Medicare Reimbursement for CPT 15004

CPT 15004 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount for this code, both the national rate and the rate adjusted for your locality, broken out by non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$404.48	$228.80
ALASKA* (AK)	$485.08	$297.97
ALABAMA (AL)	$366.19	$212.46
ARKANSAS (AR)	$361.38	$210.46
ARIZONA (AZ)	$394.23	$223.99
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$502.90	$255.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$512.06	$258.72
OXNARD-THOUSAND OAKS-VENTURA (CA)	$443.53	$235.87
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$446.56	$238.72
NAPA (CA)	$478.27	$246.71
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$503.60	$255.88
VALLEJO (CA)	$477.25	$245.69
BAKERSFIELD (CA)	$421.73	$229.18
CHICO (CA)	$419.92	$227.37
FRESNO (CA)	$419.92	$227.37
HANFORD-CORCORAN (CA)	$419.92	$227.37
MADERA (CA)	$419.92	$227.37
MERCED (CA)	$419.92	$227.37
MODESTO (CA)	$419.92	$227.37
REDDING (CA)	$419.92	$227.37
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$426.64	$234.08
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$438.47	$234.14
SALINAS (CA)	$436.79	$233.16
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$514.94	$261.59
SANTA CRUZ-WATSONVILLE (CA)	$448.42	$234.96
SANTA ROSA-PETALUMA (CA)	$452.82	$237.07
STOCKTON (CA)	$419.92	$227.37
VISALIA (CA)	$419.92	$227.37
YUBA CITY (CA)	$419.92	$227.37
EL CENTRO (CA)	$420.03	$227.47
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$445.44	$235.31
SAN LUIS OBISPO-PASO ROBLES (CA)	$430.01	$229.90
SANTA MARIA-SANTA BARBARA (CA)	$437.98	$233.13
REST OF CALIFORNIA (CA)	$419.92	$227.37
COLORADO (CO)	$416.75	$229.81
CONNECTICUT (CT)	$429.87	$240.66
DC + MD/VA SUBURBS (DC)	$456.62	$249.66
DELAWARE (DE)	$400.33	$226.75
FORT LAUDERDALE (FL)	$424.27	$246.29
MIAMI (FL)	$445.76	$262.87
REST OF FLORIDA (FL)	$404.58	$236.63
ATLANTA (GA)	$412.85	$234.35
REST OF GEORGIA (GA)	$383.14	$226.42
HAWAII, GUAM (HI)	$427.89	$228.13
IOWA (IA)	$372.07	$211.31
IDAHO (ID)	$374.81	$213.18
EAST ST. LOUIS (IL)	$406.73	$245.09
SUBURBAN CHICAGO (IL)	$427.85	$247.42
CHICAGO (IL)	$433.52	$256.95
REST OF ILLINOIS (IL)	$395.74	$235.34
INDIANA (IN)	$376.72	$213.86
KANSAS (KS)	$371.70	$212.88
KENTUCKY (KY)	$376.70	$220.51
NEW ORLEANS (LA)	$393.47	$228.14
REST OF LOUISIANA (LA)	$376.65	$221.17
METROPOLITAN BOSTON (MA)	$453.82	$244.04
REST OF MASSACHUSETTS (MA)	$415.10	$230.10
BALTIMORE/SURR. CNTYS (MD)	$428.90	$240.38
REST OF MARYLAND (MD)	$407.09	$229.30
SOUTHERN MAINE (ME)	$394.73	$220.63
REST OF MAINE (ME)	$377.90	$216.27
DETROIT (MI)	$410.48	$240.94
REST OF MICHIGAN (MI)	$386.76	$226.35
MINNESOTA (MN)	$396.71	$215.92
METROPOLITAN ST. LOUIS (MO)	$393.27	$226.02
METROPOLITAN KANSAS CITY (MO)	$389.71	$224.73
REST OF MISSOURI (MO)	$371.59	$220.15
MISSISSIPPI (MS)	$366.49	$215.22
MONTANA** (MT)	$404.44	$228.75
NORTH CAROLINA (NC)	$381.30	$217.38
NORTH DAKOTA** (ND)	$392.18	$216.50
NEBRASKA (NE)	$373.55	$211.39
NEW HAMPSHIRE (NH)	$411.51	$228.62
NORTHERN NJ (NJ)	$452.81	$249.02
REST OF NEW JERSEY (NJ)	$434.04	$242.19
NEW MEXICO (NM)	$389.19	$228.08
NEVADA** (NV)	$401.26	$225.40
MANHATTAN (NY)	$464.16	$260.01
NYC SUBURBS/LONG ISLAND (NY)	$476.10	$267.21
POUGHKPSIE/N NYC SUBURBS (NY)	$437.83	$245.45
QUEENS (NY)	$465.87	$258.20
REST OF NEW YORK (NY)	$386.61	$219.71
OHIO (OH)	$384.25	$223.85
OKLAHOMA (OK)	$374.78	$217.89
PORTLAND (OR)	$427.60	$232.41
REST OF OREGON (OR)	$397.40	$222.41
METROPOLITAN PHILADELPHIA (PA)	$420.78	$237.89
REST OF PENNSYLVANIA (PA)	$384.12	$222.84
PUERTO RICO (PR)	$406.75	$229.13
RHODE ISLAND (RI)	$412.82	$231.34
SOUTH CAROLINA (SC)	$383.56	$221.22
SOUTH DAKOTA** (SD)	$390.73	$215.05
TENNESSEE (TN)	$373.56	$213.86
BRAZORIA (TX)	$399.01	$224.91
DALLAS (TX)	$401.95	$226.96
GALVESTON (TX)	$400.48	$226.02
HOUSTON (TX)	$411.82	$237.37
BEAUMONT (TX)	$381.91	$222.04
FORT WORTH (TX)	$399.87	$226.65
AUSTIN (TX)	$416.02	$230.14
REST OF TEXAS (TX)	$390.52	$223.79
UTAH (UT)	$388.30	$223.16
VIRGINIA (VA)	$394.41	$221.71
VIRGIN ISLANDS (VI)	$406.75	$229.13
VERMONT (VT)	$391.91	$217.98
SEATTLE (KING CNTY) (WA)	$461.39	$245.82
REST OF WASHINGTON (WA)	$413.90	$228.90
WISCONSIN (WI)	$380.31	$212.00
WEST VIRGINIA (WV)	$382.69	$230.02
WYOMING** (WY)	$399.10	$223.41

