43
METROPOLITAN BOSTON (MA)	$1210.10	$1210.10
REST OF MASSACHUSETTS (MA)	$1127.28	$1127.28
BALTIMORE/SURR. CNTYS (MD)	$1189.65	$1189.65
REST OF MARYLAND (MD)	$1122.25	$1122.25
SOUTHERN MAINE (ME)	$1072.40	$1072.40
REST OF MAINE (ME)	$1042.90	$1042.90
DETROIT (MI)	$1192.39	$1192.39
REST OF MICHIGAN (MI)	$1102.76	$1102.76
MINNESOTA (MN)	$1046.19	$1046.19
METROPOLITAN ST. LOUIS (MO)	$1102.66	$1102.66
METROPOLITAN KANSAS CITY (MO)	$1094.37	$1094.37
REST OF MISSOURI (MO)	$1063.22	$1063.22
MISSISSIPPI (MS)	$1033.77	$1033.77
MONTANA** (MT)	$1121.36	$1121.36
NORTH CAROLINA (NC)	$1050.20	$1050.20
NORTH DAKOTA** (ND)	$1048.19	$1048.19
NEBRASKA (NE)	$1013.95	$1013.95
NEW HAMPSHIRE (NH)	$1122.55	$1122.55
NORTHERN NJ (NJ)	$1231.66	$1231.66
REST OF NEW JERSEY (NJ)	$1194.30	$1194.30
NEW MEXICO (NM)	$1113.26	$1113.26
NEVADA** (NV)	$1101.36	$1101.36
MANHATTAN (NY)	$1297.08	$1297.08
NYC SUBURBS/LONG ISLAND (NY)	$1341.36	$1341.36
POUGHKPSIE/N NYC SUBURBS (NY)	$1212.46	$1212.46
QUEENS (NY)	$1287.28	$1287.28
REST OF NEW YORK (NY)	$1064.91	$1064.91
OHIO (OH)	$1087.81	$1087.81
OKLAHOMA (OK)	$1051.26	$1051.26
PORTLAND (OR)	$1143.92	$1143.92
REST OF OREGON (OR)	$1083.30	$1083.30
METROPOLITAN PHILADELPHIA (PA)	$1172.61	$1172.61
REST OF PENNSYLVANIA (PA)	$1082.02	$1082.02
PUERTO RICO (PR)	$1124.15	$1124.15
RHODE ISLAND (RI)	$1132.81	$1132.81
SOUTH CAROLINA (SC)	$1072.68	$1072.68
SOUTH DAKOTA** (SD)	$1039.54	$1039.54
TENNESSEE (TN)	$1028.00	$1028.00
BRAZORIA (TX)	$1095.60	$1095.60
DALLAS (TX)	$1107.84	$1107.84
GALVESTON (TX)	$1102.33	$1102.33
HOUSTON (TX)	$1170.06	$1170.06
BEAUMONT (TX)	$1076.85	$1076.85
FORT WORTH (TX)	$1105.45	$1105.45
AUSTIN (TX)	$1131.90	$1131.90
REST OF TEXAS (TX)	$1089.22	$1089.22
UTAH (UT)	$1085.01	$1085.01
VIRGINIA (VA)	$1078.47	$1078.47
VIRGIN ISLANDS (VI)	$1124.15	$1124.15
VERMONT (VT)	$1056.55	$1056.55
SEATTLE (KING CNTY) (WA)	$1219.65	$1219.65
REST OF WASHINGTON (WA)	$1121.03	$1121.03
WISCONSIN (WI)	$1019.29	$1019.29
WEST VIRGINIA (WV)	$1122.49	$1122.49
WYOMING** (WY)	$1089.47	$1089.47

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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 Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. The practice-expense RVU often differs between non-facility (e.g., physician office) and facility (e.g., hospital) settings, which is why the two allowed amounts can differ; work and malpractice RVUs generally stay the same across settings.

RVUs — work 17.91, practice expense 11.97 (non-facility) / 11.97 (facility), malpractice 3.7 — × 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 final paid amount.
Locality-specific GPCIs mean the actual allowed amount in your area may differ from the national figure shown here.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why do the non-facility and facility amounts differ for some codes but not others?

The difference comes from the practice-expense RVU, which reflects overhead costs. When a procedure is typically performed in a facility (where the facility, not the physician's office, bears most overhead costs), the facility practice-expense RVU is lower. If both RVUs are equal for a code, the non-facility and facility amounts will match.

Why isn't the CPT descriptor shown on this page?

CPT code descriptors are copyrighted and licensed by the American Medical Association. This page displays only the code and its associated Medicare pricing inputs, not the proprietary descriptor text.

How often does the conversion factor change?

CMS updates the national conversion factor annually, typically effective January 1, as part of the Medicare Physician Fee Schedule final rule. This can shift the allowed amount even if the RVUs for a code stay the same.

Will my actual payment match the amount shown here?

Not necessarily. Your locality's GPCIs, any applicable modifiers, secondary payer coordination, sequestration, and contractor-specific policies can all cause the actual paid amount to differ from this estimate.

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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.