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CPT 22865 Medicare rate in Q3 2026

Office (non-facility) & facility

Historical · Q3 2026
$2,217.49

National (GPCI 1.000)

Facility-only: CMS developed no Office (non-facility) practice-expense RVUs for 22865 (NA indicator), so the file’s non-facility amount repeats the facility one.

$1,883.81–$2,916.09 across payment localities · Office (non-facility)

Participating physician · Before sequestration

Special payment instructions: Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. Review applicable payment rules.

CMS evidence · Q3 2026 release

Report a problem

The national PFS baseline was $2,217.49 for CPT 22865 in the Office (non-facility) setting and $2,217.49 in a facility under the Q3 2026 Physician Fee Schedule, effective July 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Contract rate as % of Medicare Copy link

Applies to your locality's allowed amount, not the $2,217.49 national baseline. How to find your contract's percentage.

Need rates from another insurer? Join the waitlist →

Allowed amount, Medicare's share, and patient share Copy link

A physician's $2,217.49 Office (non-facility) allowed amount: Medicare pays $1,738.51 after sequestration and the patient owes $443.50, once the Part B deductible is met.

Adjust for your locality →
22865: allowed amount and each party's share by who bills it, Office (non-facility), national baseline
Billed by Allowed amount Participating claim If not participating
What Medicare pays Patient coinsurance Non-participating amount Limiting charge
Physician (MD/DO) 100% Calculator $2,217.49 $1,738.51 $1,773.99 − $35.48 $443.50 $2,106.62 $2,422.61
Physician assisting at surgery (-80, -81, -82) 16% Calculator $354.80 $278.16 $283.84 − $5.68 $70.96 Not shown for assistant rows

National Q3 2026, GPCI 1.000. Each % applies before the 80/20 split and sequestration.

For the ZIP in the price card

Is $2,217.49 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($1,773.99) and the patient owes 20% coinsurance ($443.50). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 22865?

$2,106.62 in the Office (non-facility) setting—95% of the $2,217.49 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 22865?

$2,422.61 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $2,217.49 amount above. The non-participating amount is 95% of the fee schedule rate ($2,106.62), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

CMS RVU26CJuly 1 – September 30, 2026 See file rows

Which billing rules and modifiers apply? Copy link

National modifier amounts for 22865: -80/81/82 $354.80 · -AS $301.58 · -62 $1,385.93.

Global surgery period

90-day follow-up

GLOB DAYS

090

Major surgery. The fee covers the day before surgery, the day of surgery, and the 90 days after it. Related follow-up care inside that window is not billed separately.

Multiple procedures

Standard reduction applies

MULT PROC

2

When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.

-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.

Co-surgeons

Payable

CO SURG

2

Co-surgeons may be separately paid for this procedure, each typically at a percentage of the fee schedule amount.

-62 Co-surgeons, each · 62.5% $1,385.93

Team surgery

Payable by report

TEAM SURG

2

A surgical team may be paid for this procedure, but the amount is set by individual report rather than a fixed percentage.

-66 Team surgery Not payable

Not payable with 22865: -26/TC · -50.

Modifier amounts are derived, not a CMS column: Localis applies the standard MPFS percentage to the national Office (non-facility) amount. Check them against the Claims Processing Manual. Locality-adjusted amounts.

Why would a Medicare claim for 22865 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is R (restricted)—Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. See status indicators
  • 110 codes form NCCI pairs with 22865 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 185 codes pair with 22865 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
  • 22865 carries a 90-day global period—routine post-operative care within that window is included in the surgical payment rather than paid on its own claim. See how it's computed
  • Bilateral surgery: no bilateral adjustment. See billing policy
  • Multiple procedures: standard reduction applies. See billing policy

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

CMS RVU26CJuly 1 – September 30, 2026 See file rows

Can you bill it with another code? Copy link

22865 has 295 NCCI pairs (Q3 2026).

This code

22865

Modifier indicator 0

110 pairs

No modifier bypasses the edit

Modifier indicator 1

185 pairs

Only with an appropriate, documented modifier

All 295 NCCI pairs for 22865 →

Payment review for 22865 Copy link

Checking a paid 22865 line?

