Medicare Reimbursement for CPT 15116

CPT 15116 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) payment settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$164.67	$122.58
ALASKA* (AK)	$201.21	$156.39
ALABAMA (AL)	$148.49	$111.67
ARKANSAS (AR)	$146.51	$110.35
ARIZONA (AZ)	$159.97	$119.19
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$188.08	$128.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$190.85	$130.16
OXNARD-THOUSAND OAKS-VENTURA (CA)	$171.63	$121.88
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$173.52	$123.73
NAPA (CA)	$181.10	$125.63
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$188.72	$129.38
VALLEJO (CA)	$180.18	$124.71
BAKERSFIELD (CA)	$165.09	$118.96
CHICO (CA)	$163.56	$117.44
FRESNO (CA)	$163.56	$117.44
HANFORD-CORCORAN (CA)	$163.56	$117.44
MADERA (CA)	$163.56	$117.44
MERCED (CA)	$163.56	$117.44
MODESTO (CA)	$163.56	$117.44
REDDING (CA)	$163.56	$117.44
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$169.57	$123.45
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$169.43	$120.48
SALINAS (CA)	$168.76	$119.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$193.45	$132.76
SANTA CRUZ-WATSONVILLE (CA)	$171.56	$120.43
SANTA ROSA-PETALUMA (CA)	$173.13	$121.45
STOCKTON (CA)	$163.56	$117.44
VISALIA (CA)	$163.56	$117.44
YUBA CITY (CA)	$163.56	$117.44
EL CENTRO (CA)	$163.66	$117.53
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$171.18	$120.85
SAN LUIS OBISPO-PASO ROBLES (CA)	$166.33	$118.40
SANTA MARIA-SANTA BARBARA (CA)	$168.97	$119.90
REST OF CALIFORNIA (CA)	$163.56	$117.44
COLORADO (CO)	$165.67	$120.90
CONNECTICUT (CT)	$175.19	$129.86
DC + MD/VA SUBURBS (DC)	$182.66	$133.08
DELAWARE (DE)	$162.41	$120.83
FORT LAUDERDALE (FL)	$180.62	$137.99
MIAMI (FL)	$195.91	$152.10
REST OF FLORIDA (FL)	$171.24	$131.01
ATLANTA (GA)	$169.70	$126.94
REST OF GEORGIA (GA)	$161.30	$123.76
HAWAII, GUAM (HI)	$165.62	$117.77
IOWA (IA)	$147.91	$109.40
IDAHO (ID)	$149.65	$110.93
EAST ST. LOUIS (IL)	$178.48	$139.76
SUBURBAN CHICAGO (IL)	$181.42	$138.20
CHICAGO (IL)	$189.78	$147.49
REST OF ILLINOIS (IL)	$169.59	$131.17
INDIANA (IN)	$150.35	$111.33
KANSAS (KS)	$149.20	$111.16
KENTUCKY (KY)	$155.92	$118.51
NEW ORLEANS (LA)	$163.41	$123.80
REST OF LOUISIANA (LA)	$156.47	$119.22
METROPOLITAN BOSTON (MA)	$178.46	$128.21
REST OF MASSACHUSETTS (MA)	$165.59	$121.27
BALTIMORE/SURR. CNTYS (MD)	$175.11	$129.95
REST OF MARYLAND (MD)	$164.72	$122.13
SOUTHERN MAINE (ME)	$157.18	$115.48
REST OF MAINE (ME)	$152.44	$113.72
DETROIT (MI)	$175.24	$134.63
REST OF MICHIGAN (MI)	$161.47	$123.05
MINNESOTA (MN)	$153.37	$110.06
METROPOLITAN ST. LOUIS (MO)	$161.61	$121.54
METROPOLITAN KANSAS CITY (MO)	$160.30	$120.79
REST OF MISSOURI (MO)	$155.28	$119.01
MISSISSIPPI (MS)	$150.82	$114.59
MONTANA** (MT)	$164.63	$122.54
NORTH CAROLINA (NC)	$153.60	$114.33
NORTH DAKOTA** (ND)	$153.56	$111.47
NEBRASKA (NE)	$148.07	$109.22
NEW HAMPSHIRE (NH)	$164.97	$121.16
NORTHERN NJ (NJ)	$181.39	$132.57
REST OF NEW JERSEY (NJ)	$175.67	$129.71
NEW MEXICO (NM)	$163.08	$124.48
NEVADA** (NV)	$161.61	$119.48
MANHATTAN (NY)	$191.29	$142.38
NYC SUBURBS/LONG ISLAND (NY)	$198.10	$148.06
POUGHKPSIE/N NYC SUBURBS (NY)	$178.39	$132.30
QUEENS (NY)	$189.88	$140.14
REST OF NEW YORK (NY)	$155.89	$115.91
OHIO (OH)	$159.21	$120.78
OKLAHOMA (OK)	$153.60	$116.02
PORTLAND (OR)	$168.34	$121.58
REST OF OREGON (OR)	$158.85	$116.94
METROPOLITAN PHILADELPHIA (PA)	$172.39	$128.58
REST OF PENNSYLVANIA (PA)	$158.35	$119.72
PUERTO RICO (PR)	$165.09	$122.55
RHODE ISLAND (RI)	$166.32	$122.85
SOUTH CAROLINA (SC)	$156.96	$118.07
SOUTH DAKOTA** (SD)	$152.25	$110.16
TENNESSEE (TN)	$150.14	$111.88
BRAZORIA (TX)	$160.62	$118.92
DALLAS (TX)	$162.49	$120.57
GALVESTON (TX)	$161.65	$119.86
HOUSTON (TX)	$171.90	$130.11
BEAUMONT (TX)	$157.54	$119.24
FORT WORTH (TX)	$162.08	$120.59
AUSTIN (TX)	$166.44	$121.91
REST OF TEXAS (TX)	$159.56	$119.63
UTAH (UT)	$158.89	$119.33
VIRGINIA (VA)	$158.07	$116.70
VIRGIN ISLANDS (VI)	$165.09	$122.55
VERMONT (VT)	$154.78	$113.12
SEATTLE (KING CNTY) (WA)	$179.95	$128.31
REST OF WASHINGTON (WA)	$164.67	$120.36
WISCONSIN (WI)	$149.02	$108.70
WEST VIRGINIA (WV)	$164.28	$127.71
WYOMING** (WY)	$159.80	$117.72

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to account for regional 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 and facility settings because overhead costs (equipment, supplies, staff) are treated differently depending on where the service is performed.

RVUs — work 2.44, practice expense 1.93 (non-facility) / 0.67 (facility), malpractice 0.56 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, site of service, sequestration reductions, and annual budget-neutrality adjustments.
Always confirm the final allowed amount and payment with your Medicare Administrative Contractor (MAC) or official CMS PFS lookup tool.

Frequently asked

Why does the facility amount differ from the non-facility amount for this code?

Practice-expense RVUs are lower in the facility setting because the facility (e.g., hospital) bears part of the overhead costs; the non-facility setting assumes the billing practice covers more of those costs.

Does this amount reflect what the patient will owe?

No. The figures shown are the Medicare-allowed amount. Patient responsibility depends on deductible status, coinsurance (typically 20%), and any secondary coverage.

Why might my local payment differ from the national amount shown?

Medicare adjusts RVUs using locality-specific GPCIs to reflect regional differences in wages, rents, and malpractice costs, so the same code can pay differently across localities.

Can this amount change during the year?

Yes. CMS may apply mid-year adjustments such as sequestration, and the conversion factor and RVUs are updated annually, so amounts can change from year to year.

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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.