Medicare Reimbursement for CPT 15131

CPT 15131 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) estimated allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$103.21	$75.15
ALASKA* (AK)	$126.67	$96.79
ALABAMA (AL)	$93.72	$69.17
ARKANSAS (AR)	$92.54	$68.44
ARIZONA (AZ)	$100.54	$73.35
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$121.61	$82.05
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$123.56	$83.10
OXNARD-THOUSAND OAKS-VENTURA (CA)	$109.63	$76.47
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$110.66	$77.47
NAPA (CA)	$116.56	$79.58
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$121.90	$82.34
VALLEJO (CA)	$116.13	$79.16
BAKERSFIELD (CA)	$105.13	$74.38
CHICO (CA)	$104.40	$73.65
FRESNO (CA)	$104.40	$73.65
HANFORD-CORCORAN (CA)	$104.40	$73.65
MADERA (CA)	$104.40	$73.65
MERCED (CA)	$104.40	$73.65
MODESTO (CA)	$104.40	$73.65
REDDING (CA)	$104.40	$73.65
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$107.20	$76.45
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$108.39	$75.76
SALINAS (CA)	$107.97	$75.45
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$124.77	$84.31
SANTA CRUZ-WATSONVILLE (CA)	$110.04	$75.95
SANTA ROSA-PETALUMA (CA)	$111.08	$76.62
STOCKTON (CA)	$104.40	$73.65
VISALIA (CA)	$104.40	$73.65
YUBA CITY (CA)	$104.40	$73.65
EL CENTRO (CA)	$104.44	$73.69
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$109.66	$76.11
SAN LUIS OBISPO-PASO ROBLES (CA)	$106.37	$74.41
SANTA MARIA-SANTA BARBARA (CA)	$108.14	$75.43
REST OF CALIFORNIA (CA)	$104.40	$73.65
COLORADO (CO)	$104.82	$74.97
CONNECTICUT (CT)	$109.53	$79.31
DC + MD/VA SUBURBS (DC)	$114.97	$81.92
DELAWARE (DE)	$102.03	$74.31
FORT LAUDERDALE (FL)	$110.82	$82.40
MIAMI (FL)	$118.36	$89.16
REST OF FLORIDA (FL)	$105.56	$78.74
ATLANTA (GA)	$105.83	$77.33
REST OF GEORGIA (GA)	$99.93	$74.91
HAWAII, GUAM (HI)	$105.82	$73.92
IOWA (IA)	$94.08	$68.41
IDAHO (ID)	$94.97	$69.16
EAST ST. LOUIS (IL)	$108.35	$82.54
SUBURBAN CHICAGO (IL)	$111.49	$82.68
CHICAGO (IL)	$115.03	$86.83
REST OF ILLINOIS (IL)	$104.12	$78.50
INDIANA (IN)	$95.40	$69.40
KANSAS (KS)	$94.51	$69.15
KENTUCKY (KY)	$97.39	$72.45
NEW ORLEANS (LA)	$101.69	$75.29
REST OF LOUISIANA (LA)	$97.58	$72.75
METROPOLITAN BOSTON (MA)	$113.13	$79.63
REST OF MASSACHUSETTS (MA)	$104.65	$75.11
BALTIMORE/SURR. CNTYS (MD)	$109.39	$79.28
REST OF MARYLAND (MD)	$103.53	$75.14
SOUTHERN MAINE (ME)	$99.59	$71.79
REST OF MAINE (ME)	$96.27	$70.45
DETROIT (MI)	$107.56	$80.49
REST OF MICHIGAN (MI)	$100.35	$74.73
MINNESOTA (MN)	$98.42	$69.55
METROPOLITAN ST. LOUIS (MO)	$101.03	$74.32
METROPOLITAN KANSAS CITY (MO)	$100.22	$73.87
REST OF MISSOURI (MO)	$96.67	$72.48
MISSISSIPPI (MS)	$94.58	$70.42
MONTANA** (MT)	$103.19	$75.13
NORTH CAROLINA (NC)	$97.01	$70.83
NORTH DAKOTA** (ND)	$98.05	$69.99
NEBRASKA (NE)	$94.28	$68.39
NEW HAMPSHIRE (NH)	$104.00	$74.79
NORTHERN NJ (NJ)	$114.19	$81.65
REST OF NEW JERSEY (NJ)	$110.21	$79.57
NEW MEXICO (NM)	$101.16	$75.43
NEVADA** (NV)	$101.80	$73.72
MANHATTAN (NY)	$118.83	$86.23
NYC SUBURBS/LONG ISLAND (NY)	$122.42	$89.06
POUGHKPSIE/N NYC SUBURBS (NY)	$111.57	$80.85
QUEENS (NY)	$118.50	$85.33
REST OF NEW YORK (NY)	$98.34	$71.69
OHIO (OH)	$99.30	$73.68
OKLAHOMA (OK)	$96.38	$71.32
PORTLAND (OR)	$106.85	$75.67
REST OF OREGON (OR)	$100.45	$72.50
METROPOLITAN PHILADELPHIA (PA)	$107.64	$78.43
REST OF PENNSYLVANIA (PA)	$98.98	$73.22
PUERTO RICO (PR)	$103.58	$75.22
RHODE ISLAND (RI)	$104.71	$75.72
SOUTH CAROLINA (SC)	$98.43	$72.50
SOUTH DAKOTA** (SD)	$97.44	$69.39
TENNESSEE (TN)	$95.02	$69.52
BRAZORIA (TX)	$101.28	$73.47
DALLAS (TX)	$102.23	$74.29
GALVESTON (TX)	$101.78	$73.92
HOUSTON (TX)	$106.54	$78.68
BEAUMONT (TX)	$98.47	$72.94
FORT WORTH (TX)	$101.89	$74.22
AUSTIN (TX)	$104.97	$75.29
REST OF TEXAS (TX)	$100.03	$73.41
UTAH (UT)	$99.58	$73.20
VIRGINIA (VA)	$99.88	$72.30
VIRGIN ISLANDS (VI)	$103.58	$75.22
VERMONT (VT)	$98.46	$70.68
SEATTLE (KING CNTY) (WA)	$114.45	$80.02
REST OF WASHINGTON (WA)	$104.19	$74.65
WISCONSIN (WI)	$95.28	$68.40
WEST VIRGINIA (WV)	$100.96	$76.58
WYOMING** (WY)	$100.95	$72.89

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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 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, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings because overhead costs differ, which is why this code typically shows two different allowed amounts for the same work and malpractice values.

RVUs — work 1.46, practice expense 1.37 (non-facility) / 0.53 (facility), malpractice 0.26 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the final allowed amount can differ from the national figure shown here.
Always verify current rates and policy with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why are there two different amounts for the same code?

The non-facility amount reflects practice-expense costs when the service is performed in a setting like a physician's office, while the facility amount reflects lower practice-expense RVUs because overhead is covered separately when the service is performed in a hospital or other facility setting.

Does this figure reflect what my practice will actually be paid?

No. It's a national or locality-adjusted estimate based on standard RVUs and the conversion factor. Actual payment depends on your specific locality, any applicable modifiers, claim adjustments, and sequestration.

Why might the allowed amount change year to year?

The conversion factor, RVUs, and GPCIs are all updated annually by CMS, and budget-neutrality adjustments required by law can shift amounts even if a code's RVUs stay the same.

Where can I find the exact amount for my locality?

Check the locality-specific breakdown on this page or consult your Medicare Administrative Contractor's published fee schedule for the most precise, up-to-date figure.

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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.