Medicare Reimbursement for CPT 15130

CPT 15130 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 Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, and distinguishes between non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$771.23	$550.45
ALASKA* (AK)	$904.83	$669.69
ALABAMA (AL)	$691.54	$498.35
ARKANSAS (AR)	$681.54	$491.89
ARIZONA (AZ)	$749.82	$535.89
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$965.79	$654.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$983.59	$665.23
OXNARD-THOUSAND OAKS-VENTURA (CA)	$848.63	$587.67
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$854.15	$592.96
NAPA (CA)	$917.44	$626.45
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$967.32	$656.02
VALLEJO (CA)	$915.23	$624.24
BAKERSFIELD (CA)	$804.43	$562.45
CHICO (CA)	$800.65	$558.67
FRESNO (CA)	$800.65	$558.67
HANFORD-CORCORAN (CA)	$800.65	$558.67
MADERA (CA)	$800.65	$558.67
MERCED (CA)	$800.65	$558.67
MODESTO (CA)	$800.65	$558.67
REDDING (CA)	$800.65	$558.67
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$815.18	$573.21
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$837.53	$580.76
SALINAS (CA)	$834.38	$578.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$989.86	$671.50
SANTA CRUZ-WATSONVILLE (CA)	$858.86	$590.61
SANTA ROSA-PETALUMA (CA)	$867.32	$596.20
STOCKTON (CA)	$800.65	$558.67
VISALIA (CA)	$800.65	$558.67
YUBA CITY (CA)	$800.65	$558.67
EL CENTRO (CA)	$800.87	$558.90
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$852.20	$588.15
SAN LUIS OBISPO-PASO ROBLES (CA)	$821.33	$569.86
SANTA MARIA-SANTA BARBARA (CA)	$837.01	$579.58
REST OF CALIFORNIA (CA)	$800.65	$558.67
COLORADO (CO)	$795.08	$560.17
CONNECTICUT (CT)	$822.63	$584.85
DC + MD/VA SUBURBS (DC)	$875.17	$615.10
DELAWARE (DE)	$762.13	$544.00
FORT LAUDERDALE (FL)	$813.91	$590.26
MIAMI (FL)	$859.89	$630.06
REST OF FLORIDA (FL)	$772.74	$561.68
ATLANTA (GA)	$788.72	$564.41
REST OF GEORGIA (GA)	$727.94	$531.00
HAWAII, GUAM (HI)	$818.14	$567.11
IOWA (IA)	$703.15	$501.14
IDAHO (ID)	$708.99	$505.87
EAST ST. LOUIS (IL)	$778.47	$575.35
SUBURBAN CHICAGO (IL)	$820.74	$594.00
CHICAGO (IL)	$833.74	$611.86
REST OF ILLINOIS (IL)	$754.77	$553.20
INDIANA (IN)	$712.94	$508.28
KANSAS (KS)	$702.69	$503.10
KENTUCKY (KY)	$714.01	$517.73
NEW ORLEANS (LA)	$748.98	$541.23
REST OF LOUISIANA (LA)	$714.02	$518.63
METROPOLITAN BOSTON (MA)	$869.63	$606.02
REST OF MASSACHUSETTS (MA)	$791.49	$559.01
BALTIMORE/SURR. CNTYS (MD)	$820.95	$584.05
REST OF MARYLAND (MD)	$775.75	$552.32
SOUTHERN MAINE (ME)	$750.26	$531.47
REST OF MAINE (ME)	$715.70	$512.59
DETROIT (MI)	$785.33	$572.27
REST OF MICHIGAN (MI)	$735.20	$533.63
MINNESOTA (MN)	$753.43	$526.25
METROPOLITAN ST. LOUIS (MO)	$748.23	$538.05
METROPOLITAN KANSAS CITY (MO)	$740.85	$533.54
REST OF MISSOURI (MO)	$703.68	$513.37
MISSISSIPPI (MS)	$692.60	$502.51
MONTANA** (MT)	$771.14	$550.36
NORTH CAROLINA (NC)	$722.72	$516.74
NORTH DAKOTA** (ND)	$744.44	$523.66
NEBRASKA (NE)	$706.15	$502.37
NEW HAMPSHIRE (NH)	$785.31	$555.48
NORTHERN NJ (NJ)	$866.69	$610.59
REST OF NEW JERSEY (NJ)	$829.66	$588.56
NEW MEXICO (NM)	$740.37	$537.91
NEVADA** (NV)	$764.18	$543.18
MANHATTAN (NY)	$891.26	$634.71
NYC SUBURBS/LONG ISLAND (NY)	$916.46	$653.96
POUGHKPSIE/N NYC SUBURBS (NY)	$837.42	$595.67
QUEENS (NY)	$894.38	$633.42
REST OF NEW YORK (NY)	$733.79	$524.05
OHIO (OH)	$729.74	$528.17
OKLAHOMA (OK)	$709.71	$512.55
PORTLAND (OR)	$816.99	$571.71
REST OF OREGON (OR)	$755.91	$536.01
METROPOLITAN PHILADELPHIA (PA)	$804.06	$574.23
REST OF PENNSYLVANIA (PA)	$729.31	$526.63
PUERTO RICO (PR)	$775.84	$552.63
RHODE ISLAND (RI)	$786.89	$558.82
SOUTH CAROLINA (SC)	$727.91	$523.91
SOUTH DAKOTA** (SD)	$741.29	$520.51
TENNESSEE (TN)	$706.58	$505.89
BRAZORIA (TX)	$758.94	$540.15
DALLAS (TX)	$765.11	$545.21
GALVESTON (TX)	$762.07	$542.83
HOUSTON (TX)	$786.78	$567.54
BEAUMONT (TX)	$724.74	$523.83
FORT WORTH (TX)	$760.88	$543.19
AUSTIN (TX)	$794.47	$560.89
REST OF TEXAS (TX)	$742.32	$532.80
UTAH (UT)	$737.77	$530.24
VIRGINIA (VA)	$749.79	$532.77
VIRGIN ISLANDS (VI)	$775.84	$552.63
VERMONT (VT)	$744.14	$525.57
SEATTLE (KING CNTY) (WA)	$884.41	$613.52
REST OF WASHINGTON (WA)	$789.13	$556.65
WISCONSIN (WI)	$719.82	$508.32
WEST VIRGINIA (WV)	$727.65	$535.80
WYOMING** (WY)	$759.50	$538.72

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 PFS payment 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 provider's locality to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a national dollar-per-RVU figure set by CMS) to produce the allowed amount. Non-facility and facility rates differ mainly in the practice-expense RVU, since facility settings assume the hospital or facility bears more of the overhead cost.

RVUs — work 7.34, practice expense 14.4 (non-facility) / 7.79 (facility), malpractice 1.35 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount 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 insurance is responsible for the remainder.
Actual payment varies by locality, modifiers, and site of service.
Sequestration and annual budget-neutrality adjustments can change the final paid amount.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount?

The facility rate uses a lower practice-expense RVU because the facility (e.g., hospital) is assumed to absorb certain overhead costs, such as equipment and supplies, rather than the billing physician.

Does this figure represent what Medicare actually pays?

No. The figure shown is the Medicare-allowed amount before the standard 80/20 split and before any adjustments for deductibles, modifiers, or sequestration.

Why might my locality's amount differ from the national figure?

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust for regional differences in wages, rents, and malpractice costs, which can raise or lower the payment compared to the national average.

Can this amount change during the year?

Yes. CMS updates the conversion factor and RVUs annually, and mid-year adjustments such as sequestration or budget-neutrality corrections can also affect the final paid amount.

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.