Check an actual payment Model this code in a contract
What to check (5)

Four published payment rules can change what 22865 allows on a claim: status R coverage instructions, facility-only practice-expense pricing, the 90-day global package and the standard multiple-procedure reduction. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

  • Treat the published amount as conditional—status R carries special coverage instructions, so a payable fee-schedule amount does not by itself establish that this line should have paid.
  • Check the place of service: CMS marks this code facility-only (an NA in the non-facility NA indicator) and developed no Office (non-facility) practice-expense RVUs for it; the file’s non-facility column repeats the facility value.
  • Check the dates before appealing a denial: related follow-up care in the 90 days after the procedure is already paid in this fee, so a post-operative visit denied in that window was denied correctly.
  • Rank the claim’s procedure lines before calling this one short-paid: billed with a higher-valued procedure on the same date, its allowed amount is $1,108.75 instead of $2,217.49 (national, GPCI 1.000). That is the rule, not a payer error.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04).

How location and RVUs set the amount Copy link

Office (non-facility) and facility: 66.39 RVUs × $33.4009 = $2,217.49 national PFS baseline. Local GPCIs move it from $1,883.81 in Wisconsin, WI to $2,916.09 in Miami, FL.

Office (non-facility) and facility

Office (non-facility) and facility: each RVU times its GPCI, summed, times the conversion factor
Component RVU × GPCI =
Work 30.96 1.000 30.96
Practice expense 22.35 1.000 22.35
Malpractice 13.08 1.000 13.08
Total RVUs 66.39
× Conversion factor $33.4009
= National PFS baseline $2,217.49

Rates by locality Copy link

Maine: $1,992.62–$2,049.56 across 2 localities ME Wisconsin: $1,883.81 WI Vermont: $1,994.20 VT New Hampshire: $2,193.48 NH Montana: $2,216.61 MT North Dakota: $1,957.98 ND Minnesota: $1,931.57 MN Michigan: $2,208.90–$2,491.06 across 2 localities MI New York: $2,050.41–$2,799.17 across 5 localities NY Massachusetts: $2,184.91–$2,356.65 across 2 localities MA Rhode Island: $2,214.58 RI Washington: $2,166.08–$2,358.70 across 2 localities WA Idaho: $1,927.53 ID Wyoming: $2,103.90 WY South Dakota: $1,927.39 SD Iowa: $1,890.59 IA Illinois: $2,398.50–$2,794.22 across 4 localities IL Indiana: $1,938.43 IN Ohio: $2,156.03 OH Pennsylvania: $2,132.24–$2,351.02 across 2 localities PA New Jersey: $2,369.91–$2,431.78 across 2 localities NJ Connecticut: $2,387.39 CT Oregon: $2,084.75–$2,205.05 across 2 localities OR Nevada: $2,145.27 NV Utah: $2,128.13 UT Colorado: $2,181.99 CO Nebraska: $1,888.26 NE Missouri: $2,103.11–$2,182.53 across 3 localities MO Kentucky: $2,097.49 KY West Virginia: $2,307.99 WV Virginia: $2,076.35 VA Maryland: $2,200.96–$2,392.07 across 2 localities MD Delaware: $2,169.57 DE California: $2,104.02–$2,458.48 across 29 localities CA Arizona: $2,131.43 AZ New Mexico: $2,243.34 NM Kansas: $1,929.13 KS Oklahoma: $2,040.18 OK Arkansas: $1,900.34 AR Tennessee: $1,947.28 TN North Carolina: $2,009.75 NC South Carolina: $2,095.22 SC District of Columbia: $2,455.57 DC Texas: $2,119.28–$2,384.80 across 8 localities TX Louisiana: $2,113.29–$2,232.86 across 2 localities LA Mississippi: $1,999.69 MS Alabama: $1,934.56 AL Georgia: $2,220.74–$2,320.35 across 2 localities GA Florida: $2,404.39–$2,916.09 across 3 localities FL Alaska: $2,586.89 AK Hawaii: $2,135.83 HI
$1,884–$2,009 $2,009–$2,134 $2,134–$2,259 $2,259–$2,384 $2,384–$2,509 $2,509–$2,634

