Medicare Reimbursement for CPT 15111

CPT 15111 is a physician procedure code reported to Medicare and other payers; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$121.58	$90.52
ALASKA* (AK)	$148.42	$115.34
ALABAMA (AL)	$109.56	$82.38
ARKANSAS (AR)	$108.09	$81.41
ARIZONA (AZ)	$118.09	$87.99
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$138.67	$94.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$140.70	$95.90
OXNARD-THOUSAND OAKS-VENTURA (CA)	$126.61	$89.89
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$128.01	$91.26
NAPA (CA)	$133.55	$92.61
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$139.15	$95.35
VALLEJO (CA)	$132.86	$91.92
BAKERSFIELD (CA)	$121.79	$87.74
CHICO (CA)	$120.65	$86.60
FRESNO (CA)	$120.65	$86.60
HANFORD-CORCORAN (CA)	$120.65	$86.60
MADERA (CA)	$120.65	$86.60
MERCED (CA)	$120.65	$86.60
MODESTO (CA)	$120.65	$86.60
REDDING (CA)	$120.65	$86.60
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$125.15	$91.11
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$124.97	$88.84
SALINAS (CA)	$124.48	$88.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$142.65	$97.85
SANTA CRUZ-WATSONVILLE (CA)	$126.53	$88.79
SANTA ROSA-PETALUMA (CA)	$127.69	$89.54
STOCKTON (CA)	$120.65	$86.60
VISALIA (CA)	$120.65	$86.60
YUBA CITY (CA)	$120.65	$86.60
EL CENTRO (CA)	$120.72	$86.67
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$126.25	$89.10
SAN LUIS OBISPO-PASO ROBLES (CA)	$122.68	$87.30
SANTA MARIA-SANTA BARBARA (CA)	$124.63	$88.41
REST OF CALIFORNIA (CA)	$120.65	$86.60
COLORADO (CO)	$122.26	$89.21
CONNECTICUT (CT)	$129.38	$95.93
DC + MD/VA SUBURBS (DC)	$134.85	$98.26
DELAWARE (DE)	$119.89	$89.20
FORT LAUDERDALE (FL)	$133.53	$102.06
MIAMI (FL)	$144.97	$112.64
REST OF FLORIDA (FL)	$126.55	$96.85
ATLANTA (GA)	$125.34	$93.78
REST OF GEORGIA (GA)	$119.15	$91.44
HAWAII, GUAM (HI)	$122.17	$86.85
IOWA (IA)	$109.09	$80.67
IDAHO (ID)	$110.39	$81.81
EAST ST. LOUIS (IL)	$132.01	$103.43
SUBURBAN CHICAGO (IL)	$134.11	$102.21
CHICAGO (IL)	$140.40	$109.19
REST OF ILLINOIS (IL)	$125.35	$96.99
INDIANA (IN)	$110.91	$82.11
KANSAS (KS)	$110.07	$81.99
KENTUCKY (KY)	$115.12	$87.51
NEW ORLEANS (LA)	$120.69	$91.46
REST OF LOUISIANA (LA)	$115.54	$88.05
METROPOLITAN BOSTON (MA)	$131.70	$94.61
REST OF MASSACHUSETTS (MA)	$122.21	$89.50
BALTIMORE/SURR. CNTYS (MD)	$129.33	$96.00
REST OF MARYLAND (MD)	$121.60	$90.16
SOUTHERN MAINE (ME)	$115.98	$85.19
REST OF MAINE (ME)	$112.48	$83.90
DETROIT (MI)	$129.54	$99.57
REST OF MICHIGAN (MI)	$119.26	$90.90
MINNESOTA (MN)	$113.08	$81.12
METROPOLITAN ST. LOUIS (MO)	$119.33	$89.76
METROPOLITAN KANSAS CITY (MO)	$118.36	$89.20
REST OF MISSOURI (MO)	$114.67	$87.89
MISSISSIPPI (MS)	$111.33	$84.58
MONTANA** (MT)	$121.55	$90.49
NORTH CAROLINA (NC)	$113.34	$84.36
NORTH DAKOTA** (ND)	$113.25	$82.18
NEBRASKA (NE)	$109.20	$80.53
NEW HAMPSHIRE (NH)	$121.77	$89.43
NORTHERN NJ (NJ)	$133.91	$97.88
REST OF NEW JERSEY (NJ)	$129.71	$95.79
NEW MEXICO (NM)	$120.46	$91.98
NEVADA** (NV)	$119.28	$88.19
MANHATTAN (NY)	$141.33	$105.24
NYC SUBURBS/LONG ISLAND (NY)	$146.41	$109.48
POUGHKPSIE/N NYC SUBURBS (NY)	$131.74	$97.72
QUEENS (NY)	$140.26	$103.54
REST OF NEW YORK (NY)	$115.04	$85.53
OHIO (OH)	$117.57	$89.20
OKLAHOMA (OK)	$113.38	$85.64
PORTLAND (OR)	$124.21	$89.70
REST OF OREGON (OR)	$117.22	$86.28
METROPOLITAN PHILADELPHIA (PA)	$127.31	$94.98
REST OF PENNSYLVANIA (PA)	$116.92	$88.40
PUERTO RICO (PR)	$121.89	$90.49
RHODE ISLAND (RI)	$122.77	$90.68
SOUTH CAROLINA (SC)	$115.87	$87.17
SOUTH DAKOTA** (SD)	$112.26	$81.20
TENNESSEE (TN)	$110.77	$82.53
BRAZORIA (TX)	$118.55	$87.76
DALLAS (TX)	$119.94	$89.00
GALVESTON (TX)	$119.32	$88.47
HOUSTON (TX)	$127.00	$96.16
BEAUMONT (TX)	$116.31	$88.05
FORT WORTH (TX)	$119.65	$89.02
AUSTIN (TX)	$122.85	$89.99
REST OF TEXAS (TX)	$117.80	$88.32
UTAH (UT)	$117.30	$88.10
VIRGINIA (VA)	$116.65	$86.11
VIRGIN ISLANDS (VI)	$121.89	$90.49
VERMONT (VT)	$114.17	$83.42
SEATTLE (KING CNTY) (WA)	$132.78	$94.67
REST OF WASHINGTON (WA)	$121.52	$88.81
WISCONSIN (WI)	$109.88	$80.12
WEST VIRGINIA (WV)	$121.41	$94.42
WYOMING** (WY)	$117.93	$86.87

