Medicare Reimbursement for CPT 15101
CPT 15101 is a procedure code used for physician billing under Medicare Part B. 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 (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $201.41 | $100.54 |
| ALASKA* (AK) | $232.38 | $124.96 |
| ALABAMA (AL) | $179.32 | $91.06 |
| ARKANSAS (AR) | $176.55 | $89.91 |
| ARIZONA (AZ) | $195.47 | $97.73 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $253.81 | $111.58 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $258.54 | $113.08 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $222.33 | $103.10 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $223.71 | $104.38 |
| NAPA (CA) | $240.87 | $107.92 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $254.24 | $112.01 |
| VALLEJO (CA) | $240.24 | $107.30 |
| BAKERSFIELD (CA) | $210.24 | $99.69 |
| CHICO (CA) | $209.20 | $98.65 |
| FRESNO (CA) | $209.20 | $98.65 |
| HANFORD-CORCORAN (CA) | $209.20 | $98.65 |
| MADERA (CA) | $209.20 | $98.65 |
| MERCED (CA) | $209.20 | $98.65 |
| MODESTO (CA) | $209.20 | $98.65 |
| REDDING (CA) | $209.20 | $98.65 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $213.28 | $102.73 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $219.15 | $101.84 |
| SALINAS (CA) | $218.34 | $101.43 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $260.30 | $114.84 |
| SANTA CRUZ-WATSONVILLE (CA) | $225.21 | $102.65 |
| SANTA ROSA-PETALUMA (CA) | $227.43 | $103.57 |
| STOCKTON (CA) | $209.20 | $98.65 |
| VISALIA (CA) | $209.20 | $98.65 |
| YUBA CITY (CA) | $209.20 | $98.65 |
| EL CENTRO (CA) | $209.27 | $98.71 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $223.27 | $102.63 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $214.90 | $100.01 |
| SANTA MARIA-SANTA BARBARA (CA) | $219.10 | $101.49 |
| REST OF CALIFORNIA (CA) | $209.20 | $98.65 |
| COLORADO (CO) | $207.79 | $100.46 |
| CONNECTICUT (CT) | $215.41 | $106.77 |
| DC + MD/VA SUBURBS (DC) | $229.47 | $110.65 |
| DELAWARE (DE) | $198.81 | $99.15 |
| FORT LAUDERDALE (FL) | $213.39 | $111.20 |
| MIAMI (FL) | $226.25 | $121.24 |
| REST OF FLORIDA (FL) | $201.96 | $105.52 |
| ATLANTA (GA) | $206.25 | $103.76 |
| REST OF GEORGIA (GA) | $189.52 | $99.55 |
| HAWAII, GUAM (HI) | $214.23 | $99.54 |
| IOWA (IA) | $182.48 | $90.19 |
| IDAHO (ID) | $184.11 | $91.31 |
| EAST ST. LOUIS (IL) | $203.67 | $110.87 |
| SUBURBAN CHICAGO (IL) | $215.18 | $111.58 |
| CHICAGO (IL) | $218.90 | $117.52 |
| REST OF ILLINOIS (IL) | $197.02 | $104.92 |
| INDIANA (IN) | $185.20 | $91.70 |
| KANSAS (KS) | $182.38 | $91.20 |
| KENTUCKY (KY) | $185.61 | $95.94 |
| NEW ORLEANS (LA) | $195.31 | $100.39 |
| REST OF LOUISIANA (LA) | $185.63 | $96.35 |
| METROPOLITAN BOSTON (MA) | $228.04 | $107.60 |
| REST OF MASSACHUSETTS (MA) | $206.76 | $100.54 |
| BALTIMORE/SURR. CNTYS (MD) | $214.99 | $106.76 |
| REST OF MARYLAND (MD) | $202.52 | $100.44 |
| SOUTHERN MAINE (ME) | $195.53 | $95.57 |
| REST OF MAINE (ME) | $186.00 | $93.20 |
| DETROIT (MI) | $205.47 | $108.13 |
| REST OF MICHIGAN (MI) | $191.51 | $99.41 |
| MINNESOTA (MN) | $196.32 | $92.52 |
| METROPOLITAN ST. LOUIS (MO) | $195.07 | $99.04 |
| METROPOLITAN KANSAS CITY (MO) | $193.03 | $98.31 |
| REST OF MISSOURI (MO) | $182.78 | $95.83 |
| MISSISSIPPI (MS) | $179.66 | $92.81 |
| MONTANA** (MT) | $201.38 | $100.51 |
| NORTH CAROLINA (NC) | $187.94 | $93.83 |
| NORTH DAKOTA** (ND) | $193.87 | $93.00 |
| NEBRASKA (NE) | $183.30 | $90.20 |
| NEW HAMPSHIRE (NH) | $205.26 | $100.25 |
