Medicare Reimbursement for CPT 15151

CPT 15151 is a physician procedure code billed under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$125.25	$97.53
ALASKA* (AK)	$153.14	$123.62
ALABAMA (AL)	$112.58	$88.32
ARKANSAS (AR)	$111.03	$87.22
ARIZONA (AZ)	$121.50	$94.64
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$139.64	$100.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$141.54	$101.56
OXNARD-THOUSAND OAKS-VENTURA (CA)	$128.68	$95.92
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$130.26	$97.46
NAPA (CA)	$134.95	$98.41
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$140.21	$101.12
VALLEJO (CA)	$134.13	$97.59
BAKERSFIELD (CA)	$124.13	$93.75
CHICO (CA)	$122.78	$92.40
FRESNO (CA)	$122.78	$92.40
HANFORD-CORCORAN (CA)	$122.78	$92.40
MADERA (CA)	$122.78	$92.40
MERCED (CA)	$122.78	$92.40
MODESTO (CA)	$122.78	$92.40
REDDING (CA)	$122.78	$92.40
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$128.14	$97.76
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$126.93	$94.69
SALINAS (CA)	$126.43	$94.30
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$143.86	$103.88
SANTA CRUZ-WATSONVILLE (CA)	$128.21	$94.52
SANTA ROSA-PETALUMA (CA)	$129.36	$95.31
STOCKTON (CA)	$122.78	$92.40
VISALIA (CA)	$122.78	$92.40
YUBA CITY (CA)	$122.78	$92.40
EL CENTRO (CA)	$122.86	$92.48
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$128.07	$94.91
SAN LUIS OBISPO-PASO ROBLES (CA)	$124.65	$93.07
SANTA MARIA-SANTA BARBARA (CA)	$126.54	$94.21
REST OF CALIFORNIA (CA)	$122.78	$92.40
COLORADO (CO)	$125.16	$95.66
CONNECTICUT (CT)	$133.41	$103.55
DC + MD/VA SUBURBS (DC)	$138.39	$105.73
DELAWARE (DE)	$123.37	$95.98
FORT LAUDERDALE (FL)	$139.31	$111.23
MIAMI (FL)	$152.57	$123.71
REST OF FLORIDA (FL)	$131.74	$105.24
ATLANTA (GA)	$129.50	$101.33
REST OF GEORGIA (GA)	$123.77	$99.04
HAWAII, GUAM (HI)	$124.17	$92.65
IOWA (IA)	$111.49	$86.13
IDAHO (ID)	$112.98	$87.47
EAST ST. LOUIS (IL)	$138.71	$113.21
SUBURBAN CHICAGO (IL)	$139.77	$111.30
CHICAGO (IL)	$147.55	$119.69
REST OF ILLINOIS (IL)	$130.88	$105.57
INDIANA (IN)	$113.50	$87.80
KANSAS (KS)	$112.80	$87.74
KENTUCKY (KY)	$119.01	$94.37
NEW ORLEANS (LA)	$124.96	$98.88
REST OF LOUISIANA (LA)	$119.56	$95.02
METROPOLITAN BOSTON (MA)	$134.51	$101.41
REST OF MASSACHUSETTS (MA)	$125.21	$96.01
BALTIMORE/SURR. CNTYS (MD)	$133.42	$103.68
REST OF MARYLAND (MD)	$125.06	$97.00
SOUTHERN MAINE (ME)	$118.70	$91.23
REST OF MAINE (ME)	$115.47	$89.96
DETROIT (MI)	$135.19	$108.44
REST OF MICHIGAN (MI)	$123.63	$98.32
MINNESOTA (MN)	$114.76	$86.23
METROPOLITAN ST. LOUIS (MO)	$123.20	$96.81
METROPOLITAN KANSAS CITY (MO)	$122.22	$96.19
REST OF MISSOURI (MO)	$118.83	$94.93
MISSISSIPPI (MS)	$114.86	$90.99
MONTANA** (MT)	$125.22	$97.50
NORTH CAROLINA (NC)	$116.32	$90.45
NORTH DAKOTA** (ND)	$115.33	$87.61
NEBRASKA (NE)	$111.52	$85.93
NEW HAMPSHIRE (NH)	$124.95	$96.09
NORTHERN NJ (NJ)	$137.44	$105.28
REST OF NEW JERSEY (NJ)	$133.47	$103.20
NEW MEXICO (NM)	$125.01	$99.58
NEVADA** (NV)	$122.51	$94.76
MANHATTAN (NY)	$146.24	$114.03
NYC SUBURBS/LONG ISLAND (NY)	$151.94	$118.98
POUGHKPSIE/N NYC SUBURBS (NY)	$135.82	$105.46
QUEENS (NY)	$144.71	$111.94
REST OF NEW YORK (NY)	$118.12	$91.79
OHIO (OH)	$121.61	$96.30
OKLAHOMA (OK)	$116.88	$92.13
PORTLAND (OR)	$126.84	$96.04
REST OF OREGON (OR)	$120.12	$92.51
METROPOLITAN PHILADELPHIA (PA)	$131.43	$102.57
REST OF PENNSYLVANIA (PA)	$120.77	$95.32
PUERTO RICO (PR)	$125.48	$97.45
RHODE ISLAND (RI)	$126.12	$97.48
SOUTH CAROLINA (SC)	$119.45	$93.83
SOUTH DAKOTA** (SD)	$114.16	$86.44
TENNESSEE (TN)	$113.57	$88.37
BRAZORIA (TX)	$121.71	$94.24
DALLAS (TX)	$123.29	$95.68
GALVESTON (TX)	$122.60	$95.07
HOUSTON (TX)	$131.75	$104.22
BEAUMONT (TX)	$120.16	$94.93
FORT WORTH (TX)	$123.08	$95.74
AUSTIN (TX)	$126.00	$96.67
REST OF TEXAS (TX)	$121.42	$95.11
UTAH (UT)	$120.94	$94.89
VIRGINIA (VA)	$119.61	$92.35
VIRGIN ISLANDS (VI)	$125.48	$97.45
VERMONT (VT)	$116.57	$89.12
SEATTLE (KING CNTY) (WA)	$135.31	$101.29
REST OF WASHINGTON (WA)	$124.41	$95.22
WISCONSIN (WI)	$111.87	$85.31
WEST VIRGINIA (WV)	$126.76	$102.67
WYOMING** (WY)	$120.91	$93.19

