Medicare Reimbursement for CPT 15220

This page covers CPT code 15220, a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). It shows the estimated Medicare allowed amount nationally and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$782.92	$537.75
ALASKA* (AK)	$929.22	$668.12
ALABAMA (AL)	$706.43	$491.92
ARKANSAS (AR)	$696.82	$486.22
ARIZONA (AZ)	$762.59	$525.03
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$984.05	$638.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1002.38	$648.86
OXNARD-THOUSAND OAKS-VENTURA (CA)	$863.91	$574.13
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$869.35	$579.33
NAPA (CA)	$934.38	$611.26
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$985.32	$639.64
VALLEJO (CA)	$932.55	$609.43
BAKERSFIELD (CA)	$819.57	$550.87
CHICO (CA)	$816.31	$547.61
FRESNO (CA)	$816.31	$547.61
HANFORD-CORCORAN (CA)	$816.31	$547.61
MADERA (CA)	$816.31	$547.61
MERCED (CA)	$816.31	$547.61
MODESTO (CA)	$816.31	$547.61
REDDING (CA)	$816.31	$547.61
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$828.43	$559.73
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$853.61	$568.48
SALINAS (CA)	$850.36	$566.22
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1007.58	$654.06
SANTA CRUZ-WATSONVILLE (CA)	$874.72	$576.85
SANTA ROSA-PETALUMA (CA)	$883.36	$582.30
STOCKTON (CA)	$816.31	$547.61
VISALIA (CA)	$816.31	$547.61
YUBA CITY (CA)	$816.31	$547.61
EL CENTRO (CA)	$816.50	$547.80
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$868.16	$574.94
SAN LUIS OBISPO-PASO ROBLES (CA)	$837.03	$557.79
SANTA MARIA-SANTA BARBARA (CA)	$852.95	$567.09
REST OF CALIFORNIA (CA)	$816.31	$547.61
COLORADO (CO)	$808.73	$547.88
CONNECTICUT (CT)	$833.16	$569.12
DC + MD/VA SUBURBS (DC)	$887.17	$598.37
DELAWARE (DE)	$774.67	$532.45
FORT LAUDERDALE (FL)	$819.41	$571.06
MIAMI (FL)	$859.88	$604.66
REST OF FLORIDA (FL)	$780.53	$546.15
ATLANTA (GA)	$798.94	$549.85
REST OF GEORGIA (GA)	$738.05	$519.36
HAWAII, GUAM (HI)	$833.20	$554.45
IOWA (IA)	$719.39	$495.07
IDAHO (ID)	$724.64	$499.09
EAST ST. LOUIS (IL)	$782.29	$556.74
SUBURBAN CHICAGO (IL)	$826.65	$574.87
CHICAGO (IL)	$835.62	$589.23
REST OF ILLINOIS (IL)	$762.05	$538.21
INDIANA (IN)	$728.50	$501.24
KANSAS (KS)	$718.09	$496.47
KENTUCKY (KY)	$726.24	$508.29
NEW ORLEANS (LA)	$759.57	$528.87
REST OF LOUISIANA (LA)	$725.92	$508.95
METROPOLITAN BOSTON (MA)	$883.11	$590.39
REST OF MASSACHUSETTS (MA)	$805.08	$546.93
BALTIMORE/SURR. CNTYS (MD)	$831.18	$568.12
REST OF MARYLAND (MD)	$788.27	$540.16
SOUTHERN MAINE (ME)	$764.78	$521.82
REST OF MAINE (ME)	$730.22	$504.67
DETROIT (MI)	$791.71	$555.13
REST OF MICHIGAN (MI)	$745.81	$521.98
MINNESOTA (MN)	$770.56	$518.29
METROPOLITAN ST. LOUIS (MO)	$759.86	$526.46
METROPOLITAN KANSAS CITY (MO)	$752.66	$522.45
REST OF MISSOURI (MO)	$715.43	$504.10
MISSISSIPPI (MS)	$706.16	$495.07
MONTANA** (MT)	$782.84	$537.68
NORTH CAROLINA (NC)	$737.12	$508.38
NORTH DAKOTA** (ND)	$760.70	$515.53
NEBRASKA (NE)	$722.54	$496.25
NEW HAMPSHIRE (NH)	$798.00	$542.79
NORTHERN NJ (NJ)	$879.18	$594.79
REST OF NEW JERSEY (NJ)	$841.43	$573.71
NEW MEXICO (NM)	$750.43	$525.62
NEVADA** (NV)	$777.15	$531.74
MANHATTAN (NY)	$899.78	$614.91
NYC SUBURBS/LONG ISLAND (NY)	$922.94	$631.44
POUGHKPSIE/N NYC SUBURBS (NY)	$848.42	$579.97
QUEENS (NY)	$904.04	$614.26
REST OF NEW YORK (NY)	$747.71	$514.80
OHIO (OH)	$741.28	$517.45
OKLAHOMA (OK)	$723.00	$504.07
PORTLAND (OR)	$831.06	$558.68
REST OF OREGON (OR)	$769.88	$525.70
METROPOLITAN PHILADELPHIA (PA)	$814.64	$559.43
REST OF PENNSYLVANIA (PA)	$741.34	$516.28
PUERTO RICO (PR)	$787.66	$539.80
RHODE ISLAND (RI)	$799.79	$546.54
SOUTH CAROLINA (SC)	$740.68	$514.15
SOUTH DAKOTA** (SD)	$758.08	$512.91
TENNESSEE (TN)	$721.74	$498.88
BRAZORIA (TX)	$772.46	$529.50
DALLAS (TX)	$778.05	$533.87
GALVESTON (TX)	$775.22	$531.77
HOUSTON (TX)	$795.72	$552.27
BEAUMONT (TX)	$736.88	$513.79
FORT WORTH (TX)	$773.72	$531.99
AUSTIN (TX)	$807.13	$547.75
REST OF TEXAS (TX)	$754.71	$522.05
UTAH (UT)	$750.18	$519.73
VIRGINIA (VA)	$763.73	$522.73
VIRGIN ISLANDS (VI)	$787.66	$539.80
VERMONT (VT)	$759.62	$516.91
SEATTLE (KING CNTY) (WA)	$898.66	$597.84
REST OF WASHINGTON (WA)	$802.95	$544.79
WISCONSIN (WI)	$736.79	$501.92
WEST VIRGINIA (WV)	$735.90	$522.86
WYOMING** (WY)	$773.19	$528.03

