Medicare Reimbursement for CPT 23931

CPT 23931 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code, both nationally 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)	$323.99	$158.65
ALASKA* (AK)	$365.05	$188.97
ALABAMA (AL)	$287.35	$142.68
ARKANSAS (AR)	$282.71	$140.69
ARIZONA (AZ)	$314.48	$154.27
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$426.48	$193.35
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$435.13	$196.71
OXNARD-THOUSAND OAKS-VENTURA (CA)	$367.21	$171.79
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$368.72	$173.13
NAPA (CA)	$402.30	$184.39
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$426.87	$193.75
VALLEJO (CA)	$401.73	$183.82
BAKERSFIELD (CA)	$344.79	$163.59
CHICO (CA)	$343.82	$162.62
FRESNO (CA)	$343.82	$162.62
HANFORD-CORCORAN (CA)	$343.82	$162.62
MADERA (CA)	$343.82	$162.62
MERCED (CA)	$343.82	$162.62
MODESTO (CA)	$343.82	$162.62
REDDING (CA)	$343.82	$162.62
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$347.59	$166.38
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$361.88	$169.59
SALINAS (CA)	$360.57	$168.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$436.75	$198.34
SANTA CRUZ-WATSONVILLE (CA)	$374.11	$173.23
SANTA ROSA-PETALUMA (CA)	$377.93	$174.90
STOCKTON (CA)	$343.82	$162.62
VISALIA (CA)	$343.82	$162.62
YUBA CITY (CA)	$343.82	$162.62
EL CENTRO (CA)	$343.88	$162.67
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$369.92	$172.18
SAN LUIS OBISPO-PASO ROBLES (CA)	$354.68	$166.36
SANTA MARIA-SANTA BARBARA (CA)	$362.16	$169.38
REST OF CALIFORNIA (CA)	$343.82	$162.62
COLORADO (CO)	$338.31	$162.39
CONNECTICUT (CT)	$347.08	$169.02
DC + MD/VA SUBURBS (DC)	$373.49	$178.72
DELAWARE (DE)	$320.08	$156.73
FORT LAUDERDALE (FL)	$336.72	$169.23
MIAMI (FL)	$352.22	$180.10
REST OF FLORIDA (FL)	$318.76	$160.70
ATLANTA (GA)	$330.56	$162.58
REST OF GEORGIA (GA)	$298.96	$151.48
HAWAII, GUAM (HI)	$353.66	$165.68
IOWA (IA)	$295.48	$144.20
IDAHO (ID)	$297.63	$145.52
EAST ST. LOUIS (IL)	$315.64	$163.53
SUBURBAN CHICAGO (IL)	$340.25	$170.45
CHICAGO (IL)	$340.81	$174.65
REST OF ILLINOIS (IL)	$308.60	$157.65
INDIANA (IN)	$299.55	$146.28
KANSAS (KS)	$293.95	$144.49
KENTUCKY (KY)	$294.97	$147.98
NEW ORLEANS (LA)	$310.68	$155.10
REST OF LOUISIANA (LA)	$294.46	$148.14
METROPOLITAN BOSTON (MA)	$374.14	$176.73
REST OF MASSACHUSETTS (MA)	$335.96	$161.86
BALTIMORE/SURR. CNTYS (MD)	$346.15	$168.75
REST OF MARYLAND (MD)	$326.66	$159.34
SOUTHERN MAINE (ME)	$317.40	$153.56
REST OF MAINE (ME)	$299.37	$147.26
DETROIT (MI)	$323.17	$163.62
REST OF MICHIGAN (MI)	$303.53	$152.58
MINNESOTA (MN)	$323.08	$152.95
METROPOLITAN ST. LOUIS (MO)	$311.89	$154.49
METROPOLITAN KANSAS CITY (MO)	$308.32	$153.07
REST OF MISSOURI (MO)	$288.84	$146.32
MISSISSIPPI (MS)	$285.84	$143.49
MONTANA** (MT)	$323.97	$158.63
NORTH CAROLINA (NC)	$302.85	$148.59
NORTH DAKOTA** (ND)	$317.04	$151.71
NEBRASKA (NE)	$297.27	$144.67
NEW HAMPSHIRE (NH)	$332.88	$160.77
NORTHERN NJ (NJ)	$368.95	$177.16
REST OF NEW JERSEY (NJ)	$350.75	$170.20
NEW MEXICO (NM)	$305.38	$153.77
NEVADA** (NV)	$322.29	$156.79
MANHATTAN (NY)	$375.57	$183.45
NYC SUBURBS/LONG ISLAND (NY)	$385.56	$188.98
POUGHKPSIE/N NYC SUBURBS (NY)	$353.12	$172.08
QUEENS (NY)	$378.94	$183.51
REST OF NEW YORK (NY)	$307.89	$150.82
OHIO (OH)	$302.11	$151.16
OKLAHOMA (OK)	$294.36	$146.72
PORTLAND (OR)	$349.98	$166.29
REST OF OREGON (OR)	$319.51	$154.83
METROPOLITAN PHILADELPHIA (PA)	$337.67	$165.56
REST OF PENNSYLVANIA (PA)	$302.64	$150.86
PUERTO RICO (PR)	$326.59	$159.44
RHODE ISLAND (RI)	$332.19	$161.40
SOUTH CAROLINA (SC)	$303.04	$150.28
SOUTH DAKOTA** (SD)	$316.23	$150.89
TENNESSEE (TN)	$295.60	$145.31
BRAZORIA (TX)	$319.62	$155.78
DALLAS (TX)	$321.86	$157.18
GALVESTON (TX)	$320.69	$156.51
HOUSTON (TX)	$327.10	$162.92
BEAUMONT (TX)	$300.43	$149.98
FORT WORTH (TX)	$319.48	$156.46
AUSTIN (TX)	$337.42	$162.50
REST OF TEXAS (TX)	$309.98	$153.07
UTAH (UT)	$307.65	$152.23
VIRGINIA (VA)	$316.26	$153.74
VIRGIN ISLANDS (VI)	$326.59	$159.44
VERMONT (VT)	$315.69	$152.01
SEATTLE (KING CNTY) (WA)	$382.16	$179.29
REST OF WASHINGTON (WA)	$335.36	$161.26
WISCONSIN (WI)	$305.29	$146.90
WEST VIRGINIA (WV)	$295.95	$152.27
WYOMING** (WY)	$320.95	$155.61