22865 Office (non-facility) by metro, highest first

Miami, FL $2,916.09 Locality 09102-04 Long Island, NY $2,799.17 Locality 13202-02 Chicago, IL $2,794.22 Locality 06102-16 New York City, NY $2,660.62 Locality 13202-01 Queens, NY $2,612.64 Locality 13292-04 Metro East, IL $2,600.77 Locality 06102-12
Show 56 more metros
Anchorage, AK $2,586.89 Locality 02102-01 Suburban Chicago, IL $2,582.15 Locality 06102-15 Fort Lauderdale, FL $2,580.19 Locality 09102-03 Detroit, MI $2,491.06 Locality 08202-01 Washington, DC $2,455.57 Locality 12202-01 Northern New Jersey, NJ $2,431.78 Locality 12402-01 Tampa, FL $2,404.39 Locality 09102-99 San Jose, CA $2,397.75 Locality 01112-09 Baltimore, MD $2,392.07 Locality 12302-01 Hartford, CT $2,387.39 Locality 13102-00 Houston, TX $2,384.80 Locality 04412-18 San Francisco, CA $2,370.59 Locality 01112-05 Seattle, WA $2,358.70 Locality 02402-02 Boston, MA $2,356.65 Locality 14212-01 Philadelphia, PA $2,351.02 Locality 12502-01 Atlanta, GA $2,320.35 Locality 10212-01 Los Angeles, CA $2,249.70 Locality 01182-18 Riverside, CA $2,243.54 Locality 01112-62 Albuquerque, NM $2,243.34 Locality 04212-05 New Orleans, LA $2,232.86 Locality 07202-01 Ventura County, CA $2,217.60 Locality 01182-17 Providence, RI $2,214.58 Locality 14412-01 Austin, TX $2,213.05 Locality 04412-31 Portland, OR $2,205.05 Locality 02302-01 San Diego, CA $2,194.73 Locality 01182-72 St. Louis, MO $2,182.53 Locality 05302-01 Denver, CO $2,181.99 Locality 04112-01 Sacramento, CA $2,173.68 Locality 01112-63 Kansas City, MO $2,161.90 Locality 05302-02 Dallas, TX $2,161.77 Locality 04412-11 Fort Worth, TX $2,159.98 Locality 04412-28 Columbus, OH $2,156.03 Locality 15202-00 Las Vegas, NV $2,145.27 Locality 01312-00 Bakersfield, CA $2,137.98 Locality 01112-54 San Antonio, TX $2,137.04 Locality 04412-99 Honolulu, HI $2,135.83 Locality 01212-01 Pittsburgh, PA $2,132.24 Locality 12502-99 Phoenix, AZ $2,131.43 Locality 03102-00 Salt Lake City, UT $2,128.13 Locality 03502-09 Fresno, CA $2,104.02 Locality 01112-56 Louisville, KY $2,097.49 Locality 15102-00 Charleston, SC $2,095.22 Locality 11202-01 Richmond, VA $2,076.35 Locality 11302-00 Buffalo, NY $2,050.41 Locality 13282-99 Portland, ME $2,049.56 Locality 14112-03 Oklahoma City, OK $2,040.18 Locality 04312-00 Charlotte, NC $2,009.75 Locality 11502-00 Nashville, TN $1,947.28 Locality 10312-35 Indianapolis, IN $1,938.43 Locality 08102-00 Birmingham, AL $1,934.56 Locality 10112-00 Minneapolis, MN $1,931.57 Locality 06202-00 Wichita, KS $1,929.13 Locality 05202-00 Boise, ID $1,927.53 Locality 02202-00 Des Moines, IA $1,890.59 Locality 05102-00 Omaha, NE $1,888.26 Locality 05402-00 Milwaukee, WI $1,883.81 Locality 06302-00
Maine: $1,992.62–$2,049.56 across 2 localities ME Wisconsin: $1,883.81 WI Vermont: $1,994.20 VT New Hampshire: $2,193.48 NH Montana: $2,216.61 MT North Dakota: $1,957.98 ND Minnesota: $1,931.57 MN Michigan: $2,208.90–$2,491.06 across 2 localities MI New York: $2,050.41–$2,799.17 across 5 localities NY Massachusetts: $2,184.91–$2,356.65 across 2 localities MA Rhode Island: $2,214.58 RI Washington: $2,166.08–$2,358.70 across 2 localities WA Idaho: $1,927.53 ID Wyoming: $2,103.90 WY South Dakota: $1,927.39 SD Iowa: $1,890.59 IA Illinois: $2,398.50–$2,794.22 across 4 localities IL Indiana: $1,938.43 IN Ohio: $2,156.03 OH Pennsylvania: $2,132.24–$2,351.02 across 2 localities PA New Jersey: $2,369.91–$2,431.78 across 2 localities NJ Connecticut: $2,387.39 CT Oregon: $2,084.75–$2,205.05 across 2 localities OR Nevada: $2,145.27 NV Utah: $2,128.13 UT Colorado: $2,181.99 CO Nebraska: $1,888.26 NE Missouri: $2,103.11–$2,182.53 across 3 localities MO Kentucky: $2,097.49 KY West Virginia: $2,307.99 WV Virginia: $2,076.35 VA Maryland: $2,200.96–$2,392.07 across 2 localities MD Delaware: $2,169.57 DE California: $2,104.02–$2,458.48 across 29 localities CA Arizona: $2,131.43 AZ New Mexico: $2,243.34 NM Kansas: $1,929.13 KS Oklahoma: $2,040.18 OK Arkansas: $1,900.34 AR Tennessee: $1,947.28 TN North Carolina: $2,009.75 NC South Carolina: $2,095.22 SC District of Columbia: $2,455.57 DC Texas: $2,119.28–$2,384.80 across 8 localities TX Louisiana: $2,113.29–$2,232.86 across 2 localities LA Mississippi: $1,999.69 MS Alabama: $1,934.56 AL Georgia: $2,220.74–$2,320.35 across 2 localities GA Florida: $2,404.39–$2,916.09 across 3 localities FL Alaska: $2,586.89 AK Hawaii: $2,135.83 HI
$1,884–$2,009 $2,009–$2,134 $2,134–$2,259 $2,259–$2,384 $2,384–$2,509 $2,509–$2,634

