Medicare Reimbursement for CPT 23630

CPT 23630 is a physician procedure code reported to Medicare for payment under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility and facility settings. Because the non-facility and facility practice-expense RVUs are the same for this code, the estimated allowed amount does not differ between the two settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$734.15	$734.15
ALASKA* (AK)	$895.45	$895.45
ALABAMA (AL)	$663.65	$663.65
ARKANSAS (AR)	$654.95	$654.95
ARIZONA (AZ)	$714.10	$714.10
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$857.26	$857.26
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$870.67	$870.67
OXNARD-THOUSAND OAKS-VENTURA (CA)	$775.34	$775.34
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$783.02	$783.02
NAPA (CA)	$822.71	$822.71
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$859.66	$859.66
VALLEJO (CA)	$819.26	$819.26
BAKERSFIELD (CA)	$743.79	$743.79
CHICO (CA)	$737.96	$737.96
FRESNO (CA)	$737.96	$737.96
HANFORD-CORCORAN (CA)	$737.96	$737.96
MADERA (CA)	$737.96	$737.96
MERCED (CA)	$737.96	$737.96
MODESTO (CA)	$737.96	$737.96
REDDING (CA)	$737.96	$737.96
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$760.64	$760.64
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$765.90	$765.90
SALINAS (CA)	$762.90	$762.90
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$880.47	$880.47
SANTA CRUZ-WATSONVILLE (CA)	$777.33	$777.33
SANTA ROSA-PETALUMA (CA)	$784.59	$784.59
STOCKTON (CA)	$737.96	$737.96
VISALIA (CA)	$737.96	$737.96
YUBA CITY (CA)	$737.96	$737.96
EL CENTRO (CA)	$738.31	$738.31
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$774.79	$774.79
SAN LUIS OBISPO-PASO ROBLES (CA)	$751.69	$751.69
SANTA MARIA-SANTA BARBARA (CA)	$764.10	$764.10
REST OF CALIFORNIA (CA)	$737.96	$737.96
COLORADO (CO)	$743.29	$743.29
CONNECTICUT (CT)	$780.43	$780.43
DC + MD/VA SUBURBS (DC)	$817.55	$817.55
DELAWARE (DE)	$724.92	$724.92
FORT LAUDERDALE (FL)	$795.25	$795.25
MIAMI (FL)	$855.00	$855.00
REST OF FLORIDA (FL)	$755.55	$755.55
ATLANTA (GA)	$754.46	$754.46
REST OF GEORGIA (GA)	$713.20	$713.20
HAWAII, GUAM (HI)	$748.23	$748.23
IOWA (IA)	$664.51	$664.51
IDAHO (ID)	$671.47	$671.47
EAST ST. LOUIS (IL)	$780.07	$780.07
SUBURBAN CHICAGO (IL)	$799.59	$799.59
CHICAGO (IL)	$829.43	$829.43
REST OF ILLINOIS (IL)	$746.05	$746.05
INDIANA (IN)	$674.62	$674.62
KANSAS (KS)	$668.54	$668.54
KENTUCKY (KY)	$692.72	$692.72
NEW ORLEANS (LA)	$724.90	$724.90
REST OF LOUISIANA (LA)	$694.47	$694.47
METROPOLITAN BOSTON (MA)	$802.46	$802.46
REST OF MASSACHUSETTS (MA)	$742.28	$742.28
BALTIMORE/SURR. CNTYS (MD)	$779.67	$779.67
REST OF MARYLAND (MD)	$735.65	$735.65
SOUTHERN MAINE (ME)	$705.27	$705.27
REST OF MAINE (ME)	$681.97	$681.97
DETROIT (MI)	$771.32	$771.32
REST OF MICHIGAN (MI)	$715.46	$715.46
MINNESOTA (MN)	$693.80	$693.80
METROPOLITAN ST. LOUIS (MO)	$718.97	$718.97
METROPOLITAN KANSAS CITY (MO)	$713.05	$713.05
REST OF MISSOURI (MO)	$688.25	$688.25
MISSISSIPPI (MS)	$671.37	$671.37
MONTANA** (MT)	$734.01	$734.01
NORTH CAROLINA (NC)	$687.32	$687.32
NORTH DAKOTA** (ND)	$692.29	$692.29
NEBRASKA (NE)	$665.73	$665.73
NEW HAMPSHIRE (NH)	$738.43	$738.43
NORTHERN NJ (NJ)	$811.73	$811.73
REST OF NEW JERSEY (NJ)	$784.14	$784.14
NEW MEXICO (NM)	$721.81	$721.81
NEVADA** (NV)	$722.70	$722.70
MANHATTAN (NY)	$849.22	$849.22
NYC SUBURBS/LONG ISLAND (NY)	$876.94	$876.94
POUGHKPSIE/N NYC SUBURBS (NY)	$794.78	$794.78
QUEENS (NY)	$845.46	$845.46
REST OF NEW YORK (NY)	$697.25	$697.25
OHIO (OH)	$706.94	$706.94
OKLAHOMA (OK)	$684.27	$684.27
PORTLAND (OR)	$757.06	$757.06
REST OF OREGON (OR)	$711.94	$711.94
METROPOLITAN PHILADELPHIA (PA)	$767.04	$767.04
REST OF PENNSYLVANIA (PA)	$704.09	$704.09
PUERTO RICO (PR)	$736.61	$736.61
RHODE ISLAND (RI)	$743.62	$743.62
SOUTH CAROLINA (SC)	$699.31	$699.31
SOUTH DAKOTA** (SD)	$687.36	$687.36
TENNESSEE (TN)	$672.46	$672.46
BRAZORIA (TX)	$718.53	$718.53
DALLAS (TX)	$725.97	$725.97
GALVESTON (TX)	$722.55	$722.55
HOUSTON (TX)	$761.17	$761.17
BEAUMONT (TX)	$700.41	$700.41
FORT WORTH (TX)	$723.69	$723.69
AUSTIN (TX)	$745.33	$745.33
REST OF TEXAS (TX)	$711.03	$711.03
UTAH (UT)	$707.80	$707.80
VIRGINIA (VA)	$708.00	$708.00
VIRGIN ISLANDS (VI)	$736.61	$736.61
VERMONT (VT)	$696.14	$696.14
SEATTLE (KING CNTY) (WA)	$810.96	$810.96
REST OF WASHINGTON (WA)	$738.71	$738.71
WISCONSIN (WI)	$671.97	$671.97
WEST VIRGINIA (WV)	$722.70	$722.70
WYOMING** (WY)	$715.83	$715.83

