Medicare Reimbursement for CPT 12015

CPT 12015 is a 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) estimated allowed amount at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$210.76	$90.18
ALASKA* (AK)	$244.95	$116.53
ALABAMA (AL)	$187.93	$82.43
ARKANSAS (AR)	$185.08	$81.50
ARIZONA (AZ)	$204.56	$87.72
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$262.39	$92.38
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$267.16	$93.28
OXNARD-THOUSAND OAKS-VENTURA (CA)	$230.98	$88.45
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$232.55	$89.90
NAPA (CA)	$249.44	$90.52
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$262.89	$92.87
VALLEJO (CA)	$248.72	$89.80
BAKERSFIELD (CA)	$218.87	$86.72
CHICO (CA)	$217.67	$85.52
FRESNO (CA)	$217.67	$85.52
HANFORD-CORCORAN (CA)	$217.67	$85.52
MADERA (CA)	$217.67	$85.52
MERCED (CA)	$217.67	$85.52
MODESTO (CA)	$217.67	$85.52
REDDING (CA)	$217.67	$85.52
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$222.39	$90.24
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$227.71	$87.48
SALINAS (CA)	$226.86	$87.11
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$269.20	$95.33
SANTA CRUZ-WATSONVILLE (CA)	$233.59	$87.09
SANTA ROSA-PETALUMA (CA)	$235.88	$87.81
STOCKTON (CA)	$217.67	$85.52
VISALIA (CA)	$217.67	$85.52
YUBA CITY (CA)	$217.67	$85.52
EL CENTRO (CA)	$217.74	$85.59
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$231.76	$87.55
SAN LUIS OBISPO-PASO ROBLES (CA)	$223.33	$85.99
SANTA MARIA-SANTA BARBARA (CA)	$227.59	$87.00
REST OF CALIFORNIA (CA)	$217.67	$85.52
COLORADO (CO)	$216.74	$88.44
CONNECTICUT (CT)	$225.27	$95.41
DC + MD/VA SUBURBS (DC)	$239.33	$97.29
DELAWARE (DE)	$208.02	$88.89
FORT LAUDERDALE (FL)	$224.35	$102.20
MIAMI (FL)	$238.63	$113.11
REST OF FLORIDA (FL)	$212.36	$97.09
ATLANTA (GA)	$216.01	$93.51
REST OF GEORGIA (GA)	$199.37	$91.81
HAWAII, GUAM (HI)	$222.60	$85.51
IOWA (IA)	$190.71	$80.38
IDAHO (ID)	$192.49	$81.56
EAST ST. LOUIS (IL)	$215.13	$104.20
SUBURBAN CHICAGO (IL)	$226.11	$102.28
CHICAGO (IL)	$230.90	$109.72
REST OF ILLINOIS (IL)	$207.58	$97.50
INDIANA (IN)	$193.60	$81.82
KANSAS (KS)	$190.84	$81.83
KENTUCKY (KY)	$194.90	$87.71
NEW ORLEANS (LA)	$204.99	$91.53
REST OF LOUISIANA (LA)	$195.01	$88.30
METROPOLITAN BOSTON (MA)	$237.32	$93.35
REST OF MASSACHUSETTS (MA)	$215.78	$88.81
BALTIMORE/SURR. CNTYS (MD)	$224.88	$95.50
REST OF MARYLAND (MD)	$211.78	$89.75
SOUTHERN MAINE (ME)	$204.15	$84.66
REST OF MAINE (ME)	$194.68	$83.75
DETROIT (MI)	$216.24	$99.88
REST OF MICHIGAN (MI)	$201.21	$91.12
MINNESOTA (MN)	$204.23	$80.16
METROPOLITAN ST. LOUIS (MO)	$204.47	$89.68
METROPOLITAN KANSAS CITY (MO)	$202.39	$89.17
REST OF MISSOURI (MO)	$192.22	$88.28
MISSISSIPPI (MS)	$188.63	$84.81
MONTANA** (MT)	$210.73	$90.15
NORTH CAROLINA (NC)	$196.64	$84.14
NORTH DAKOTA** (ND)	$202.03	$81.45
NEBRASKA (NE)	$191.49	$80.19
NEW HAMPSHIRE (NH)	$214.32	$88.80
NORTHERN NJ (NJ)	$236.88	$97.01
REST OF NEW JERSEY (NJ)	$226.87	$95.20
NEW MEXICO (NM)	$202.79	$92.22
NEVADA** (NV)	$208.44	$87.74
MANHATTAN (NY)	$244.82	$104.71
NYC SUBURBS/LONG ISLAND (NY)	$252.35	$108.99
POUGHKPSIE/N NYC SUBURBS (NY)	$229.25	$97.22
QUEENS (NY)	$245.33	$102.81
REST OF NEW YORK (NY)	$199.81	$85.27
OHIO (OH)	$199.43	$89.34
OKLAHOMA (OK)	$193.40	$85.73
PORTLAND (OR)	$222.64	$88.68
REST OF OREGON (OR)	$205.87	$85.77
METROPOLITAN PHILADELPHIA (PA)	$220.15	$94.63
REST OF PENNSYLVANIA (PA)	$199.16	$88.47
PUERTO RICO (PR)	$211.99	$90.08
RHODE ISLAND (RI)	$214.74	$90.18
SOUTH CAROLINA (SC)	$198.55	$87.14
SOUTH DAKOTA** (SD)	$201.00	$80.42
TENNESSEE (TN)	$191.98	$82.37
BRAZORIA (TX)	$206.86	$87.37
DALLAS (TX)	$208.73	$88.63
GALVESTON (TX)	$207.83	$88.09
HOUSTON (TX)	$215.88	$96.15
BEAUMONT (TX)	$197.87	$88.15
FORT WORTH (TX)	$207.60	$88.71
AUSTIN (TX)	$216.85	$89.28
REST OF TEXAS (TX)	$202.62	$88.19
UTAH (UT)	$201.36	$88.02
VIRGINIA (VA)	$204.20	$85.67
VIRGIN ISLANDS (VI)	$211.99	$90.08
VERMONT (VT)	$202.18	$82.81
SEATTLE (KING CNTY) (WA)	$241.17	$93.22
REST OF WASHINGTON (WA)	$215.06	$88.09
WISCONSIN (WI)	$195.06	$79.55
WEST VIRGINIA (WV)	$199.85	$95.07
WYOMING** (WY)	$206.94	$86.36

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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 PFS 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 the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the same code can show two different allowed amounts. These amounts are recalculated each year as RVUs, GPCIs, and the conversion factor are updated.

RVUs — work 1.93, practice expense 3.94 (non-facility) / 0.33 (facility), malpractice 0.44 — × 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 beneficiary or secondary insurance is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why are there two different amounts for this code?

One reflects the non-facility (e.g., office) setting and the other the facility (e.g., hospital) setting, because practice-expense RVUs differ based on where the service is performed.

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

Each locality has its own GPCI values for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost differences before the conversion factor is applied.

Does this amount include the patient's share?

No. The figure shown is the total allowed amount; Medicare generally pays 80% after the deductible, with the remaining 20% typically owed by the patient or secondary payer.

Can modifiers change this amount?

Yes. Modifiers (such as those indicating bilateral procedures, reduced services, or multiple procedures) can increase or decrease the final payment relative to the base PFS amount shown here.

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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.