Medicare Reimbursement for CPT 15201

CPT 15201 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, nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$148.30	$64.80
ALASKA* (AK)	$172.73	$83.80
ALABAMA (AL)	$132.77	$59.71
ARKANSAS (AR)	$130.82	$59.09
ARIZONA (AZ)	$144.17	$63.26
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$187.96	$70.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$191.52	$71.11
OXNARD-THOUSAND OAKS-VENTURA (CA)	$164.36	$65.66
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$165.33	$66.55
NAPA (CA)	$178.25	$68.19
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$188.22	$70.49
VALLEJO (CA)	$177.87	$67.82
BAKERSFIELD (CA)	$155.48	$63.96
CHICO (CA)	$154.83	$63.31
FRESNO (CA)	$154.83	$63.31
HANFORD-CORCORAN (CA)	$154.83	$63.31
MADERA (CA)	$154.83	$63.31
MERCED (CA)	$154.83	$63.31
MODESTO (CA)	$154.83	$63.31
REDDING (CA)	$154.83	$63.31
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$157.31	$65.79
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$162.18	$65.07
SALINAS (CA)	$161.58	$64.80
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$192.58	$72.17
SANTA CRUZ-WATSONVILLE (CA)	$166.61	$65.15
SANTA ROSA-PETALUMA (CA)	$168.27	$65.72
STOCKTON (CA)	$154.83	$63.31
VISALIA (CA)	$154.83	$63.31
YUBA CITY (CA)	$154.83	$63.31
EL CENTRO (CA)	$154.87	$63.35
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$165.19	$65.32
SAN LUIS OBISPO-PASO ROBLES (CA)	$159.02	$63.92
SANTA MARIA-SANTA BARBARA (CA)	$162.13	$64.77
REST OF CALIFORNIA (CA)	$154.83	$63.31
COLORADO (CO)	$153.38	$64.53
CONNECTICUT (CT)	$158.28	$68.35
DC + MD/VA SUBURBS (DC)	$168.86	$70.49
DELAWARE (DE)	$146.57	$64.07
FORT LAUDERDALE (FL)	$155.78	$71.19
MIAMI (FL)	$164.04	$77.12
REST OF FLORIDA (FL)	$147.87	$68.04
ATLANTA (GA)	$151.53	$66.70
REST OF GEORGIA (GA)	$139.24	$64.76
HAWAII, GUAM (HI)	$158.43	$63.49
IOWA (IA)	$135.38	$58.97
IDAHO (ID)	$136.45	$59.63
EAST ST. LOUIS (IL)	$148.29	$71.47
SUBURBAN CHICAGO (IL)	$157.17	$71.41
CHICAGO (IL)	$159.04	$75.12
REST OF ILLINOIS (IL)	$144.14	$67.90
INDIANA (IN)	$137.23	$59.83
KANSAS (KS)	$135.13	$59.64
KENTUCKY (KY)	$136.82	$62.59
NEW ORLEANS (LA)	$143.59	$65.01
REST OF LOUISIANA (LA)	$136.76	$62.86
METROPOLITAN BOSTON (MA)	$168.14	$68.44
REST OF MASSACHUSETTS (MA)	$152.60	$64.67
BALTIMORE/SURR. CNTYS (MD)	$157.93	$68.33
REST OF MARYLAND (MD)	$149.27	$64.77
SOUTHERN MAINE (ME)	$144.59	$61.84
REST OF MAINE (ME)	$137.59	$60.77
DETROIT (MI)	$150.16	$69.58
REST OF MICHIGAN (MI)	$140.81	$64.57
MINNESOTA (MN)	$145.72	$59.80
METROPOLITAN ST. LOUIS (MO)	$143.63	$64.14
METROPOLITAN KANSAS CITY (MO)	$142.17	$63.77
REST OF MISSOURI (MO)	$134.64	$62.66
MISSISSIPPI (MS)	$132.74	$60.84
MONTANA** (MT)	$148.28	$64.78
NORTH CAROLINA (NC)	$138.99	$61.08
NORTH DAKOTA** (ND)	$143.74	$60.23
NEBRASKA (NE)	$136.01	$58.94
NEW HAMPSHIRE (NH)	$151.34	$64.41
NORTHERN NJ (NJ)	$167.14	$70.28
REST OF NEW JERSEY (NJ)	$159.74	$68.56
NEW MEXICO (NM)	$141.75	$65.18
NEVADA** (NV)	$147.11	$63.53
MANHATTAN (NY)	$171.36	$74.33
NYC SUBURBS/LONG ISLAND (NY)	$176.07	$76.79
POUGHKPSIE/N NYC SUBURBS (NY)	$161.12	$69.68
QUEENS (NY)	$172.20	$73.50
REST OF NEW YORK (NY)	$141.14	$61.81
OHIO (OH)	$139.88	$63.64
OKLAHOMA (OK)	$136.15	$61.58
PORTLAND (OR)	$157.85	$65.08
REST OF OREGON (OR)	$145.63	$62.46
METROPOLITAN PHILADELPHIA (PA)	$154.56	$67.63
REST OF PENNSYLVANIA (PA)	$139.88	$63.22
PUERTO RICO (PR)	$149.26	$64.84
RHODE ISLAND (RI)	$151.51	$65.25
SOUTH CAROLINA (SC)	$139.74	$62.58
SOUTH DAKOTA** (SD)	$143.20	$59.70
TENNESSEE (TN)	$135.87	$59.96
BRAZORIA (TX)	$146.08	$63.33
DALLAS (TX)	$147.21	$64.04
GALVESTON (TX)	$146.64	$63.72
HOUSTON (TX)	$150.85	$67.93
BEAUMONT (TX)	$138.98	$62.99
FORT WORTH (TX)	$146.33	$64.00
AUSTIN (TX)	$153.17	$64.82
REST OF TEXAS (TX)	$142.58	$63.34
UTAH (UT)	$141.66	$63.17
VIRGINIA (VA)	$144.38	$62.30
VIRGIN ISLANDS (VI)	$149.26	$64.84
VERMONT (VT)	$143.53	$60.86
SEATTLE (KING CNTY) (WA)	$171.19	$68.73
REST OF WASHINGTON (WA)	$152.19	$64.27
WISCONSIN (WI)	$138.89	$58.89
WEST VIRGINIA (WV)	$138.83	$66.27
WYOMING** (WY)	$146.30	$62.80

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 7 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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. These locality-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, since overhead costs differ between the two; typically the non-facility rate is higher because it reflects the practice absorbing more direct costs. The conversion factor itself is set annually by CMS and applies uniformly across all codes before locality adjustments.

RVUs — work 1.29, practice expense 2.92 (non-facility) / 0.42 (facility), malpractice 0.23 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

Figures shown are estimates 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.
Actual payment can vary by locality GPCI values, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

Facility pricing uses a lower practice-expense RVU because the facility (e.g., hospital) — not the billing practice — absorbs certain overhead and resource costs when the service is performed there.

Will my locality's payment match the national amount shown?

No. The national amount uses a GPCI value of 1.0 for illustration; actual payments are adjusted up or down based on your locality's specific wage, rent, and malpractice cost indices.

Does this amount include the patient's coinsurance?

No. The figure represents the full Medicare-allowed amount. Medicare generally pays 80% of this after the deductible, with the remaining 20% owed by the patient or secondary payer.

Can modifiers change this amount?

Yes. Modifiers (such as for bilateral procedures, reduced services, or multiple procedure reductions) can increase or decrease the final paid amount relative to the base fee schedule rate shown here.

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.