Medicare Reimbursement for CPT 15157

CPT 15157 is a procedure code reported to Medicare and other payers; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both at the national level and adjustable by locality, and separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$189.05	$147.97
ALASKA* (AK)	$230.35	$186.59
ALABAMA (AL)	$169.50	$133.55
ARKANSAS (AR)	$167.12	$131.82
ARIZONA (AZ)	$183.24	$143.43
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$209.74	$151.81
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$212.54	$153.30
OXNARD-THOUSAND OAKS-VENTURA (CA)	$193.63	$145.07
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$196.05	$147.45
NAPA (CA)	$202.84	$148.69
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$210.64	$152.71
VALLEJO (CA)	$201.55	$147.40
BAKERSFIELD (CA)	$186.81	$141.78
CHICO (CA)	$184.69	$139.66
FRESNO (CA)	$184.69	$139.66
HANFORD-CORCORAN (CA)	$184.69	$139.66
MADERA (CA)	$184.69	$139.66
MERCED (CA)	$184.69	$139.66
MODESTO (CA)	$184.69	$139.66
REDDING (CA)	$184.69	$139.66
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$193.15	$148.13
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$190.89	$143.11
SALINAS (CA)	$190.14	$142.53
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$216.21	$156.97
SANTA CRUZ-WATSONVILLE (CA)	$192.79	$142.88
SANTA ROSA-PETALUMA (CA)	$194.52	$144.07
STOCKTON (CA)	$184.69	$139.66
VISALIA (CA)	$184.69	$139.66
YUBA CITY (CA)	$184.69	$139.66
EL CENTRO (CA)	$184.82	$139.79
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$192.60	$143.46
SAN LUIS OBISPO-PASO ROBLES (CA)	$187.48	$140.68
SANTA MARIA-SANTA BARBARA (CA)	$190.30	$142.40
REST OF CALIFORNIA (CA)	$184.69	$139.66
COLORADO (CO)	$188.59	$144.88
CONNECTICUT (CT)	$201.54	$157.29
DC + MD/VA SUBURBS (DC)	$208.85	$160.45
DELAWARE (DE)	$186.10	$145.51
FORT LAUDERDALE (FL)	$211.21	$169.59
MIAMI (FL)	$232.05	$189.28
REST OF FLORIDA (FL)	$199.47	$160.20
ATLANTA (GA)	$195.68	$153.94
REST OF GEORGIA (GA)	$187.12	$150.47
HAWAII, GUAM (HI)	$186.82	$140.11
IOWA (IA)	$167.63	$130.04
IDAHO (ID)	$169.96	$132.16
EAST ST. LOUIS (IL)	$210.62	$172.82
SUBURBAN CHICAGO (IL)	$211.85	$169.66
CHICAGO (IL)	$224.23	$182.94
REST OF ILLINOIS (IL)	$198.27	$160.76
INDIANA (IN)	$170.76	$132.67
KANSAS (KS)	$169.74	$132.60
KENTUCKY (KY)	$179.61	$143.09
NEW ORLEANS (LA)	$188.81	$150.16
REST OF LOUISIANA (LA)	$180.49	$144.13
METROPOLITAN BOSTON (MA)	$202.73	$153.68
REST OF MASSACHUSETTS (MA)	$188.69	$145.43
BALTIMORE/SURR. CNTYS (MD)	$201.60	$157.52
REST OF MARYLAND (MD)	$188.64	$147.07
SOUTHERN MAINE (ME)	$178.73	$138.02
REST OF MAINE (ME)	$173.89	$136.09
DETROIT (MI)	$204.88	$165.24
REST OF MICHIGAN (MI)	$186.82	$149.31
MINNESOTA (MN)	$172.35	$130.08
METROPOLITAN ST. LOUIS (MO)	$185.99	$146.88
METROPOLITAN KANSAS CITY (MO)	$184.49	$145.91
REST OF MISSOURI (MO)	$179.42	$144.01
MISSISSIPPI (MS)	$173.16	$137.78
MONTANA** (MT)	$189.00	$147.91
NORTH CAROLINA (NC)	$175.18	$136.85
NORTH DAKOTA** (ND)	$173.38	$132.29
NEBRASKA (NE)	$167.65	$129.73
NEW HAMPSHIRE (NH)	$188.41	$145.64
NORTHERN NJ (NJ)	$207.38	$159.72
REST OF NEW JERSEY (NJ)	$201.48	$156.62
NEW MEXICO (NM)	$188.97	$151.30
NEVADA** (NV)	$184.71	$143.58
MANHATTAN (NY)	$221.27	$173.53
NYC SUBURBS/LONG ISLAND (NY)	$230.17	$181.32
POUGHKPSIE/N NYC SUBURBS (NY)	$205.15	$160.16
QUEENS (NY)	$218.77	$170.21
REST OF NEW YORK (NY)	$177.97	$138.94
OHIO (OH)	$183.62	$146.11
OKLAHOMA (OK)	$176.23	$139.54
PORTLAND (OR)	$191.05	$145.41
REST OF OREGON (OR)	$180.95	$140.03
METROPOLITAN PHILADELPHIA (PA)	$198.56	$155.79
REST OF PENNSYLVANIA (PA)	$182.28	$144.57
PUERTO RICO (PR)	$189.37	$147.83
RHODE ISLAND (RI)	$190.20	$147.76
SOUTH CAROLINA (SC)	$180.17	$142.21
SOUTH DAKOTA** (SD)	$171.53	$130.45
TENNESSEE (TN)	$170.94	$133.59
BRAZORIA (TX)	$183.44	$142.73
DALLAS (TX)	$185.92	$145.00
GALVESTON (TX)	$184.84	$144.04
HOUSTON (TX)	$199.30	$158.50
BEAUMONT (TX)	$181.34	$143.96
FORT WORTH (TX)	$185.62	$145.11
AUSTIN (TX)	$190.00	$146.53
REST OF TEXAS (TX)	$183.18	$144.20
UTAH (UT)	$182.47	$143.85
VIRGINIA (VA)	$180.19	$139.81
VIRGIN ISLANDS (VI)	$189.37	$147.83
VERMONT (VT)	$175.37	$134.69
SEATTLE (KING CNTY) (WA)	$203.82	$153.41
REST OF WASHINGTON (WA)	$187.45	$144.19
WISCONSIN (WI)	$168.07	$128.71
WEST VIRGINIA (WV)	$191.93	$156.23
WYOMING** (WY)	$182.19	$141.11

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit 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 performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why the two allowed amounts shown differ. These figures represent the total allowed amount before any patient cost-sharing is applied.

RVUs — work 2.93, practice expense 1.94 (non-facility) / 0.71 (facility), malpractice 0.79 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement can vary.
Medicare typically pays 80% of the allowed amount after the Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean the actual rate in your area may differ from the national figure shown.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount for CPT 15157?

Facility amounts use a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is separately billing for overhead, supplies, and staff, whereas non-facility settings like a physician's office bear those costs directly.

Does this amount reflect what the patient will owe?

No. The figures shown are the total Medicare-allowed amount. After the Part B deductible, Medicare generally pays 80% and the patient or secondary payer is responsible for the remaining 20%, subject to any applicable modifiers or secondary coverage.

Will my local Medicare rate match the national amount shown?

Not necessarily. The national figure uses a GPCI value of 1.00 for all cost components, while actual local rates are adjusted by that locality's specific GPCIs for work, practice expense, and malpractice.

Why can't you show the CPT code description?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so we reference the code generically rather than reproducing the official descriptor.

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.