Medicare Reimbursement for CPT 13151
This page covers CPT code 13151, a procedure code defined by the American Medical Association. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, 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) | $419.18 | $233.14 |
| ALASKA* (AK) | $499.30 | $301.17 |
| ALABAMA (AL) | $379.28 | $216.50 |
| ARKANSAS (AR) | $374.25 | $214.44 |
| ARIZONA (AZ) | $408.68 | $228.40 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $530.09 | $267.77 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $540.10 | $271.83 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $464.38 | $244.48 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $467.16 | $247.07 |
| NAPA (CA) | $502.93 | $257.72 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $530.66 | $268.34 |
| VALLEJO (CA) | $502.11 | $256.90 |
| BAKERSFIELD (CA) | $440.41 | $236.51 |
| CHICO (CA) | $438.91 | $235.01 |
| FRESNO (CA) | $438.91 | $235.01 |
| HANFORD-CORCORAN (CA) | $438.91 | $235.01 |
| MADERA (CA) | $438.91 | $235.01 |
| MERCED (CA) | $438.91 | $235.01 |
| MODESTO (CA) | $438.91 | $235.01 |
| REDDING (CA) | $438.91 | $235.01 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $444.34 | $240.44 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $459.09 | $242.73 |
| SALINAS (CA) | $457.34 | $241.72 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $542.42 | $274.15 |
| SANTA CRUZ-WATSONVILLE (CA) | $470.56 | $244.51 |
| SANTA ROSA-PETALUMA (CA) | $475.22 | $246.76 |
| STOCKTON (CA) | $438.91 | $235.01 |
| VISALIA (CA) | $438.91 | $235.01 |
| YUBA CITY (CA) | $438.91 | $235.01 |
| EL CENTRO (CA) | $438.99 | $235.09 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $466.97 | $244.46 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $450.14 | $238.24 |
| SANTA MARIA-SANTA BARBARA (CA) | $458.75 | $241.82 |
| REST OF CALIFORNIA (CA) | $438.91 | $235.01 |
| COLORADO (CO) | $433.94 | $235.99 |
| CONNECTICUT (CT) | $445.63 | $245.26 |
| DC + MD/VA SUBURBS (DC) | $475.19 | $256.03 |
| DELAWARE (DE) | $415.07 | $231.26 |
| FORT LAUDERDALE (FL) | $436.07 | $247.61 |
| MIAMI (FL) | $455.43 | $261.75 |
| REST OF FLORIDA (FL) | $416.09 | $238.23 |
| ATLANTA (GA) | $427.14 | $238.12 |
| REST OF GEORGIA (GA) | $394.18 | $228.23 |
| HAWAII, GUAM (HI) | $447.93 | $236.40 |
| IOWA (IA) | $386.91 | $216.68 |
| IDAHO (ID) | $389.48 | $218.32 |
| EAST ST. LOUIS (IL) | $415.22 | $244.06 |
| SUBURBAN CHICAGO (IL) | $440.12 | $249.05 |
| CHICAGO (IL) | $443.10 | $256.13 |
| REST OF ILLINOIS (IL) | $405.86 | $236.00 |
| INDIANA (IN) | $391.53 | $219.07 |
| KANSAS (KS) | $385.82 | $217.64 |
| KENTUCKY (KY) | $388.77 | $223.38 |
| NEW ORLEANS (LA) | $406.04 | $230.98 |
| REST OF LOUISIANA (LA) | $388.44 | $223.79 |
| METROPOLITAN BOSTON (MA) | $473.81 | $251.67 |
| REST OF MASSACHUSETTS (MA) | $431.90 | $235.99 |
| BALTIMORE/SURR. CNTYS (MD) | $444.47 | $244.84 |
| REST OF MARYLAND (MD) | $422.36 | $234.08 |
| SOUTHERN MAINE (ME) | $410.67 | $226.30 |
| REST OF MAINE (ME) | $391.97 | $220.81 |
| DETROIT (MI) | $421.50 | $241.96 |
| REST OF MICHIGAN (MI) | $398.61 | $228.75 |
| MINNESOTA (MN) | $415.00 | $223.56 |
| METROPOLITAN ST. LOUIS (MO) | $406.68 | $229.56 |
| METROPOLITAN KANSAS CITY (MO) | $402.86 | $228.17 |
| REST OF MISSOURI (MO) | $382.70 | $222.33 |
| MISSISSIPPI (MS) | $378.52 | $218.33 |
| MONTANA** (MT) | $419.15 | $233.10 |
| NORTH CAROLINA (NC) | $395.65 | $222.07 |
| NORTH DAKOTA** (ND) | $409.26 | $223.22 |
| NEBRASKA (NE) | $388.68 | $216.96 |
| NEW HAMPSHIRE (NH) | $427.80 | $234.13 |
| NORTHERN NJ (NJ) | $471.01 | $255.20 |
| REST OF NEW JERSEY (NJ) | $450.48 | $247.32 |
