Medicare Reimbursement for CPT 10160

CPT 10160 is a procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and, where available, adjusted for locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$131.60	$91.52
ALASKA* (AK)	$155.13	$112.45
ALABAMA (AL)	$118.59	$83.52
ARKANSAS (AR)	$116.95	$82.52
ARIZONA (AZ)	$128.18	$89.34
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$167.46	$110.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$170.65	$112.86
OXNARD-THOUSAND OAKS-VENTURA (CA)	$146.29	$98.91
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$147.12	$99.71
NAPA (CA)	$158.73	$105.90
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$167.64	$111.12
VALLEJO (CA)	$158.47	$105.64
BAKERSFIELD (CA)	$138.49	$94.56
CHICO (CA)	$138.02	$94.09
FRESNO (CA)	$138.02	$94.09
HANFORD-CORCORAN (CA)	$138.02	$94.09
MADERA (CA)	$138.02	$94.09
MERCED (CA)	$138.02	$94.09
MODESTO (CA)	$138.02	$94.09
REDDING (CA)	$138.02	$94.09
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$139.76	$95.83
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$144.52	$97.91
SALINAS (CA)	$143.98	$97.52
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$171.40	$113.60
SANTA CRUZ-WATSONVILLE (CA)	$148.36	$99.66
SANTA ROSA-PETALUMA (CA)	$149.84	$100.62
STOCKTON (CA)	$138.02	$94.09
VISALIA (CA)	$138.02	$94.09
YUBA CITY (CA)	$138.02	$94.09
EL CENTRO (CA)	$138.05	$94.12
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$147.13	$99.20
SAN LUIS OBISPO-PASO ROBLES (CA)	$141.70	$96.05
SANTA MARIA-SANTA BARBARA (CA)	$144.45	$97.72
REST OF CALIFORNIA (CA)	$138.02	$94.09
COLORADO (CO)	$136.39	$93.74
CONNECTICUT (CT)	$140.12	$96.95
DC + MD/VA SUBURBS (DC)	$149.62	$102.41
DELAWARE (DE)	$130.24	$90.64
FORT LAUDERDALE (FL)	$137.03	$96.43
MIAMI (FL)	$143.28	$101.55
REST OF FLORIDA (FL)	$130.53	$92.21
ATLANTA (GA)	$134.16	$93.44
REST OF GEORGIA (GA)	$123.39	$87.64
HAWAII, GUAM (HI)	$141.06	$95.49
IOWA (IA)	$121.11	$84.43
IDAHO (ID)	$121.94	$85.07
EAST ST. LOUIS (IL)	$130.18	$93.30
SUBURBAN CHICAGO (IL)	$138.32	$97.16
CHICAGO (IL)	$139.23	$98.95
REST OF ILLINOIS (IL)	$127.17	$90.58
INDIANA (IN)	$122.61	$85.46
KANSAS (KS)	$120.74	$84.51
KENTUCKY (KY)	$121.65	$86.02
NEW ORLEANS (LA)	$127.28	$89.57
REST OF LOUISIANA (LA)	$121.54	$86.07
METROPOLITAN BOSTON (MA)	$149.27	$101.41
REST OF MASSACHUSETTS (MA)	$135.70	$93.49
BALTIMORE/SURR. CNTYS (MD)	$139.76	$96.75
REST OF MARYLAND (MD)	$132.59	$92.03
SOUTHERN MAINE (ME)	$128.86	$89.14
REST OF MAINE (ME)	$122.74	$85.86
DETROIT (MI)	$132.27	$93.59
REST OF MICHIGAN (MI)	$124.85	$88.26
MINNESOTA (MN)	$130.32	$89.07
METROPOLITAN ST. LOUIS (MO)	$127.51	$89.35
METROPOLITAN KANSAS CITY (MO)	$126.26	$88.62
REST OF MISSOURI (MO)	$119.66	$85.11
MISSISSIPPI (MS)	$118.32	$83.81
MONTANA** (MT)	$131.59	$91.51
NORTH CAROLINA (NC)	$123.94	$86.55
NORTH DAKOTA** (ND)	$128.43	$88.34
NEBRASKA (NE)	$121.69	$84.70
NEW HAMPSHIRE (NH)	$134.44	$92.71
NORTHERN NJ (NJ)	$148.21	$101.72
REST OF NEW JERSEY (NJ)	$141.61	$97.85
NEW MEXICO (NM)	$125.58	$88.82
NEVADA** (NV)	$130.79	$90.67
MANHATTAN (NY)	$151.19	$104.62
NYC SUBURBS/LONG ISLAND (NY)	$154.95	$107.29
POUGHKPSIE/N NYC SUBURBS (NY)	$142.68	$98.79
QUEENS (NY)	$152.13	$104.76
REST OF NEW YORK (NY)	$125.74	$87.66
OHIO (OH)	$124.20	$87.61
OKLAHOMA (OK)	$121.26	$85.47
PORTLAND (OR)	$140.37	$95.84
REST OF OREGON (OR)	$129.67	$89.75
METROPOLITAN PHILADELPHIA (PA)	$136.87	$95.15
REST OF PENNSYLVANIA (PA)	$124.29	$87.50
PUERTO RICO (PR)	$132.46	$91.94
RHODE ISLAND (RI)	$134.62	$93.21
SOUTH CAROLINA (SC)	$124.30	$87.26
SOUTH DAKOTA** (SD)	$128.05	$87.97
TENNESSEE (TN)	$121.34	$84.91
BRAZORIA (TX)	$129.98	$90.26
DALLAS (TX)	$130.87	$90.94
GALVESTON (TX)	$130.41	$90.61
HOUSTON (TX)	$133.34	$93.54
BEAUMONT (TX)	$123.52	$87.05
FORT WORTH (TX)	$130.08	$90.56
AUSTIN (TX)	$136.03	$93.63
REST OF TEXAS (TX)	$126.72	$88.68
UTAH (UT)	$125.92	$88.25
VIRGINIA (VA)	$128.57	$89.18
VIRGIN ISLANDS (VI)	$132.46	$91.94
VERMONT (VT)	$128.10	$88.42
SEATTLE (KING CNTY) (WA)	$152.07	$102.89
REST OF WASHINGTON (WA)	$135.38	$93.18
WISCONSIN (WI)	$124.31	$85.91
WEST VIRGINIA (WV)	$122.70	$87.87
WYOMING** (WY)	$130.21	$90.13