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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 PFS amounts are 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 performed, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly in the practice-expense RVU, since facility settings (like hospitals) typically have the facility, not the physician, absorbing overhead costs. This results in a lower facility rate compared to non-facility for the same code.

RVUs — work 7.89, practice expense 14.43 (non-facility) / 7.09 (facility), malpractice 1.12 — × 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 the Part B deductible; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claims-processing adjustments, sequestration, and annual budget-neutrality adjustments to the conversion factor.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility rate lower than the non-facility rate for CPT 15220?

The facility rate uses a lower practice-expense RVU because the facility (e.g., hospital) bears the overhead costs instead of the physician's own practice, resulting in a reduced payment to the billing physician.

Why does the Medicare payment differ by locality for the same code?

Each locality has its own GPCI values for work, practice expense, and malpractice, reflecting regional cost differences in wages, rent, and liability insurance, which adjust the RVUs before the conversion factor is applied.

Does this amount reflect what the patient or secondary insurer will pay?

No. The figures shown represent the Medicare-allowed amount; Medicare generally pays 80% of this after the deductible, with the remaining 20% owed by the patient or a secondary payer.

Can modifiers change the reimbursement for CPT 15220?

Yes. Modifiers (e.g., for bilateral procedures, reduced services, or multiple procedure reductions) can increase or decrease the final payment relative to the base PFS amount 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.