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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 Physician Fee Schedule assigns each code a Work RVU, a Practice Expense (PE) RVU, and a Malpractice (MP) RVU, reflecting physician effort, overhead costs, and liability insurance respectively. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, since costs vary by region. 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 PE RVUs are typically higher than facility PE RVUs because they account for the overhead of running an office-based practice, whereas facility rates assume the hospital or ASC absorbs those costs separately.

RVUs — work 4.47, practice expense 7.02 (non-facility) / 1.76 (facility), malpractice 0.62 — × 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 specifics.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can all change the final paid amount.
Rates are updated annually and subject to budget-neutrality adjustments, so this year's figure will not apply in future years.
Always confirm the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility rate differ from the non-facility rate for CPT 15004?

The facility rate uses a lower Practice Expense RVU because it assumes the hospital or ambulatory surgical center is billing separately for overhead costs like equipment and supplies, while the non-facility rate reflects the full overhead of an office-based setting.

Why might the amount I was paid differ from the figure shown here?

Actual payment can vary due to your specific locality's GPCI values, applied modifiers, secondary procedure reductions, sequestration, or contractual adjustments from your MAC.

Does this amount represent what Medicare will pay me?

No — this is the total allowed amount. Medicare generally reimburses 80% of it after the patient's deductible is met, with the patient or supplemental insurer covering the rest.

Why is the CPT descriptor not shown on this page?

CPT code descriptors are copyrighted by the American Medical Association, so this page refers to the code generically rather than reproducing the licensed text.

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.