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 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 pricing for this code is based on three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility rates apply when the service is performed in a setting like a physician's office, using a higher practice-expense RVU, while facility rates apply in hospital or facility settings where the facility bears some overhead costs, resulting in a lower practice-expense RVU. Because GPCIs vary by locality, the same code can have different allowed amounts across the country.

RVUs — work 1.22, practice expense 2.56 (non-facility) / 1.36 (facility), malpractice 0.16 — × 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 insurer is responsible for the remainder.
Actual payment can vary based on modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Amounts shown reflect the Medicare Physician Fee Schedule and may not match payments from Medicare Advantage plans or other payers.
Always verify current rates with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why is the facility amount lower than the non-facility amount?

In facility settings, the facility itself absorbs certain overhead and equipment costs, so the practice-expense RVU assigned to the professional service is lower, reducing the total allowed amount compared to non-facility settings.

Does this amount reflect what the patient will pay?

No. The figures shown are the Medicare-allowed amounts before cost-sharing. Medicare generally pays 80% after the deductible, with the patient or a secondary payer responsible for the remaining 20%.

Why might my locality's payment differ from the national amount?

Medicare adjusts RVUs using Geographic Practice Cost Indices (GPCIs) that reflect regional differences in wages, rents, and malpractice costs, so the same code can price differently by locality.

Can modifiers change this amount?

Yes. Modifiers (e.g., bilateral, multiple procedure, or professional/technical component modifiers) can increase or decrease the allowed amount and are not reflected in this base 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.