Medicare Reimbursement for CPT 15005
CPT 15005 is a procedure code billed under Medicare Part B; the specific service it describes is defined by the American Medical Association's CPT codebook and is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $124.59 | $78.16 |
| ALASKA* (AK) | $149.51 | $100.07 |
| ALABAMA (AL) | $112.02 | $71.39 |
| ARKANSAS (AR) | $110.46 | $70.58 |
| ARIZONA (AZ) | $121.06 | $76.07 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $148.07 | $82.60 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $150.49 | $83.54 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $132.89 | $78.01 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $134.09 | $79.17 |
| NAPA (CA) | $141.72 | $80.53 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $148.45 | $82.99 |
| VALLEJO (CA) | $141.16 | $79.97 |
| BAKERSFIELD (CA) | $127.00 | $76.12 |
| CHICO (CA) | $126.07 | $75.19 |
| FRESNO (CA) | $126.07 | $75.19 |
| HANFORD-CORCORAN (CA) | $126.07 | $75.19 |
| MADERA (CA) | $126.07 | $75.19 |
| MERCED (CA) | $126.07 | $75.19 |
| MODESTO (CA) | $126.07 | $75.19 |
| REDDING (CA) | $126.07 | $75.19 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $129.72 | $78.84 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $131.15 | $77.16 |
| SALINAS (CA) | $130.65 | $76.84 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $152.06 | $85.12 |
| SANTA CRUZ-WATSONVILLE (CA) | $133.55 | $77.14 |
| SANTA ROSA-PETALUMA (CA) | $134.82 | $77.80 |
| STOCKTON (CA) | $126.07 | $75.19 |
| VISALIA (CA) | $126.07 | $75.19 |
| YUBA CITY (CA) | $126.07 | $75.19 |
| EL CENTRO (CA) | $126.13 | $75.24 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $132.93 | $77.40 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $128.70 | $75.82 |
| SANTA MARIA-SANTA BARBARA (CA) | $130.92 | $76.79 |
| REST OF CALIFORNIA (CA) | $126.07 | $75.19 |
| COLORADO (CO) | $126.64 | $77.24 |
| CONNECTICUT (CT) | $132.72 | $82.72 |
| DC + MD/VA SUBURBS (DC) | $139.56 | $84.87 |
| DELAWARE (DE) | $122.97 | $77.10 |
| FORT LAUDERDALE (FL) | $134.56 | $87.53 |
| MIAMI (FL) | $144.46 | $96.12 |
| REST OF FLORIDA (FL) | $127.61 | $83.22 |
| ATLANTA (GA) | $128.00 | $80.83 |
| REST OF GEORGIA (GA) | $120.16 | $78.75 |
| HAWAII, GUAM (HI) | $128.18 | $75.39 |
| IOWA (IA) | $112.54 | $70.06 |
| IDAHO (ID) | $113.71 | $71.00 |
| EAST ST. LOUIS (IL) | $131.21 | $88.50 |
| SUBURBAN CHICAGO (IL) | $135.37 | $87.69 |
| CHICAGO (IL) | $139.96 | $93.30 |
| REST OF ILLINOIS (IL) | $125.66 | $83.27 |
| INDIANA (IN) | $114.29 | $71.25 |
| KANSAS (KS) | $113.08 | $71.11 |
| KENTUCKY (KY) | $116.84 | $75.56 |
| NEW ORLEANS (LA) | $122.52 | $78.84 |
| REST OF LOUISIANA (LA) | $117.08 | $75.99 |
| METROPOLITAN BOSTON (MA) | $137.33 | $81.90 |
| REST OF MASSACHUSETTS (MA) | $126.35 | $77.47 |
| BALTIMORE/SURR. CNTYS (MD) | $132.57 | $82.76 |
| REST OF MARYLAND (MD) | $124.91 | $77.92 |
| SOUTHERN MAINE (ME) | $119.84 | $73.84 |
| REST OF MAINE (ME) | $115.40 | $72.69 |
| DETROIT (MI) | $130.24 | $85.43 |
| REST OF MICHIGAN (MI) | $120.73 | $78.34 |
| MINNESOTA (MN) | $118.36 | $70.59 |
| METROPOLITAN ST. LOUIS (MO) | $121.67 | $77.48 |
| METROPOLITAN KANSAS CITY (MO) | $120.60 | $77.00 |
| REST OF MISSOURI (MO) | $115.86 | $75.83 |
| MISSISSIPPI (MS) | $113.13 | $73.15 |
| MONTANA** (MT) | $124.56 | $78.14 |
| NORTH CAROLINA (NC) | $116.39 | $73.07 |
| NORTH DAKOTA** (ND) | $117.84 | $71.41 |
| NEBRASKA (NE) | $112.82 | $69.96 |
| NEW HAMPSHIRE (NH) | $125.67 | $77.34 |
| NORTHERN NJ (NJ) | $138.42 | $84.56 |
| REST OF NEW JERSEY (NJ) | $133.39 | $82.70 |
| NEW MEXICO (NM) | $121.79 | $79.22 |
| NEVADA** (NV) | $122.75 | $76.28 |
