Medicare Reimbursement for CPT 13152

CPT 13152 is a procedure code used in Medicare billing; the exact clinical description is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$490.66	$278.56
ALASKA* (AK)	$587.78	$361.90
ALABAMA (AL)	$444.78	$259.20
ARKANSAS (AR)	$439.00	$256.81
ARIZONA (AZ)	$478.54	$273.02
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$616.94	$317.89
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$628.46	$322.62
OXNARD-THOUSAND OAKS-VENTURA (CA)	$541.77	$291.07
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$545.16	$294.26
NAPA (CA)	$585.81	$306.27
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$617.64	$318.58
VALLEJO (CA)	$584.81	$305.27
BAKERSFIELD (CA)	$514.44	$281.98
CHICO (CA)	$512.61	$280.15
FRESNO (CA)	$512.61	$280.15
HANFORD-CORCORAN (CA)	$512.61	$280.15
MADERA (CA)	$512.61	$280.15
MERCED (CA)	$512.61	$280.15
MODESTO (CA)	$512.61	$280.15
REDDING (CA)	$512.61	$280.15
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$519.24	$286.78
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$535.76	$289.09
SALINAS (CA)	$533.71	$287.89
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$631.30	$325.46
SANTA CRUZ-WATSONVILLE (CA)	$548.56	$290.86
SANTA ROSA-PETALUMA (CA)	$553.97	$293.52
STOCKTON (CA)	$512.61	$280.15
VISALIA (CA)	$512.61	$280.15
YUBA CITY (CA)	$512.61	$280.15
EL CENTRO (CA)	$512.71	$280.25
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$544.62	$290.95
SAN LUIS OBISPO-PASO ROBLES (CA)	$525.34	$283.77
SANTA MARIA-SANTA BARBARA (CA)	$535.26	$287.95
REST OF CALIFORNIA (CA)	$512.61	$280.15
COLORADO (CO)	$507.25	$281.58
CONNECTICUT (CT)	$521.23	$292.80
DC + MD/VA SUBURBS (DC)	$555.09	$305.25
DELAWARE (DE)	$485.92	$276.37
FORT LAUDERDALE (FL)	$510.97	$296.12
MIAMI (FL)	$533.96	$313.17
REST OF FLORIDA (FL)	$487.87	$285.11
ATLANTA (GA)	$500.02	$284.53
REST OF GEORGIA (GA)	$462.57	$273.39
HAWAII, GUAM (HI)	$522.67	$281.52
IOWA (IA)	$453.19	$259.12
IDAHO (ID)	$456.22	$261.09
EAST ST. LOUIS (IL)	$487.62	$292.49
SUBURBAN CHICAGO (IL)	$515.61	$297.78
CHICAGO (IL)	$519.74	$306.59
REST OF ILLINOIS (IL)	$476.35	$282.71
INDIANA (IN)	$458.56	$261.95
KANSAS (KS)	$452.11	$260.38
KENTUCKY (KY)	$456.04	$267.49
NEW ORLEANS (LA)	$475.95	$276.37
REST OF LOUISIANA (LA)	$455.73	$268.03
METROPOLITAN BOSTON (MA)	$553.03	$299.79
REST OF MASSACHUSETTS (MA)	$505.01	$281.67
BALTIMORE/SURR. CNTYS (MD)	$519.90	$292.32
REST OF MARYLAND (MD)	$494.28	$279.64
SOUTHERN MAINE (ME)	$480.47	$270.29
REST OF MAINE (ME)	$459.26	$264.13
DETROIT (MI)	$494.27	$289.59
REST OF MICHIGAN (MI)	$467.51	$273.87
MINNESOTA (MN)	$484.91	$266.66
METROPOLITAN ST. LOUIS (MO)	$476.48	$274.56
METROPOLITAN KANSAS CITY (MO)	$472.12	$272.96
REST OF MISSOURI (MO)	$449.24	$266.42
MISSISSIPPI (MS)	$444.16	$261.55
MONTANA** (MT)	$490.62	$278.52
NORTH CAROLINA (NC)	$463.45	$265.57
NORTH DAKOTA** (ND)	$478.56	$266.46
NEBRASKA (NE)	$455.17	$259.41
NEW HAMPSHIRE (NH)	$500.26	$279.47
NORTHERN NJ (NJ)	$550.41	$304.38
REST OF NEW JERSEY (NJ)	$526.85	$295.24
NEW MEXICO (NM)	$470.16	$275.67
NEVADA** (NV)	$487.55	$275.25
MANHATTAN (NY)	$561.73	$315.28
NYC SUBURBS/LONG ISLAND (NY)	$575.25	$323.07
POUGHKPSIE/N NYC SUBURBS (NY)	$530.91	$298.67
QUEENS (NY)	$564.72	$314.03
REST OF NEW YORK (NY)	$469.79	$268.30
OHIO (OH)	$465.05	$271.40
OKLAHOMA (OK)	$454.42	$265.01
PORTLAND (OR)	$521.11	$285.47
REST OF OREGON (OR)	$483.42	$272.18
METROPOLITAN PHILADELPHIA (PA)	$509.87	$289.08
REST OF PENNSYLVANIA (PA)	$465.24	$270.54
PUERTO RICO (PR)	$493.61	$279.18
RHODE ISLAND (RI)	$501.54	$282.45
SOUTH CAROLINA (SC)	$465.09	$269.11
SOUTH DAKOTA** (SD)	$477.13	$265.03
TENNESSEE (TN)	$454.27	$261.47
BRAZORIA (TX)	$484.90	$274.72
DALLAS (TX)	$488.15	$276.90
GALVESTON (TX)	$486.47	$275.86
HOUSTON (TX)	$497.64	$287.03
BEAUMONT (TX)	$462.55	$269.54
FORT WORTH (TX)	$485.45	$276.32
AUSTIN (TX)	$505.87	$281.47
REST OF TEXAS (TX)	$473.57	$272.29
UTAH (UT)	$470.81	$271.44
VIRGINIA (VA)	$479.63	$271.14
VIRGIN ISLANDS (VI)	$493.61	$279.18
VERMONT (VT)	$477.63	$267.66
SEATTLE (KING CNTY) (WA)	$562.88	$302.64
REST OF WASHINGTON (WA)	$503.75	$280.42
WISCONSIN (WI)	$464.12	$260.93
WEST VIRGINIA (WV)	$460.63	$276.32
WYOMING** (WY)	$485.36	$273.27

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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 using Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why the two allowed amounts for the same code can diverge. The conversion factor is set annually by CMS and applies uniformly across all codes before locality adjustments.

RVUs — work 5.21, practice expense 8.87 (non-facility) / 2.52 (facility), malpractice 0.61 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment depends on claim-specific factors.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always confirm current rates and locality-specific figures with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility amount lower than the non-facility amount for CPT 13152?

In a facility setting (e.g., hospital), the facility bears more of the overhead costs, so the practice-expense RVU used for that code is lower, reducing the total allowed amount compared to a non-facility (office) setting.

Does this allowed amount reflect what Medicare actually pays?

No. The PFS allowed amount is the base used to calculate payment; Medicare generally reimburses 80% of it after the deductible, with the remainder owed by the patient or secondary insurance.

Why might my locality's payment differ from the national figure shown here?

GPCIs vary by locality to account for differences in local labor, rent, and malpractice costs, which shifts the RVU-adjusted total up or down relative to the national average.

Will this amount change next year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can alter the final allowed amount from year to year.

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.