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 5 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 procedure code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital, ASC) settings because overhead costs differ, which is why this code shows two separate national and locality-level amounts.

RVUs — work 1.8, practice expense 1.42 (non-facility) / 0.49 (facility), malpractice 0.42 — × 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 patient meets the annual Part B deductible; the patient or secondary insurance is generally responsible for the remainder.
Actual payment can vary based on 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 CPT 15111 have different amounts for non-facility and facility settings?

The practice expense RVU component differs because non-facility settings (like a physician's office) include overhead costs such as staff, supplies, and equipment, while facility settings (like a hospital) separately bill for those overhead costs, resulting in a lower practice expense RVU and generally a lower facility payment.

Does the amount shown reflect what Medicare will actually pay?

No. The figure is an estimated allowed amount under the national PFS formula. Actual reimbursement depends on the patient's specific locality, any modifiers applied, deductible status, sequestration, and other adjustments.

Why do amounts vary by locality for the same CPT code?

Medicare applies Geographic Practice Cost Indices (GPCIs) to the work, practice expense, and malpractice RVUs to account for regional differences in costs, which causes the same code to have different allowed amounts across localities.

Where can I find the official Medicare rate for my area?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules, and CMS releases the annual PFS final rule, which are the authoritative sources for confirming exact payment amounts.

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.