Medicare Reimbursement for CPT Code 23935

CPT code 23935 is a physician procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$495.34	$495.34
ALASKA* (AK)	$595.59	$595.59
ALABAMA (AL)	$445.97	$445.97
ARKANSAS (AR)	$439.85	$439.85
ARIZONA (AZ)	$481.51	$481.51
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$590.21	$590.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$599.92	$599.92
OXNARD-THOUSAND OAKS-VENTURA (CA)	$529.22	$529.22
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$533.95	$533.95
NAPA (CA)	$564.70	$564.70
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$591.69	$591.69
VALLEJO (CA)	$562.58	$562.58
BAKERSFIELD (CA)	$505.74	$505.74
CHICO (CA)	$502.16	$502.16
FRESNO (CA)	$502.16	$502.16
HANFORD-CORCORAN (CA)	$502.16	$502.16
MADERA (CA)	$502.16	$502.16
MERCED (CA)	$502.16	$502.16
MODESTO (CA)	$502.16	$502.16
REDDING (CA)	$502.16	$502.16
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$516.13	$516.13
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$522.47	$522.47
SALINAS (CA)	$520.45	$520.45
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$605.96	$605.96
SANTA CRUZ-WATSONVILLE (CA)	$532.05	$532.05
SANTA ROSA-PETALUMA (CA)	$537.09	$537.09
STOCKTON (CA)	$502.16	$502.16
VISALIA (CA)	$502.16	$502.16
YUBA CITY (CA)	$502.16	$502.16
EL CENTRO (CA)	$502.38	$502.38
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$529.54	$529.54
SAN LUIS OBISPO-PASO ROBLES (CA)	$512.66	$512.66
SANTA MARIA-SANTA BARBARA (CA)	$521.54	$521.54
REST OF CALIFORNIA (CA)	$502.16	$502.16
COLORADO (CO)	$503.95	$503.95
CONNECTICUT (CT)	$527.41	$527.41
DC + MD/VA SUBURBS (DC)	$554.92	$554.92
DELAWARE (DE)	$489.06	$489.06
FORT LAUDERDALE (FL)	$533.59	$533.59
MIAMI (FL)	$571.74	$571.74
REST OF FLORIDA (FL)	$506.43	$506.43
ATLANTA (GA)	$508.59	$508.59
REST OF GEORGIA (GA)	$477.30	$477.30
HAWAII, GUAM (HI)	$510.51	$510.51
IOWA (IA)	$448.40	$448.40
IDAHO (ID)	$452.92	$452.92
EAST ST. LOUIS (IL)	$519.83	$519.83
SUBURBAN CHICAGO (IL)	$536.90	$536.90
CHICAGO (IL)	$554.24	$554.24
REST OF ILLINOIS (IL)	$498.54	$498.54
INDIANA (IN)	$455.19	$455.19
KANSAS (KS)	$450.36	$450.36
KENTUCKY (KY)	$464.54	$464.54
NEW ORLEANS (LA)	$486.84	$486.84
REST OF LOUISIANA (LA)	$465.43	$465.43
METROPOLITAN BOSTON (MA)	$546.44	$546.44
REST OF MASSACHUSETTS (MA)	$502.79	$502.79
BALTIMORE/SURR. CNTYS (MD)	$526.77	$526.77
REST OF MARYLAND (MD)	$496.78	$496.78
SOUTHERN MAINE (ME)	$477.12	$477.12
REST OF MAINE (ME)	$459.39	$459.39
DETROIT (MI)	$516.58	$516.58
REST OF MICHIGAN (MI)	$479.69	$479.69
MINNESOTA (MN)	$471.85	$471.85
METROPOLITAN ST. LOUIS (MO)	$483.70	$483.70
METROPOLITAN KANSAS CITY (MO)	$479.44	$479.44
REST OF MISSOURI (MO)	$460.51	$460.51
MISSISSIPPI (MS)	$450.06	$450.06
MONTANA** (MT)	$495.25	$495.25
NORTH CAROLINA (NC)	$463.30	$463.30
NORTH DAKOTA** (ND)	$469.54	$469.54
NEBRASKA (NE)	$449.53	$449.53
NEW HAMPSHIRE (NH)	$499.92	$499.92
NORTHERN NJ (NJ)	$550.44	$550.44
REST OF NEW JERSEY (NJ)	$530.32	$530.32
NEW MEXICO (NM)	$483.80	$483.80
NEVADA** (NV)	$488.33	$488.33
MANHATTAN (NY)	$573.63	$573.63
NYC SUBURBS/LONG ISLAND (NY)	$591.99	$591.99
POUGHKPSIE/N NYC SUBURBS (NY)	$537.00	$537.00
QUEENS (NY)	$572.26	$572.26
REST OF NEW YORK (NY)	$470.23	$470.23
OHIO (OH)	$474.44	$474.44
OKLAHOMA (OK)	$459.53	$459.53
PORTLAND (OR)	$514.65	$514.65
REST OF OREGON (OR)	$481.46	$481.46
METROPOLITAN PHILADELPHIA (PA)	$517.47	$517.47
REST OF PENNSYLVANIA (PA)	$472.93	$472.93
PUERTO RICO (PR)	$497.37	$497.37
RHODE ISLAND (RI)	$502.65	$502.65
SOUTH CAROLINA (SC)	$470.27	$470.27
SOUTH DAKOTA** (SD)	$466.50	$466.50
TENNESSEE (TN)	$453.01	$453.01
BRAZORIA (TX)	$485.25	$485.25
DALLAS (TX)	$490.06	$490.06
GALVESTON (TX)	$487.82	$487.82
HOUSTON (TX)	$511.61	$511.61
BEAUMONT (TX)	$470.28	$470.28
FORT WORTH (TX)	$488.19	$488.19
AUSTIN (TX)	$504.96	$504.96
REST OF TEXAS (TX)	$478.67	$478.67
UTAH (UT)	$476.26	$476.26
VIRGINIA (VA)	$478.42	$478.42
VIRGIN ISLANDS (VI)	$497.37	$497.37
VERMONT (VT)	$471.44	$471.44
SEATTLE (KING CNTY) (WA)	$553.20	$553.20
REST OF WASHINGTON (WA)	$500.60	$500.60
WISCONSIN (WI)	$455.03	$455.03
WEST VIRGINIA (WV)	$482.06	$482.06
WYOMING** (WY)	$484.05	$484.05