| NEW MEXICO (NM) | $400.86 | $230.26 |
| NEVADA** (NV) | $416.65 | $230.42 |
| MANHATTAN (NY) | $480.32 | $264.14 |
| NYC SUBURBS/LONG ISLAND (NY) | $491.90 | $270.70 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $453.86 | $250.14 |
| QUEENS (NY) | $483.14 | $263.24 |
| REST OF NEW YORK (NY) | $401.16 | $224.42 |
| OHIO (OH) | $396.59 | $226.73 |
| OKLAHOMA (OK) | $387.51 | $221.37 |
| PORTLAND (OR) | $446.16 | $239.47 |
| REST OF OREGON (OR) | $413.18 | $227.88 |
| METROPOLITAN PHILADELPHIA (PA) | $435.66 | $241.99 |
| REST OF PENNSYLVANIA (PA) | $396.84 | $226.06 |
| PUERTO RICO (PR) | $421.80 | $233.71 |
| RHODE ISLAND (RI) | $428.68 | $236.50 |
| SOUTH CAROLINA (SC) | $396.83 | $224.92 |
| SOUTH DAKOTA** (SD) | $408.09 | $222.05 |
| TENNESSEE (TN) | $387.68 | $218.57 |
| BRAZORIA (TX) | $414.29 | $229.92 |
| DALLAS (TX) | $417.04 | $231.74 |
| GALVESTON (TX) | $415.61 | $230.87 |
| HOUSTON (TX) | $424.76 | $240.02 |
| BEAUMONT (TX) | $394.49 | $225.19 |
| FORT WORTH (TX) | $414.64 | $231.20 |
| AUSTIN (TX) | $432.71 | $235.88 |
| REST OF TEXAS (TX) | $404.24 | $227.69 |
| UTAH (UT) | $401.81 | $226.93 |
| VIRGINIA (VA) | $409.83 | $226.95 |
| VIRGIN ISLANDS (VI) | $421.80 | $233.71 |
| VERMONT (VT) | $408.32 | $224.14 |
| SEATTLE (KING CNTY) (WA) | $482.48 | $254.21 |
| REST OF WASHINGTON (WA) | $430.87 | $234.97 |
| WISCONSIN (WI) | $396.65 | $218.43 |
| WEST VIRGINIA (WV) | $392.16 | $230.49 |
| WYOMING** (WY) | $414.84 | $228.80 |
Look up another code or locality →
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): physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility rates (e.g., office settings) use a higher practice-expense RVU than facility rates (e.g., hospital settings), since the provider incurs more overhead costs in non-facility settings. This is why the same code often has two different national or locality-adjusted amounts.
RVUs — work 4.23, practice expense 7.82 (non-facility) / 2.25 (facility), malpractice 0.5 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only — actual payment depends on the specific locality, claim details, and Medicare Administrative Contractor (MAC) processing.
- Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
- Modifiers, multiple-procedure reductions, and other claim-specific adjustments can change the final paid amount.
- Amounts are subject to sequestration reductions and annual budget-neutrality adjustments made by CMS.
- Always verify current rates and local policies with your MAC before billing or appealing a denial.
Frequently asked
Why is the facility amount lower than the non-facility amount for the same code?
Facility rates use a lower practice-expense RVU because the hospital or facility — not the billing provider — bears most of the overhead and supply costs for the service.
Does this amount apply everywhere in the country?
No. The national amount is a baseline; actual payment is adjusted using locality-specific GPCIs, so the real allowed amount can be higher or lower depending on where the service was performed.
Can I use this figure to predict an exact payment on a claim?
No. This is an estimate based on standard PFS inputs. Final payment depends on additional factors such as modifiers, secondary payer coordination, and claim-specific adjustments applied by the MAC.
Why don't you show the CPT code's description?
CPT descriptors are copyrighted by the American Medical Association and cannot be reproduced here. Refer to your CPT codebook or EHR system for the official description.
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.
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