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units per patient per day — Date of Service Edit: Clinical. 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

The Medicare 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 Indices (GPCIs) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher when the physician's practice bears the overhead (non-facility) versus when a facility such as a hospital bears it (facility). The work and malpractice RVUs generally stay the same across settings, while the practice-expense RVU — and therefore the total payment — typically changes.

RVUs — work 1.79, practice expense 7.56 (non-facility) / 2.61 (facility), malpractice 0.35 — × 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 deductible; the beneficiary or secondary payer is responsible for the rest.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Rates vary by locality based on GPCIs; the national figures shown are reference points, not locality-specific guarantees.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility rate lower than the non-facility rate for this code?

In the facility setting, the hospital or facility bears the practice-expense overhead (equipment, supplies, staff), so Medicare assigns a lower practice-expense RVU to the physician's payment. In non-facility settings, the physician's practice absorbs those costs, resulting in a higher practice-expense RVU and overall payment.

Does this amount reflect what the patient and Medicare will actually pay?

No. The figure shown is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% after the deductible, and the beneficiary or a secondary payer covers the remainder, subject to any applicable modifiers or adjustments.

Why might my MAC's payment differ from the amount shown here?

Local GPCIs, applied modifiers, multiple-procedure payment reductions, sequestration, and yearly budget-neutrality adjustments can all cause the actual paid amount to differ from the national or estimated locality figure.

Can I use this figure to predict reimbursement for a specific claim?

Use it only as a general reference. Actual reimbursement depends on the patient's specific locality, place of service, applicable modifiers, and current MAC policies.

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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.