Medicare Reimbursement for CPT Code 15100

This page covers a Medicare-recognized procedure code billed under the Physician Fee Schedule (PFS). It shows the estimated Medicare-allowed payment amount nationally and the inputs used to calculate it, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$922.53	$660.34
ALASKA* (AK)	$1089.92	$810.68
ALABAMA (AL)	$827.79	$598.37
ARKANSAS (AR)	$815.96	$590.73
ARIZONA (AZ)	$896.72	$642.65
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1136.40	$766.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1156.62	$778.53
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1005.13	$695.22
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1012.48	$702.30
NAPA (CA)	$1082.03	$736.46
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1138.57	$768.87
VALLEJO (CA)	$1078.91	$733.33
BAKERSFIELD (CA)	$955.21	$667.84
CHICO (CA)	$949.91	$662.54
FRESNO (CA)	$949.91	$662.54
HANFORD-CORCORAN (CA)	$949.91	$662.54
MADERA (CA)	$949.91	$662.54
MERCED (CA)	$949.91	$662.54
MODESTO (CA)	$949.91	$662.54
REDDING (CA)	$949.91	$662.54
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$970.45	$683.08
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$991.97	$687.04
SALINAS (CA)	$988.21	$684.33
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1165.48	$787.40
SANTA CRUZ-WATSONVILLE (CA)	$1015.03	$696.46
SANTA ROSA-PETALUMA (CA)	$1024.90	$702.93
STOCKTON (CA)	$949.91	$662.54
VISALIA (CA)	$949.91	$662.54
YUBA CITY (CA)	$949.91	$662.54
EL CENTRO (CA)	$950.23	$662.86
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1008.12	$694.53
SAN LUIS OBISPO-PASO ROBLES (CA)	$972.97	$674.33
SANTA MARIA-SANTA BARBARA (CA)	$991.00	$685.28
REST OF CALIFORNIA (CA)	$949.91	$662.54
COLORADO (CO)	$946.76	$667.78
CONNECTICUT (CT)	$983.68	$701.29
DC + MD/VA SUBURBS (DC)	$1042.63	$733.76
DELAWARE (DE)	$911.26	$652.21
FORT LAUDERDALE (FL)	$981.05	$715.45
MIAMI (FL)	$1042.07	$769.12
REST OF FLORIDA (FL)	$931.02	$680.36
ATLANTA (GA)	$944.91	$678.51
REST OF GEORGIA (GA)	$876.85	$642.97
HAWAII, GUAM (HI)	$969.16	$671.05
IOWA (IA)	$838.47	$598.56
IDAHO (ID)	$846.00	$604.78
EAST ST. LOUIS (IL)	$944.31	$703.09
SUBURBAN CHICAGO (IL)	$988.52	$719.25
CHICAGO (IL)	$1010.09	$746.58
REST OF ILLINOIS (IL)	$911.78	$672.40
INDIANA (IN)	$850.58	$607.53
KANSAS (KS)	$839.39	$602.37
KENTUCKY (KY)	$857.57	$624.47
NEW ORLEANS (LA)	$899.56	$652.83
REST OF LOUISIANA (LA)	$858.17	$626.12
METROPOLITAN BOSTON (MA)	$1032.80	$719.73
REST OF MASSACHUSETTS (MA)	$943.17	$667.08
BALTIMORE/SURR. CNTYS (MD)	$981.97	$700.63
REST OF MARYLAND (MD)	$926.96	$661.62
SOUTHERN MAINE (ME)	$894.16	$634.33
REST OF MAINE (ME)	$855.50	$614.28
DETROIT (MI)	$947.52	$694.50
REST OF MICHIGAN (MI)	$884.09	$644.71
MINNESOTA (MN)	$893.18	$623.38
METROPOLITAN ST. LOUIS (MO)	$896.91	$647.30
METROPOLITAN KANSAS CITY (MO)	$888.34	$642.14
REST OF MISSOURI (MO)	$846.85	$620.83
MISSISSIPPI (MS)	$831.32	$605.57
MONTANA** (MT)	$922.41	$660.21
NORTH CAROLINA (NC)	$863.56	$618.93
NORTH DAKOTA** (ND)	$884.64	$622.44
NEBRASKA (NE)	$841.55	$599.54
NEW HAMPSHIRE (NH)	$936.55	$663.60