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 pricing starts with three Relative Value Units (RVUs) assigned to the 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 performed, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice expense RVUs differ between non-facility and facility settings because overhead costs (staff, supplies, equipment) are treated differently depending on where the service is rendered, which is why the same code can have two different allowed amounts. The conversion factor itself is updated annually and can change due to legislative or budget-neutrality adjustments.

RVUs — work 1.95, practice expense 1.3 (non-facility) / 0.47 (facility), malpractice 0.5 — × 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 Part B deductible; the patient or secondary insurance is responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral adjustments, and sequestration can change the final paid amount.
Locality-specific GPCIs and annual budget-neutrality adjustments mean amounts can shift from year to year or region to region.
Always verify the current fee schedule amount and any applicable edits with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount for CPT 15151?

In a facility setting (like a hospital), the facility itself bills separately for overhead costs such as equipment and staff, so the physician's practice expense RVU — and therefore the PFS amount — is lower than when the same service is performed in a non-facility setting like a private office.

Does the amount shown reflect what Medicare will actually pay?

No. The figure is the Medicare-allowed amount before the standard 20% coinsurance and any unmet deductible are applied, and it does not account for modifiers, sequestration, or other adjustments specific to a claim.

Why do amounts vary by locality?

Medicare adjusts RVUs using Geographic Practice Cost Indices (GPCIs) that reflect regional differences in wages, rents, and malpractice costs, so the same code can have different allowed amounts depending on where the service is billed.

Will this amount change next year?

Yes, it can. The conversion factor and RVUs are reviewed and may be updated annually, and budget-neutrality requirements or legislative changes can also affect the final allowed 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.