Medicare Reimbursement for CPT 15115

CPT 15115 is a procedure code defined by the American Medical Association; this page does not reproduce its official descriptor due to licensing restrictions. It shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026 at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$862.75	$650.98
ALASKA* (AK)	$1045.86	$820.33
ALABAMA (AL)	$781.12	$595.82
ARKANSAS (AR)	$770.96	$589.05
ARIZONA (AZ)	$840.18	$634.98
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1037.90	$739.31
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1055.43	$750.07
OXNARD-THOUSAND OAKS-VENTURA (CA)	$927.52	$677.22
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$935.35	$684.83
NAPA (CA)	$991.73	$712.63
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1040.07	$741.48
VALLEJO (CA)	$988.61	$709.51
BAKERSFIELD (CA)	$886.21	$654.12
CHICO (CA)	$880.82	$648.73
FRESNO (CA)	$880.82	$648.73
HANFORD-CORCORAN (CA)	$880.82	$648.73
MADERA (CA)	$880.82	$648.73
MERCED (CA)	$880.82	$648.73
MODESTO (CA)	$880.82	$648.73
REDDING (CA)	$880.82	$648.73
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$901.41	$669.32
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$916.71	$670.43
SALINAS (CA)	$913.15	$667.72
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1064.30	$758.94
SANTA CRUZ-WATSONVILLE (CA)	$933.64	$676.35
SANTA ROSA-PETALUMA (CA)	$942.56	$682.51
STOCKTON (CA)	$880.82	$648.73
VISALIA (CA)	$880.82	$648.73
YUBA CITY (CA)	$880.82	$648.73
EL CENTRO (CA)	$881.14	$649.05
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$929.13	$675.86
SAN LUIS OBISPO-PASO ROBLES (CA)	$899.37	$658.18
SANTA MARIA-SANTA BARBARA (CA)	$915.07	$668.15
REST OF CALIFORNIA (CA)	$880.82	$648.73
COLORADO (CO)	$880.80	$655.49
CONNECTICUT (CT)	$916.72	$688.65
DC + MD/VA SUBURBS (DC)	$966.61	$717.15
DELAWARE (DE)	$852.96	$643.74
FORT LAUDERDALE (FL)	$919.90	$705.39
MIAMI (FL)	$977.98	$757.54
REST OF FLORIDA (FL)	$875.85	$673.40
ATLANTA (GA)	$883.58	$668.43
REST OF GEORGIA (GA)	$828.39	$639.50
HAWAII, GUAM (HI)	$895.01	$654.24
IOWA (IA)	$787.60	$593.83
IDAHO (ID)	$794.60	$599.78
EAST ST. LOUIS (IL)	$892.91	$698.09
SUBURBAN CHICAGO (IL)	$926.22	$708.74
CHICAGO (IL)	$950.09	$737.27
REST OF ILLINOIS (IL)	$861.12	$667.78
INDIANA (IN)	$798.45	$602.15
KANSAS (KS)	$789.67	$598.24
KENTUCKY (KY)	$809.42	$621.17
NEW ORLEANS (LA)	$845.96	$646.69
REST OF LOUISIANA (LA)	$810.44	$623.03
METROPOLITAN BOSTON (MA)	$954.51	$701.67
REST OF MASSACHUSETTS (MA)	$878.54	$655.56
BALTIMORE/SURR. CNTYS (MD)	$915.25	$688.03
REST OF MARYLAND (MD)	$866.37	$652.06
SOUTHERN MAINE (ME)	$835.32	$625.46
REST OF MAINE (ME)	$804.11	$609.29
DETROIT (MI)	$891.41	$687.06
REST OF MICHIGAN (MI)	$833.43	$640.09
MINNESOTA (MN)	$830.35	$612.44
METROPOLITAN ST. LOUIS (MO)	$842.16	$640.56
METROPOLITAN KANSAS CITY (MO)	$834.95	$636.11
REST OF MISSOURI (MO)	$801.53	$619.00
MISSISSIPPI (MS)	$786.11	$603.78
MONTANA** (MT)	$862.62	$650.86
NORTH CAROLINA (NC)	$810.80	$613.23
NORTH DAKOTA** (ND)	$824.85	$613.09
NEBRASKA (NE)	$789.84	$594.38
NEW HAMPSHIRE (NH)	$872.46	$652.02
NORTHERN NJ (NJ)	$959.28	$713.63
REST OF NEW JERSEY (NJ)	$923.33	$692.09
NEW MEXICO (NM)	$839.75	$645.56
NEVADA** (NV)	$852.52	$640.55
MANHATTAN (NY)	$993.55	$747.49
NYC SUBURBS/LONG ISLAND (NY)	$1022.49	$770.71
POUGHKPSIE/N NYC SUBURBS (NY)	$933.67	$701.79
QUEENS (NY)	$993.00	$742.70
REST OF NEW YORK (NY)	$822.22	$621.05
OHIO (OH)	$825.71	$632.37
OKLAHOMA (OK)	$802.34	$613.24
PORTLAND (OR)	$900.19	$664.93
REST OF OREGON (OR)	$842.07	$631.16
METROPOLITAN PHILADELPHIA (PA)	$899.36	$678.92
REST OF PENNSYLVANIA (PA)	$823.85	$629.45
PUERTO RICO (PR)	$866.54	$652.44
RHODE ISLAND (RI)	$877.08	$658.33
SOUTH CAROLINA (SC)	$820.38	$624.71
SOUTH DAKOTA** (SD)	$820.38	$608.62
TENNESSEE (TN)	$793.94	$601.45
BRAZORIA (TX)	$847.77	$637.91
DALLAS (TX)	$855.27	$644.35
GALVESTON (TX)	$851.69	$641.41
HOUSTON (TX)	$886.65	$676.37
BEAUMONT (TX)	$819.38	$626.67
FORT WORTH (TX)	$851.78	$642.98
AUSTIN (TX)	$881.24	$657.19
REST OF TEXAS (TX)	$834.55	$633.59
UTAH (UT)	$830.35	$631.29
VIRGINIA (VA)	$836.65	$628.49
VIRGIN ISLANDS (VI)	$866.54	$652.44
VERMONT (VT)	$826.91	$617.27
SEATTLE (KING CNTY) (WA)	$967.40	$707.57
REST OF WASHINGTON (WA)	$875.15	$652.16
WISCONSIN (WI)	$800.47	$597.61
WEST VIRGINIA (WV)	$833.71	$649.69
WYOMING** (WY)	$846.16	$634.40

Look up another code or locality →

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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to this code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the dollar amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two amounts shown differ.

RVUs — work 11, practice expense 12.92 (non-facility) / 6.58 (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 patient meets their deductible; the patient or secondary payer is generally responsible for the remainder.
Actual payment can vary by 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 is the facility amount lower than the non-facility amount?

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is absorbing certain overhead and resource costs separately, whereas the non-facility rate reflects costs borne entirely by the billing practice.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare Physician Fee Schedule allowed amount before the standard 20% coinsurance, deductible, modifiers, and any local or annual adjustments are applied.

Why does the amount vary by locality?

Geographic Practice Cost Indices (GPCIs) adjust the RVUs for each locality to reflect differences in local wages, rents, and malpractice costs, so the same code can price differently across regions.

Can I use this figure to predict my exact reimbursement?

No. Use it as a general estimate; actual reimbursement depends on your specific locality, place of service, modifiers applied, and any payment policy changes in effect at the time of service.

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.