Medicare Reimbursement for CPT Code 13160

CPT 13160 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS); the full clinical descriptor is proprietary to the AMA and is not reproduced here. This page shows the estimated Medicare-allowed amount for this code, both at the national level and adjusted for your specific locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$740.83	$740.83
ALASKA* (AK)	$923.51	$923.51
ALABAMA (AL)	$675.57	$675.57
ARKANSAS (AR)	$667.54	$667.54
ARIZONA (AZ)	$722.10	$722.10
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$851.96	$851.96
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$864.80	$864.80
OXNARD-THOUSAND OAKS-VENTURA (CA)	$776.07	$776.07
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$784.32	$784.32
NAPA (CA)	$819.61	$819.61
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$854.35	$854.35
VALLEJO (CA)	$816.17	$816.17
BAKERSFIELD (CA)	$747.60	$747.60
CHICO (CA)	$741.69	$741.69
FRESNO (CA)	$741.69	$741.69
HANFORD-CORCORAN (CA)	$741.69	$741.69
MADERA (CA)	$741.69	$741.69
MERCED (CA)	$741.69	$741.69
MODESTO (CA)	$741.69	$741.69
REDDING (CA)	$741.69	$741.69
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$764.32	$764.32
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$767.81	$767.81
SALINAS (CA)	$764.73	$764.73
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$874.55	$874.55
SANTA CRUZ-WATSONVILLE (CA)	$776.41	$776.41
SANTA ROSA-PETALUMA (CA)	$783.56	$783.56
STOCKTON (CA)	$741.69	$741.69
VISALIA (CA)	$741.69	$741.69
YUBA CITY (CA)	$741.69	$741.69
EL CENTRO (CA)	$742.05	$742.05
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$775.07	$775.07
SAN LUIS OBISPO-PASO ROBLES (CA)	$753.67	$753.67
SANTA MARIA-SANTA BARBARA (CA)	$765.51	$765.51
REST OF CALIFORNIA (CA)	$741.69	$741.69
COLORADO (CO)	$748.00	$748.00
CONNECTICUT (CT)	$784.85	$784.85
DC + MD/VA SUBURBS (DC)	$819.52	$819.52
DELAWARE (DE)	$732.37	$732.37
FORT LAUDERDALE (FL)	$801.13	$801.13
MIAMI (FL)	$859.50	$859.50
REST OF FLORIDA (FL)	$763.86	$763.86
ATLANTA (GA)	$760.56	$760.56
REST OF GEORGIA (GA)	$724.21	$724.21
HAWAII, GUAM (HI)	$749.47	$749.47
IOWA (IA)	$674.86	$674.86
IDAHO (ID)	$681.58	$681.58
EAST ST. LOUIS (IL)	$789.67	$789.67
SUBURBAN CHICAGO (IL)	$805.25	$805.25
CHICAGO (IL)	$835.80	$835.80
REST OF ILLINOIS (IL)	$756.09	$756.09
INDIANA (IN)	$684.44	$684.44
KANSAS (KS)	$679.30	$679.30
KENTUCKY (KY)	$703.95	$703.95
NEW ORLEANS (LA)	$733.94	$733.94
REST OF LOUISIANA (LA)	$705.85	$705.85
METROPOLITAN BOSTON (MA)	$803.23	$803.23
REST OF MASSACHUSETTS (MA)	$747.63	$747.63
BALTIMORE/SURR. CNTYS (MD)	$784.06	$784.06
REST OF MARYLAND (MD)	$742.34	$742.34
SOUTHERN MAINE (ME)	$712.44	$712.44
REST OF MAINE (ME)	$692.03	$692.03
DETROIT (MI)	$779.20	$779.20
REST OF MICHIGAN (MI)	$725.65	$725.65
MINNESOTA (MN)	$699.53	$699.53
METROPOLITAN ST. LOUIS (MO)	$727.60	$727.60
METROPOLITAN KANSAS CITY (MO)	$722.23	$722.23
REST OF MISSOURI (MO)	$700.57	$700.57
MISSISSIPPI (MS)	$683.80	$683.80
MONTANA** (MT)	$740.69	$740.69
NORTH CAROLINA (NC)	$696.85	$696.85
NORTH DAKOTA** (ND)	$699.17	$699.17
NEBRASKA (NE)	$675.75	$675.75
NEW HAMPSHIRE (NH)	$743.49	$743.49
NORTHERN NJ (NJ)	$814.88	$814.88
REST OF NEW JERSEY (NJ)	$788.95	$788.95
NEW MEXICO (NM)	$731.81	$731.81
NEVADA** (NV)	$729.40	$729.40
MANHATTAN (NY)	$852.16	$852.16
NYC SUBURBS/LONG ISLAND (NY)	$878.69	$878.69
POUGHKPSIE/N NYC SUBURBS (NY)	$799.67	$799.67
QUEENS (NY)	$847.63	$847.63
REST OF NEW YORK (NY)	$706.07	$706.07
OHIO (OH)	$717.16	$717.16
OKLAHOMA (OK)	$695.38	$695.38
PORTLAND (OR)	$760.07	$760.07
REST OF OREGON (OR)	$718.89	$718.89
METROPOLITAN PHILADELPHIA (PA)	$772.85	$772.85
REST OF PENNSYLVANIA (PA)	$714.13	$714.13
PUERTO RICO (PR)	$742.84	$742.84
RHODE ISLAND (RI)	$749.90	$749.90
SOUTH CAROLINA (SC)	$709.14	$709.14
SOUTH DAKOTA** (SD)	$694.26	$694.26
TENNESSEE (TN)	$683.01	$683.01
BRAZORIA (TX)	$726.03	$726.03
DALLAS (TX)	$733.29	$733.29
GALVESTON (TX)	$729.95	$729.95
HOUSTON (TX)	$768.39	$768.39
BEAUMONT (TX)	$710.78	$710.78
FORT WORTH (TX)	$731.41	$731.41
AUSTIN (TX)	$749.78	$749.78
REST OF TEXAS (TX)	$719.82	$719.82
UTAH (UT)	$716.96	$716.96
VIRGINIA (VA)	$715.47	$715.47
VIRGIN ISLANDS (VI)	$742.84	$742.84
VERMONT (VT)	$703.40	$703.40
SEATTLE (KING CNTY) (WA)	$810.84	$810.84
REST OF WASHINGTON (WA)	$743.93	$743.93
WISCONSIN (WI)	$680.59	$680.59
WEST VIRGINIA (WV)	$734.57	$734.57
WYOMING** (WY)	$722.60	$722.60