NORTHERN NJ (NJ)	$1033.00	$728.86
REST OF NEW JERSEY (NJ)	$990.96	$704.65
NEW MEXICO (NM)	$890.83	$650.40
NEVADA** (NV)	$912.42	$649.96
MANHATTAN (NY)	$1067.45	$762.77
NYC SUBURBS/LONG ISLAND (NY)	$1099.22	$787.46
POUGHKPSIE/N NYC SUBURBS (NY)	$1001.39	$714.29
QUEENS (NY)	$1068.99	$759.07
REST OF NEW YORK (NY)	$876.76	$627.68
OHIO (OH)	$876.37	$636.99
OKLAHOMA (OK)	$850.91	$616.77
PORTLAND (OR)	$970.90	$679.60
REST OF OREGON (OR)	$901.44	$640.29
METROPOLITAN PHILADELPHIA (PA)	$962.64	$689.69
REST OF PENNSYLVANIA (PA)	$875.04	$634.34
PUERTO RICO (PR)	$927.48	$662.40
RHODE ISLAND (RI)	$939.47	$668.62
SOUTH CAROLINA (SC)	$872.20	$629.93
SOUTH DAKOTA** (SD)	$880.17	$617.98
TENNESSEE (TN)	$844.18	$605.84
BRAZORIA (TX)	$906.25	$646.41
DALLAS (TX)	$914.23	$653.08
GALVESTON (TX)	$910.38	$650.02
HOUSTON (TX)	$945.34	$684.98
BEAUMONT (TX)	$869.73	$631.13
FORT WORTH (TX)	$909.69	$651.17
AUSTIN (TX)	$947.02	$669.61
REST OF TEXAS (TX)	$888.99	$640.16
UTAH (UT)	$883.84	$637.38
VIRGINIA (VA)	$894.66	$636.92
VIRGIN ISLANDS (VI)	$927.48	$662.40
VERMONT (VT)	$885.65	$626.08
SEATTLE (KING CNTY) (WA)	$1048.74	$727.03
REST OF WASHINGTON (WA)	$939.91	$663.81
WISCONSIN (WI)	$855.86	$604.67
WEST VIRGINIA (WV)	$879.76	$651.91
WYOMING** (WY)	$905.95	$643.75

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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 amount is built from three Relative Value Units (RVUs) — work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (equipment, supplies, staff time) are typically higher when a service is performed in a physician's office versus a hospital or other facility.

RVUs — work 9.65, practice expense 16.06 (non-facility) / 8.21 (facility), malpractice 1.91 — × 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 annual Part B deductible is met; the patient or secondary insurer is generally responsible for the remainder.
Actual payment varies by locality GPCI, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality changes to the conversion factor.
Always verify current-year rates and locality-specific amounts with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is bearing some of the overhead costs, whereas the non-facility rate assumes the billing practice covers those costs itself.

Does this amount reflect what Medicare will actually pay for a specific claim?

No. It's a national or locality-adjusted estimate based on standard RVUs and the conversion factor. Actual reimbursement can be affected by modifiers, place of service, sequestration, and other claim-specific factors.

How often do these figures change?

The conversion factor and RVUs are updated annually (and sometimes mid-year) through CMS rulemaking, so amounts can change from one year to the next even if the code itself is unchanged.

Where can I find the exact amount for my locality?

Check the CMS Physician Fee Schedule Look-Up Tool or contact your MAC, since GPCI-adjusted amounts vary by geographic locality and are not reflected in the national average alone.

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.