| NORTHERN NJ (NJ) | $227.02 | $110.01 |
| REST OF NEW JERSEY (NJ) | $217.08 | $106.93 |
| NEW MEXICO (NM) | $192.95 | $100.45 |
| NEVADA** (NV) | $199.42 | $98.45 |
| MANHATTAN (NY) | $233.92 | $116.71 |
| NYC SUBURBS/LONG ISLAND (NY) | $240.94 | $121.00 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $219.20 | $108.74 |
| QUEENS (NY) | $234.74 | $115.51 |
| REST OF NEW YORK (NY) | $191.01 | $95.18 |
| OHIO (OH) | $189.97 | $97.88 |
| OKLAHOMA (OK) | $184.39 | $94.31 |
| PORTLAND (OR) | $213.77 | $101.71 |
| REST OF OREGON (OR) | $197.11 | $96.64 |
| METROPOLITAN PHILADELPHIA (PA) | $210.30 | $105.30 |
| REST OF PENNSYLVANIA (PA) | $189.84 | $97.24 |
| PUERTO RICO (PR) | $202.68 | $100.70 |
| RHODE ISLAND (RI) | $205.48 | $101.28 |
| SOUTH CAROLINA (SC) | $189.43 | $96.22 |
| SOUTH DAKOTA** (SD) | $192.98 | $92.11 |
| TENNESSEE (TN) | $183.46 | $91.77 |
| BRAZORIA (TX) | $197.87 | $97.91 |
| DALLAS (TX) | $199.58 | $99.11 |
| GALVESTON (TX) | $198.75 | $98.58 |
| HOUSTON (TX) | $205.70 | $105.54 |
| BEAUMONT (TX) | $188.57 | $96.78 |
| FORT WORTH (TX) | $198.42 | $98.96 |
| AUSTIN (TX) | $207.76 | $101.04 |
| REST OF TEXAS (TX) | $193.41 | $97.69 |
| UTAH (UT) | $192.16 | $97.34 |
| VIRGINIA (VA) | $195.42 | $96.27 |
| VIRGIN ISLANDS (VI) | $202.68 | $100.70 |
| VERMONT (VT) | $193.81 | $93.95 |
| SEATTLE (KING CNTY) (WA) | $231.99 | $108.22 |
| REST OF WASHINGTON (WA) | $206.13 | $99.91 |
| WISCONSIN (WI) | $187.06 | $90.42 |
| WEST VIRGINIA (WV) | $189.51 | $101.85 |
| WYOMING** (WY) | $198.11 | $97.24 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 40 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) assigned to a 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, reflecting local cost-of-living and practice cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility settings (like a physician office, which bears more overhead) and facility settings (like a hospital, where the facility bills separately for overhead), which is why non-facility and facility amounts differ for the same code.
RVUs — work 1.68, practice expense 3.97 (non-facility) / 0.95 (facility), malpractice 0.38 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This figure is an estimate only, not a guarantee of payment.
- Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary insurer is responsible for the remainder.
- Actual payment can vary based on the specific locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The facility amount is lower because it excludes most practice-expense overhead, which is instead billed separately by the facility (e.g., hospital) rather than the physician's practice.
Why might the amount I receive differ from the national figure shown here?
The national amount uses average GPCIs; actual payment is recalculated using the GPCIs for the specific locality where the service was rendered, and may also reflect modifiers, sequestration, or other adjustments.
Does this page tell me what my patient will owe?
No. This page shows the Medicare allowed amount estimate. Patient responsibility depends on deductible status, secondary coverage, and the 20% coinsurance Medicare generally applies after the deductible.
Does the conversion factor change every year?
Yes. CMS updates the conversion factor annually, and the dollar amounts shown reflect the specific year's conversion factor used in this calculation.
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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