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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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the locality where the service is furnished. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs can differ between non-facility (e.g., office) and facility (e.g., hospital) settings depending on who bears the overhead cost, though for this code they are reported as the same value. The resulting figure represents the total allowed amount before any patient cost-sharing is applied.

RVUs — work 10.31, practice expense 9.56 (non-facility) / 9.56 (facility), malpractice 2.11 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral billing, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean the actual allowed amount can vary significantly from the national figure.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Does the allowed amount shown here reflect what the provider actually gets paid?

It reflects the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible, with the remainder owed by the patient or secondary payer, and the final payment can still be adjusted by modifiers, sequestration, or other factors.

Why might the amount differ between non-facility and facility settings?

The two settings can carry different practice-expense RVUs because Medicare accounts separately for who incurs overhead costs (e.g., the physician's office versus a hospital). For this code, those practice-expense RVUs are the same, so the national estimate is identical in both settings.

Why does my locality's rate differ from the national amount shown?

Local Geographic Practice Cost Indices adjust the work, practice-expense, and malpractice RVUs to reflect regional cost-of-living and practice-cost differences before applying the conversion factor, which can raise or lower the final allowed amount compared to the national figure.

Where can I confirm the exact amount my MAC will pay?

Your Medicare Administrative Contractor publishes the finalized locality-specific fee schedule each year, which should be used to confirm the exact allowed amount, along with any applicable coverage and billing requirements.

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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.