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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

Medicare's Physician Fee Schedule amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility and facility rates can differ because practice-expense RVUs are typically higher in non-facility settings, where the physician's office bears more overhead costs; for this code, the non-facility and facility amounts shown are identical.

RVUs — work 6.22, practice expense 7.31 (non-facility) / 7.31 (facility), malpractice 1.3 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national averages and the inputs described above — not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality GPCI, applicable modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality changes to the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the fee schedule show both non-facility and facility amounts?

Non-facility rates apply when the service is performed in a physician's office or other non-facility setting, where the practice bears overhead costs. Facility rates apply when the service is performed in a hospital or ambulatory surgical center, where the facility bears most overhead. Practice-expense RVUs — and sometimes the resulting payment — differ between the two settings, though for some codes they may be the same.

Why might my actual payment differ from the national amount shown?

The national amount uses a GPCI value of 1.0 for all components. Actual Medicare payments are adjusted using locality-specific GPCIs for work, practice expense, and malpractice, so the final allowed amount in your area may be higher or lower.

Does this amount include everything Medicare will pay?

No. This reflects the Medicare-allowed amount before the standard 20% coinsurance, deductible, and any applicable modifier, sequestration, or claim-specific adjustments are applied.

Can I use this figure to predict appeal or denial outcomes?

No. This page is a pricing reference only. Claim denials and appeals depend on coverage policy, medical necessity documentation, coding accuracy, and MAC-specific rules, not solely on the fee schedule amount.

More free billing tools: all Medicare fees · fee calculator · denial code decoder

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.