Medicare Reimbursement for CPT 15003

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and displays its Medicare Physician Fee Schedule allowed amount for 2026. Amounts are shown nationally and can vary by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$74.82	$39.75
ALASKA* (AK)	$87.92	$50.57
ALABAMA (AL)	$66.86	$36.18
ARKANSAS (AR)	$65.87	$35.75
ARIZONA (AZ)	$72.63	$38.64
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$91.36	$41.91
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$92.96	$42.38
OXNARD-THOUSAND OAKS-VENTURA (CA)	$81.06	$39.61
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$81.69	$40.20
NAPA (CA)	$87.10	$40.87
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$91.57	$42.12
VALLEJO (CA)	$86.80	$40.58
BAKERSFIELD (CA)	$77.07	$38.63
CHICO (CA)	$76.58	$38.14
FRESNO (CA)	$76.58	$38.14
HANFORD-CORCORAN (CA)	$76.58	$38.14
MADERA (CA)	$76.58	$38.14
MERCED (CA)	$76.58	$38.14
MODESTO (CA)	$76.58	$38.14
REDDING (CA)	$76.58	$38.14
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$78.51	$40.07
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$79.94	$39.15
SALINAS (CA)	$79.63	$38.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$93.79	$43.22
SANTA CRUZ-WATSONVILLE (CA)	$81.77	$39.16
SANTA ROSA-PETALUMA (CA)	$82.56	$39.49
STOCKTON (CA)	$76.58	$38.14
VISALIA (CA)	$76.58	$38.14
YUBA CITY (CA)	$76.58	$38.14
EL CENTRO (CA)	$76.61	$38.17
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$81.23	$39.28
SAN LUIS OBISPO-PASO ROBLES (CA)	$78.41	$38.47
SANTA MARIA-SANTA BARBARA (CA)	$79.85	$38.96
REST OF CALIFORNIA (CA)	$76.58	$38.14
COLORADO (CO)	$76.55	$39.23
CONNECTICUT (CT)	$79.89	$42.12
DC + MD/VA SUBURBS (DC)	$84.51	$43.20
DELAWARE (DE)	$73.83	$39.18
FORT LAUDERDALE (FL)	$80.23	$44.70
MIAMI (FL)	$85.76	$49.25
REST OF FLORIDA (FL)	$75.96	$42.43
ATLANTA (GA)	$76.79	$41.16
REST OF GEORGIA (GA)	$71.36	$40.07
HAWAII, GUAM (HI)	$78.14	$38.27
IOWA (IA)	$67.56	$35.47
IDAHO (ID)	$68.23	$35.96
EAST ST. LOUIS (IL)	$77.49	$45.23
SUBURBAN CHICAGO (IL)	$80.80	$44.78
CHICAGO (IL)	$83.00	$47.75
REST OF ILLINOIS (IL)	$74.48	$42.46
INDIANA (IN)	$68.61	$36.10
KANSAS (KS)	$67.73	$36.03
KENTUCKY (KY)	$69.56	$38.38
NEW ORLEANS (LA)	$73.11	$40.11
REST OF LOUISIANA (LA)	$69.65	$38.61
METROPOLITAN BOSTON (MA)	$83.52	$41.64
REST OF MASSACHUSETTS (MA)	$76.28	$39.35
BALTIMORE/SURR. CNTYS (MD)	$79.78	$42.15
REST OF MARYLAND (MD)	$75.10	$39.61
SOUTHERN MAINE (ME)	$72.21	$37.46
REST OF MAINE (ME)	$69.13	$36.86
DETROIT (MI)	$77.45	$43.60
REST OF MICHIGAN (MI)	$71.87	$39.85
MINNESOTA (MN)	$71.83	$35.74
METROPOLITAN ST. LOUIS (MO)	$72.78	$39.39
METROPOLITAN KANSAS CITY (MO)	$72.07	$39.14
REST OF MISSOURI (MO)	$68.76	$38.53
MISSISSIPPI (MS)	$67.31	$37.11
MONTANA** (MT)	$74.81	$39.74
NORTH CAROLINA (NC)	$69.78	$37.06
NORTH DAKOTA** (ND)	$71.25	$36.18
NEBRASKA (NE)	$67.79	$35.42
NEW HAMPSHIRE (NH)	$75.82	$39.31
NORTHERN NJ (NJ)	$83.71	$43.03
REST OF NEW JERSEY (NJ)	$80.38	$42.08
NEW MEXICO (NM)	$72.48	$40.32
NEVADA** (NV)	$73.86	$38.75
MANHATTAN (NY)	$86.93	$46.18
NYC SUBURBS/LONG ISLAND (NY)	$89.72	$48.02
POUGHKPSIE/N NYC SUBURBS (NY)	$81.31	$42.91
QUEENS (NY)	$86.92	$45.47
REST OF NEW YORK (NY)	$70.89	$37.58
OHIO (OH)	$71.15	$39.13
OKLAHOMA (OK)	$68.90	$37.58
PORTLAND (OR)	$78.44	$39.48
REST OF OREGON (OR)	$72.86	$37.93
METROPOLITAN PHILADELPHIA (PA)	$78.20	$41.69
REST OF PENNSYLVANIA (PA)	$70.98	$38.79
PUERTO RICO (PR)	$75.20	$39.74
RHODE ISLAND (RI)	$76.07	$39.85
SOUTH CAROLINA (SC)	$70.67	$38.26
SOUTH DAKOTA** (SD)	$70.83	$35.75
TENNESSEE (TN)	$68.14	$36.26
BRAZORIA (TX)	$73.32	$38.56
DALLAS (TX)	$74.03	$39.10
GALVESTON (TX)	$73.69	$38.87
HOUSTON (TX)	$76.99	$42.16
BEAUMONT (TX)	$70.54	$38.63
FORT WORTH (TX)	$73.68	$39.10
AUSTIN (TX)	$76.66	$39.56
REST OF TEXAS (TX)	$72.05	$38.77
UTAH (UT)	$71.64	$38.67
VIRGINIA (VA)	$72.32	$37.85
VIRGIN ISLANDS (VI)	$75.20	$39.74
VERMONT (VT)	$71.42	$36.70
SEATTLE (KING CNTY) (WA)	$84.73	$41.69
REST OF WASHINGTON (WA)	$75.99	$39.06
WISCONSIN (WI)	$68.86	$35.26
WEST VIRGINIA (WV)	$71.81	$41.33
WYOMING** (WY)	$73.25	$38.18

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 60 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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to this code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is performed, reflecting local cost differences. The locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, since overhead costs differ depending on where the service is rendered, which is why the two allowed amounts differ.

RVUs — work 0.78, practice expense 1.28 (non-facility) / 0.23 (facility), malpractice 0.18 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement depends on claim-specific factors.
Medicare typically pays 80% of the allowed amount after the patient meets their annual Part B deductible; 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.
Fee schedule amounts can vary by locality due to GPCI differences; always confirm the current rate with your Medicare Administrative Contractor (MAC).
Rates are effective for the stated year and may be revised through CMS corrections or legislative action.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is absorbing certain overhead and resource costs, whereas the non-facility rate assumes the billing provider bears those costs directly.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-allowed amount before the standard 80/20 split, deductible, and any applicable adjustments like modifiers or sequestration are applied.

Why might the amount differ in my locality compared to the national figure?

Local GPCI values for work, practice expense, and malpractice RVUs adjust the national rate up or down based on regional cost-of-living and practice cost differences.

Can this code's payment change mid-year?

It's uncommon but possible — CMS occasionally issues corrections, and budget-neutrality or legislative adjustments can affect the conversion factor or RVUs between annual updates.

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.