22865 Facility by metro, highest first

Miami, FL $2,916.09 Locality 09102-04 Long Island, NY $2,799.17 Locality 13202-02 Chicago, IL $2,794.22 Locality 06102-16 New York City, NY $2,660.62 Locality 13202-01 Queens, NY $2,612.64 Locality 13292-04 Metro East, IL $2,600.77 Locality 06102-12
Show 56 more metros
Anchorage, AK $2,586.89 Locality 02102-01 Suburban Chicago, IL $2,582.15 Locality 06102-15 Fort Lauderdale, FL $2,580.19 Locality 09102-03 Detroit, MI $2,491.06 Locality 08202-01 Washington, DC $2,455.57 Locality 12202-01 Northern New Jersey, NJ $2,431.78 Locality 12402-01 Tampa, FL $2,404.39 Locality 09102-99 San Jose, CA $2,397.75 Locality 01112-09 Baltimore, MD $2,392.07 Locality 12302-01 Hartford, CT $2,387.39 Locality 13102-00 Houston, TX $2,384.80 Locality 04412-18 San Francisco, CA $2,370.59 Locality 01112-05 Seattle, WA $2,358.70 Locality 02402-02 Boston, MA $2,356.65 Locality 14212-01 Philadelphia, PA $2,351.02 Locality 12502-01 Atlanta, GA $2,320.35 Locality 10212-01 Los Angeles, CA $2,249.70 Locality 01182-18 Riverside, CA $2,243.54 Locality 01112-62 Albuquerque, NM $2,243.34 Locality 04212-05 New Orleans, LA $2,232.86 Locality 07202-01 Ventura County, CA $2,217.60 Locality 01182-17 Providence, RI $2,214.58 Locality 14412-01 Austin, TX $2,213.05 Locality 04412-31 Portland, OR $2,205.05 Locality 02302-01 San Diego, CA $2,194.73 Locality 01182-72 St. Louis, MO $2,182.53 Locality 05302-01 Denver, CO $2,181.99 Locality 04112-01 Sacramento, CA $2,173.68 Locality 01112-63 Kansas City, MO $2,161.90 Locality 05302-02 Dallas, TX $2,161.77 Locality 04412-11 Fort Worth, TX $2,159.98 Locality 04412-28 Columbus, OH $2,156.03 Locality 15202-00 Las Vegas, NV $2,145.27 Locality 01312-00 Bakersfield, CA $2,137.98 Locality 01112-54 San Antonio, TX $2,137.04 Locality 04412-99 Honolulu, HI $2,135.83 Locality 01212-01 Pittsburgh, PA $2,132.24 Locality 12502-99 Phoenix, AZ $2,131.43 Locality 03102-00 Salt Lake City, UT $2,128.13 Locality 03502-09 Fresno, CA $2,104.02 Locality 01112-56 Louisville, KY $2,097.49 Locality 15102-00 Charleston, SC $2,095.22 Locality 11202-01 Richmond, VA $2,076.35 Locality 11302-00 Buffalo, NY $2,050.41 Locality 13282-99 Portland, ME $2,049.56 Locality 14112-03 Oklahoma City, OK $2,040.18 Locality 04312-00 Charlotte, NC $2,009.75 Locality 11502-00 Nashville, TN $1,947.28 Locality 10312-35 Indianapolis, IN $1,938.43 Locality 08102-00 Birmingham, AL $1,934.56 Locality 10112-00 Minneapolis, MN $1,931.57 Locality 06202-00 Wichita, KS $1,929.13 Locality 05202-00 Boise, ID $1,927.53 Locality 02202-00 Des Moines, IA $1,890.59 Locality 05102-00 Omaha, NE $1,888.26 Locality 05402-00 Milwaukee, WI $1,883.81 Locality 06302-00