| MANHATTAN (NY) | $144.48 | $90.53 |
| NYC SUBURBS/LONG ISLAND (NY) | $149.20 | $94.00 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $135.12 | $84.28 |
| QUEENS (NY) | $144.06 | $89.19 |
| REST OF NEW YORK (NY) | $118.16 | $74.05 |
| OHIO (OH) | $119.36 | $76.97 |
| OKLAHOMA (OK) | $115.51 | $74.05 |
| PORTLAND (OR) | $129.30 | $77.72 |
| REST OF OREGON (OR) | $120.97 | $74.73 |
| METROPOLITAN PHILADELPHIA (PA) | $130.22 | $81.89 |
| REST OF PENNSYLVANIA (PA) | $118.95 | $76.33 |
| PUERTO RICO (PR) | $125.09 | $78.15 |
| RHODE ISLAND (RI) | $126.37 | $78.41 |
| SOUTH CAROLINA (SC) | $118.24 | $75.34 |
| SOUTH DAKOTA** (SD) | $117.04 | $70.62 |
| TENNESSEE (TN) | $113.77 | $71.56 |
| BRAZORIA (TX) | $121.95 | $75.94 |
| DALLAS (TX) | $123.20 | $76.96 |
| GALVESTON (TX) | $122.62 | $76.52 |
| HOUSTON (TX) | $128.84 | $82.74 |
| BEAUMONT (TX) | $118.28 | $76.03 |
| FORT WORTH (TX) | $122.73 | $76.96 |
| AUSTIN (TX) | $126.94 | $77.82 |
| REST OF TEXAS (TX) | $120.37 | $76.31 |
| UTAH (UT) | $119.76 | $76.12 |
| VIRGINIA (VA) | $120.21 | $74.57 |
| VIRGIN ISLANDS (VI) | $125.09 | $78.15 |
| VERMONT (VT) | $118.36 | $72.40 |
| SEATTLE (KING CNTY) (WA) | $138.99 | $82.02 |
| REST OF WASHINGTON (WA) | $125.79 | $76.90 |
| WISCONSIN (WI) | $114.16 | $69.68 |
| WEST VIRGINIA (WV) | $121.47 | $81.13 |
| WYOMING** (WY) | $121.63 | $75.21 |
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Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 19 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 PFS amount is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, and the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital outpatient, ASC) settings because overhead costs differ, which is why the non-facility and facility rates differ. Work and malpractice RVUs generally stay the same across settings, while the practice-expense component shifts.
RVUs — work 1.56, practice expense 1.83 (non-facility) / 0.44 (facility), malpractice 0.34 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only, not a guarantee of payment.
- Medicare typically pays 80% of the allowed amount after the Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
- Actual payment can vary due to modifiers, place of service, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
- Locality-adjusted amounts differ from the national figure shown here; always confirm the exact locality used for a specific claim.
- Always verify current rates and coverage policy 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 for this code?
The practice-expense RVU is lower in the facility setting because the facility (not the physician's office) bears certain overhead costs like equipment and staff time, so Medicare pays a smaller practice-expense portion to the billing physician.
Does this page show what Medicare actually pays?
It shows the PFS allowed amount, which is the basis for payment. Medicare generally pays 80% of this allowed amount after the deductible, with the remainder owed by the patient or a secondary payer.
Why might my locality's payment differ from the national amount shown?
Each Medicare locality has its own GPCI values reflecting local cost differences for work, practice expense, and malpractice, which raise or lower the allowed amount relative to the national average.
Can modifiers or other codes billed the same day change this amount?
Yes. Modifiers, bilateral or multiple-procedure rules, and other codes billed on the same claim can increase or decrease the final payment relative to the standalone PFS amount shown here.
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.
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