Medicare Reimbursement for CPT 13153

CPT 13153 is a procedure code billed under Medicare Part B; 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 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)	$189.05	$113.56
ALASKA* (AK)	$228.86	$148.47
ALABAMA (AL)	$171.39	$105.34
ARKANSAS (AR)	$169.18	$104.34
ARIZONA (AZ)	$184.23	$111.09
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$230.31	$123.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$234.32	$125.47
OXNARD-THOUSAND OAKS-VENTURA (CA)	$204.80	$115.58
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$206.40	$117.10
NAPA (CA)	$219.67	$120.18
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$230.71	$124.28
VALLEJO (CA)	$219.08	$119.59
BAKERSFIELD (CA)	$195.38	$112.64
CHICO (CA)	$194.34	$111.61
FRESNO (CA)	$194.34	$111.61
HANFORD-CORCORAN (CA)	$194.34	$111.61
MADERA (CA)	$194.34	$111.61
MERCED (CA)	$194.34	$111.61
MODESTO (CA)	$194.34	$111.61
REDDING (CA)	$194.34	$111.61
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$198.23	$115.50
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$202.48	$114.69
SALINAS (CA)	$201.70	$114.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$235.99	$127.14
SANTA CRUZ-WATSONVILLE (CA)	$206.50	$114.78
SANTA ROSA-PETALUMA (CA)	$208.49	$115.79
STOCKTON (CA)	$194.34	$111.61
VISALIA (CA)	$194.34	$111.61
YUBA CITY (CA)	$194.34	$111.61
EL CENTRO (CA)	$194.40	$111.67
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$205.38	$115.09
SAN LUIS OBISPO-PASO ROBLES (CA)	$198.62	$112.64
SANTA MARIA-SANTA BARBARA (CA)	$202.16	$114.15
REST OF CALIFORNIA (CA)	$194.34	$111.61
COLORADO (CO)	$193.72	$113.40
CONNECTICUT (CT)	$200.79	$119.49
DC + MD/VA SUBURBS (DC)	$212.31	$123.39
DELAWARE (DE)	$187.03	$112.45
FORT LAUDERDALE (FL)	$200.06	$123.59
MIAMI (FL)	$211.52	$132.93
REST OF FLORIDA (FL)	$190.72	$118.55
ATLANTA (GA)	$193.29	$116.60
REST OF GEORGIA (GA)	$180.61	$113.27
HAWAII, GUAM (HI)	$197.62	$111.80
IOWA (IA)	$173.34	$104.27
IDAHO (ID)	$174.75	$105.30
EAST ST. LOUIS (IL)	$193.28	$123.83
SUBURBAN CHICAGO (IL)	$201.56	$124.04
CHICAGO (IL)	$205.66	$129.80
REST OF ILLINOIS (IL)	$187.16	$118.24
INDIANA (IN)	$175.60	$105.63
KANSAS (KS)	$173.53	$105.29
KENTUCKY (KY)	$176.98	$109.87
NEW ORLEANS (LA)	$184.81	$113.78
REST OF LOUISIANA (LA)	$177.10	$110.29
METROPOLITAN BOSTON (MA)	$210.21	$120.08
REST OF MASSACHUSETTS (MA)	$193.12	$113.64
BALTIMORE/SURR. CNTYS (MD)	$200.40	$119.41
REST OF MARYLAND (MD)	$190.03	$113.64
SOUTHERN MAINE (ME)	$183.72	$108.91
REST OF MAINE (ME)	$176.54	$107.09
DETROIT (MI)	$193.81	$120.97
REST OF MICHIGAN (MI)	$181.94	$113.02
MINNESOTA (MN)	$183.47	$105.80
METROPOLITAN ST. LOUIS (MO)	$184.30	$112.43
METROPOLITAN KANSAS CITY (MO)	$182.70	$111.82
REST OF MISSOURI (MO)	$175.00	$109.93
MISSISSIPPI (MS)	$172.08	$107.08
MONTANA** (MT)	$189.03	$113.54
NORTH CAROLINA (NC)	$178.04	$107.61
NORTH DAKOTA** (ND)	$181.91	$106.42
NEBRASKA (NE)	$173.91	$104.23
NEW HAMPSHIRE (NH)	$191.63	$113.05
NORTHERN NJ (NJ)	$210.67	$123.11
REST OF NEW JERSEY (NJ)	$202.47	$120.04
NEW MEXICO (NM)	$183.20	$113.98
NEVADA** (NV)	$187.14	$111.58
MANHATTAN (NY)	$217.18	$129.46
NYC SUBURBS/LONG ISLAND (NY)	$223.13	$133.37
POUGHKPSIE/N NYC SUBURBS (NY)	$204.52	$121.86
QUEENS (NY)	$217.44	$128.21
REST OF NEW YORK (NY)	$180.50	$108.79
OHIO (OH)	$180.49	$111.57
OKLAHOMA (OK)	$175.72	$108.31
PORTLAND (OR)	$198.26	$114.39
REST OF OREGON (OR)	$185.08	$109.90
METROPOLITAN PHILADELPHIA (PA)	$196.85	$118.26
REST OF PENNSYLVANIA (PA)	$180.23	$110.93
PUERTO RICO (PR)	$189.96	$113.65
RHODE ISLAND (RI)	$192.51	$114.53
SOUTH CAROLINA (SC)	$179.68	$109.93
SOUTH DAKOTA** (SD)	$181.06	$105.58
TENNESSEE (TN)	$174.42	$105.81
BRAZORIA (TX)	$186.13	$111.32
DALLAS (TX)	$187.64	$112.46
GALVESTON (TX)	$186.90	$111.95
HOUSTON (TX)	$193.49	$118.54
BEAUMONT (TX)	$179.24	$110.54
FORT WORTH (TX)	$186.80	$112.37
AUSTIN (TX)	$193.61	$113.74
REST OF TEXAS (TX)	$182.81	$111.17
UTAH (UT)	$181.85	$110.89
VIRGINIA (VA)	$183.82	$109.62
VIRGIN ISLANDS (VI)	$189.96	$113.65
VERMONT (VT)	$182.11	$107.38
SEATTLE (KING CNTY) (WA)	$213.32	$120.70
REST OF WASHINGTON (WA)	$192.46	$112.97
WISCONSIN (WI)	$176.55	$104.23
WEST VIRGINIA (WV)	$181.19	$115.60
WYOMING** (WY)	$185.92	$110.44

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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's allowed amount for this procedure code is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — which are each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ depending on whether the service is reported in a non-facility setting (such as an office) versus a facility setting (such as a hospital), which is why the two amounts differ. The conversion factor and GPCIs are updated annually and can shift the final payment even if the RVUs stay the same.

RVUs — work 2.32, practice expense 2.98 (non-facility) / 0.72 (facility), malpractice 0.36 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on the national or locality-adjusted PFS formula — actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Always verify the specific locality rate and any applicable adjustments with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount?

Facility and non-facility rates use different practice-expense RVUs because Medicare assumes the overhead costs (staff, equipment, supplies) differ depending on where the service is performed.

Will my locality's payment match the national amount shown here?

Not necessarily. Localities have different GPCIs for work, practice expense, and malpractice, so the final adjusted amount can be higher or lower than the national figure.

Does this amount reflect what Medicare will actually pay me?

No — this is a calculated estimate from the published PFS inputs. Medicare generally pays 80% of the allowed amount after deductible, and claims-level adjustments can further change the actual payment.

Why might this code's payment change next year?

The conversion factor, GPCIs, and sometimes the RVUs themselves are updated annually by CMS, which can raise or lower the calculated amount even without any change in how the code is billed.

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.