Look up another code or locality →

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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can have different practice-expense RVUs, which is why two allowed amounts are often shown; for this code, those practice-expense RVUs are the same, so the non-facility and facility amounts match.

RVUs — work 11.74, practice expense 8.34 (non-facility) / 8.34 (facility), malpractice 2.1 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national RVUs and the conversion factor for the stated year — actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, place-of-service rules, multiple-procedure reductions, and sequestration can change the final payment.
Annual budget-neutrality adjustments and conversion factor updates mean amounts can shift year to year.
Always confirm the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does CPT 13160 show the same amount for facility and non-facility settings?

The practice-expense RVU used in the Medicare formula is identical for both settings for this code, so the calculated allowed amount comes out the same whether the service is billed from an office or a facility.

Why isn't the CPT descriptor shown on this page?

CPT code descriptions are copyrighted by the American Medical Association. This page provides pricing information only; refer to a licensed CPT reference or your MAC's fee schedule for the official descriptor.

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

Not necessarily. The national figure uses standardized GPCI values, while your actual locality-specific payment reflects local wage, rent, and malpractice cost indices, which can raise or lower the final amount.

Does this amount reflect what Medicare will actually pay?

It reflects the Medicare-allowed amount before patient responsibility. Medicare generally reimburses 80% of this amount after the deductible, with modifiers and other adjustments potentially changing the final payment.

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.