Medicare Reimbursement for CPT 15200

CPT 15200 is a procedure code defined by the American Medical Association; its specific clinical description is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjustable by locality, and separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$875.77	$605.22
ALASKA* (AK)	$1036.55	$748.41
ALABAMA (AL)	$788.06	$551.33
ARKANSAS (AR)	$777.06	$544.66
ARIZONA (AZ)	$852.20	$590.04
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1091.64	$710.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1111.59	$721.46
OXNARD-THOUSAND OAKS-VENTURA (CA)	$961.27	$641.49
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$967.73	$647.67
NAPA (CA)	$1037.71	$681.13
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1093.34	$711.87
VALLEJO (CA)	$1035.26	$678.67
BAKERSFIELD (CA)	$912.51	$615.99
CHICO (CA)	$908.25	$611.73
FRESNO (CA)	$908.25	$611.73
HANFORD-CORCORAN (CA)	$908.25	$611.73
MADERA (CA)	$908.25	$611.73
MERCED (CA)	$908.25	$611.73
MODESTO (CA)	$908.25	$611.73
REDDING (CA)	$908.25	$611.73
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$924.43	$627.91
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$949.27	$634.62
SALINAS (CA)	$945.67	$632.11
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1118.56	$728.43
SANTA CRUZ-WATSONVILLE (CA)	$972.24	$643.53
SANTA ROSA-PETALUMA (CA)	$981.79	$649.55
STOCKTON (CA)	$908.25	$611.73
VISALIA (CA)	$908.25	$611.73
YUBA CITY (CA)	$908.25	$611.73
EL CENTRO (CA)	$908.50	$611.98
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$965.20	$641.62
SAN LUIS OBISPO-PASO ROBLES (CA)	$930.94	$622.79
SANTA MARIA-SANTA BARBARA (CA)	$948.47	$633.01
REST OF CALIFORNIA (CA)	$908.25	$611.73
COLORADO (CO)	$902.15	$614.29
CONNECTICUT (CT)	$932.89	$641.51
DC + MD/VA SUBURBS (DC)	$991.46	$672.75
DELAWARE (DE)	$865.87	$598.57
FORT LAUDERDALE (FL)	$923.11	$649.05
MIAMI (FL)	$974.01	$692.37
REST OF FLORIDA (FL)	$877.75	$619.11
ATLANTA (GA)	$895.18	$620.30
REST OF GEORGIA (GA)	$828.40	$587.07
HAWAII, GUAM (HI)	$926.98	$619.37
IOWA (IA)	$800.70	$553.15
IDAHO (ID)	$807.15	$558.25
EAST ST. LOUIS (IL)	$884.36	$635.45
SUBURBAN CHICAGO (IL)	$930.78	$652.93
CHICAGO (IL)	$945.38	$673.48
REST OF ILLINOIS (IL)	$858.07	$611.06
INDIANA (IN)	$811.49	$560.70
KANSAS (KS)	$800.26	$555.68
KENTUCKY (KY)	$812.93	$572.42
NEW ORLEANS (LA)	$851.45	$596.86
REST OF LOUISIANA (LA)	$812.98	$573.54
METROPOLITAN BOSTON (MA)	$984.86	$661.82
REST OF MASSACHUSETTS (MA)	$898.34	$613.45
BALTIMORE/SURR. CNTYS (MD)	$930.94	$640.64
REST OF MARYLAND (MD)	$880.98	$607.18
SOUTHERN MAINE (ME)	$852.53	$584.42
REST OF MAINE (ME)	$814.61	$565.71
DETROIT (MI)	$891.67	$630.59
REST OF MICHIGAN (MI)	$836.32	$589.31
MINNESOTA (MN)	$855.80	$577.41
METROPOLITAN ST. LOUIS (MO)	$850.54	$592.98
METROPOLITAN KANSAS CITY (MO)	$842.43	$588.38
REST OF MISSOURI (MO)	$801.64	$568.43
MISSISSIPPI (MS)	$789.34	$556.40
MONTANA** (MT)	$875.67	$605.12
NORTH CAROLINA (NC)	$822.33	$569.91
NORTH DAKOTA** (ND)	$846.01	$575.46
NEBRASKA (NE)	$803.97	$554.26
NEW HAMPSHIRE (NH)	$891.15	$609.51
NORTHERN NJ (NJ)	$982.39	$668.55
REST OF NEW JERSEY (NJ)	$941.10	$645.66
NEW MEXICO (NM)	$842.04	$593.95
NEVADA** (NV)	$867.93	$597.11
MANHATTAN (NY)	$1009.69	$695.32
NYC SUBURBS/LONG ISLAND (NY)	$1037.52	$715.84
POUGHKPSIE/N NYC SUBURBS (NY)	$949.83	$653.59
QUEENS (NY)	$1013.03	$693.25
REST OF NEW YORK (NY)	$834.50	$577.48
OHIO (OH)	$830.26	$583.25
OKLAHOMA (OK)	$808.13	$566.53
PORTLAND (OR)	$926.29	$625.71
REST OF OREGON (OR)	$858.78	$589.32
METROPOLITAN PHILADELPHIA (PA)	$912.44	$630.80
REST OF PENNSYLVANIA (PA)	$829.74	$581.38
PUERTO RICO (PR)	$880.83	$607.30
RHODE ISLAND (RI)	$893.44	$613.96
SOUTH CAROLINA (SC)	$828.15	$578.16
SOUTH DAKOTA** (SD)	$842.50	$571.96
TENNESSEE (TN)	$804.55	$558.62
BRAZORIA (TX)	$862.38	$594.27
DALLAS (TX)	$869.23	$599.76
GALVESTON (TX)	$865.84	$597.19
HOUSTON (TX)	$893.30	$624.65
BEAUMONT (TX)	$824.72	$578.52
FORT WORTH (TX)	$864.60	$597.84
AUSTIN (TX)	$901.26	$615.03
REST OF TEXAS (TX)	$844.00	$587.25
UTAH (UT)	$839.00	$584.68
VIRGINIA (VA)	$852.07	$586.12
VIRGIN ISLANDS (VI)	$880.83	$607.30
VERMONT (VT)	$845.74	$577.90
SEATTLE (KING CNTY) (WA)	$1001.30	$669.33
REST OF WASHINGTON (WA)	$895.64	$610.75
WISCONSIN (WI)	$818.94	$559.75
WEST VIRGINIA (WV)	$828.23	$593.13
WYOMING** (WY)	$862.75	$592.20

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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: 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 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 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 resource costs differ, which is why the two settings show different allowed amounts. These figures are recalculated each year as RVUs, GPCIs, and the conversion factor are updated by CMS.

RVUs — work 8.92, practice expense 15.8 (non-facility) / 7.7 (facility), malpractice 1.5 — × 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 annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality adjustments.
Always confirm the current, locality-specific amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility amount different from the non-facility amount?

The practice expense RVU is lower in the facility setting because the facility (not the physician's office) absorbs certain overhead costs like equipment and supplies, so the total allowed amount is typically lower than in a non-facility setting.

Does this amount apply to my specific locality?

The national amount is a baseline; actual payment is adjusted using locality-specific GPCIs, so amounts can be higher or lower depending on where the service is furnished.

Why did the amount change from last year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and these updates — along with budget-neutrality adjustments — can raise or lower the allowed amount year over year.

Can modifiers affect this amount?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the final allowed amount relative to the base PFS rate shown here.

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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.