Q3 2026, each locality's GPCIs, before sequestration. Multi-locality states are shaded by their mean. Look up your exact locality →

CMS RVU26CJuly 1 – September 30, 2026 See file rows

Source & method Copy link

  1. 01 PPRRVU2026_Jul_nonQPP.csv · Q3 2026 (RVU26C) · row 2,075—status R, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q3 2026 release
    Effective
    July 1 – September 30, 2026
    Locator
    PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip · row 2,075 of 19,356 · via CMS
    Fields read
    Status R (col 4) Work RVU 30.96 (col 6) Office (non-facility) PE RVU 22.35 (col 7) Facility PE RVU 22.35 (col 9) Malpractice RVU 13.08 (col 11)
    SHA-256 b7d197e73211ef68…
    Doesn’t establish
    A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
    Note
    Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
  2. 02 Conversion factor · same file · row 2,075 · column 26—$33.4009
    Source
    Conversion factor, read from the same file as the RVUs
  3. 03 NCCI · Q3 2026—the code-pair edits
    Source
    National Correct Coding Initiative (NCCI)
    Effective
    Same quarter as the Q3 2026 rate
  4. 04 Derived Modifier amounts—calculated by Localis from standard MPFS percentages limits
    Source
    Modifier amounts apply standard MPFS percentages to this code’s billing indicators.
    Doesn’t establish
    A CMS-published amount: we derive these rather than read them from CMS. Confirm them against the current Claims Processing Manual before relying on them for payment.

Cite this rate

CPT 22865 National PFS baseline: Office (non-facility) $2,217.49; Facility $2,217.49 (Q3 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26C, PPRRVU2026_Jul_nonQPP.csv row 2,075. Localis. https://localishealth.com/cpt/22865/2026/C

Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON

How has it changed? Copy link

$2,217.49 Office (non-facility) and $2,217.49 Facility since Jan 1, 2026, after a -0.9% decrease in the Office (non-facility) amount. +5.2% increase since Q1 2013; peak $2,352.32 in Q1 2020.

  1. Jan 1, 2026 – present

    Q1 2026

    Still in effect · 4 releases at this rate
    Office
    $2,217.49 (−$20.56, -0.9% decrease)
    Facility
    $2,217.49 (−$20.56, -0.9% decrease)

    Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present

    • +$72.96 the conversion factor
    • −$67.80 practice-expense RVUs
    • −$26.39 work RVUs
    • +$0.67 malpractice RVUs

  2. Jan 1, 2025 – Dec 31, 2025

    Q1 2025

    4 releases at this rate
    Office
    $2,238.05 (−$53.79, -2.3% decrease)
    Facility
    $2,238.05 (−$53.79, -2.3% decrease)

    Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025

    • −$64.78 the conversion factor
    • +$16.17 practice-expense RVUs
    • −$5.18 malpractice RVUs

  3. Mar 9, 2024 – Dec 31, 2024

    Q1 2024

    4 releases at this rate
    Office
    $2,291.84 (+$37.40, +1.7% increase)
    Facility
    $2,291.84 (+$37.40, +1.7% increase)

    Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024

    • +$37.40 the conversion factor

  4. Jan 1, 2024 – Mar 8, 2024 · Superseded revision

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    $2,254.44
    Facility
    $2,254.44

  5. Jan 1, 2023 – Dec 31, 2023

    Q1 2023

    4 releases at this rate
    Office
    $2,311.45 (−$11.32, -0.5% decrease)
    Facility
    $2,311.45 (−$11.32, -0.5% decrease)

    Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023

    • −$48.25 the conversion factor
    • +$22.70 malpractice RVUs
    • +$14.23 practice-expense RVUs

  6. Jan 1, 2022 – Dec 31, 2022

    Q1 2022

    4 releases at this rate
    Office
    $2,322.77 (+$0.29, 0.0% no change)
    Facility
    $2,322.77 (+$0.29, 0.0% no change)

    Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022

    • −$19.09 the conversion factor
    • +$13.84 malpractice RVUs
    • +$5.54 practice-expense RVUs

National baseline (GPCI 1.000), before sequestration.

How each change is split
The chips under each change split the Office (non-facility) move into the conversion factor's share, which CMS sets for every code, and 22865's own work, practice-expense and malpractice RVUs. CMS doesn't publish this split; we derive it from each release's RVUs and conversion factor. We apply the new conversion factor to the earlier RVUs first, then price each RVU change at the new conversion factor. Another order would move a few cents between columns, but every total stays the same.
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 22865 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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