Medicare Reimbursement for CPT 15221

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and shows its Medicare Physician Fee Schedule (PFS) allowed amount for 2026. Amounts are presented both as a national average and adjusted for locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$133.94	$57.78
ALASKA* (AK)	$156.06	$74.96
ALABAMA (AL)	$119.97	$53.34
ARKANSAS (AR)	$118.22	$52.80
ARIZONA (AZ)	$130.23	$56.44
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$170.07	$62.69
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$173.29	$63.48
OXNARD-THOUSAND OAKS-VENTURA (CA)	$148.61	$58.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$149.48	$59.39
NAPA (CA)	$161.24	$60.87
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$170.29	$62.92
VALLEJO (CA)	$160.91	$60.54
BAKERSFIELD (CA)	$140.56	$57.09
CHICO (CA)	$139.99	$56.53
FRESNO (CA)	$139.99	$56.53
HANFORD-CORCORAN (CA)	$139.99	$56.53
MADERA (CA)	$139.99	$56.53
MERCED (CA)	$139.99	$56.53
MODESTO (CA)	$139.99	$56.53
REDDING (CA)	$139.99	$56.53
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$142.15	$58.69
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$146.66	$58.09
SALINAS (CA)	$146.11	$57.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$174.22	$64.41
SANTA CRUZ-WATSONVILLE (CA)	$150.68	$58.15
SANTA ROSA-PETALUMA (CA)	$152.18	$58.66
STOCKTON (CA)	$139.99	$56.53
VISALIA (CA)	$139.99	$56.53
YUBA CITY (CA)	$139.99	$56.53
EL CENTRO (CA)	$140.03	$56.56
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$149.39	$58.31
SAN LUIS OBISPO-PASO ROBLES (CA)	$143.80	$57.06
SANTA MARIA-SANTA BARBARA (CA)	$146.62	$57.82
REST OF CALIFORNIA (CA)	$139.99	$56.53
COLORADO (CO)	$138.60	$57.58
CONNECTICUT (CT)	$142.93	$60.91
DC + MD/VA SUBURBS (DC)	$152.54	$62.83
DELAWARE (DE)	$132.39	$57.15
FORT LAUDERDALE (FL)	$140.49	$63.34
MIAMI (FL)	$147.78	$68.50
REST OF FLORIDA (FL)	$133.40	$60.60
ATLANTA (GA)	$136.81	$59.44
REST OF GEORGIA (GA)	$125.66	$57.73
HAWAII, GUAM (HI)	$143.25	$56.66
IOWA (IA)	$122.39	$52.70
IDAHO (ID)	$123.34	$53.27
EAST ST. LOUIS (IL)	$133.63	$63.57
SUBURBAN CHICAGO (IL)	$141.76	$63.55
CHICAGO (IL)	$143.30	$66.77
REST OF ILLINOIS (IL)	$130.00	$60.47
INDIANA (IN)	$124.04	$53.45
KANSAS (KS)	$122.13	$53.28
KENTUCKY (KY)	$123.54	$55.84
NEW ORLEANS (LA)	$129.62	$57.96
REST OF LOUISIANA (LA)	$123.48	$56.08
METROPOLITAN BOSTON (MA)	$151.96	$61.03
REST OF MASSACHUSETTS (MA)	$137.89	$57.70
BALTIMORE/SURR. CNTYS (MD)	$142.60	$60.89
REST OF MARYLAND (MD)	$134.84	$57.77
SOUTHERN MAINE (ME)	$130.68	$55.21
REST OF MAINE (ME)	$124.33	$54.27
DETROIT (MI)	$135.42	$61.93
REST OF MICHIGAN (MI)	$127.10	$57.57
MINNESOTA (MN)	$131.80	$53.44
METROPOLITAN ST. LOUIS (MO)	$129.70	$57.20
METROPOLITAN KANSAS CITY (MO)	$128.38	$56.88
REST OF MISSOURI (MO)	$121.55	$55.90
MISSISSIPPI (MS)	$119.89	$54.32
MONTANA** (MT)	$133.92	$57.77
NORTH CAROLINA (NC)	$125.60	$54.54
NORTH DAKOTA** (ND)	$129.97	$53.82
NEBRASKA (NE)	$122.97	$52.68
NEW HAMPSHIRE (NH)	$136.73	$57.46
NORTHERN NJ (NJ)	$150.99	$62.66
REST OF NEW JERSEY (NJ)	$144.28	$61.12
NEW MEXICO (NM)	$127.93	$58.10
NEVADA** (NV)	$132.91	$56.68
MANHATTAN (NY)	$154.67	$66.18
NYC SUBURBS/LONG ISLAND (NY)	$158.87	$68.32
POUGHKPSIE/N NYC SUBURBS (NY)	$145.49	$62.10
QUEENS (NY)	$155.48	$65.47
REST OF NEW YORK (NY)	$127.53	$55.18
OHIO (OH)	$126.29	$56.76
OKLAHOMA (OK)	$122.98	$54.97
PORTLAND (OR)	$142.67	$58.07
REST OF OREGON (OR)	$131.60	$55.75
METROPOLITAN PHILADELPHIA (PA)	$139.55	$60.28
REST OF PENNSYLVANIA (PA)	$126.31	$56.40
PUERTO RICO (PR)	$134.81	$57.82
RHODE ISLAND (RI)	$136.87	$58.21
SOUTH CAROLINA (SC)	$126.21	$55.84
SOUTH DAKOTA** (SD)	$129.50	$53.35
TENNESSEE (TN)	$122.79	$53.57
BRAZORIA (TX)	$131.98	$56.51
DALLAS (TX)	$132.98	$57.13
GALVESTON (TX)	$132.48	$56.86
HOUSTON (TX)	$136.14	$60.52
BEAUMONT (TX)	$125.50	$56.20
FORT WORTH (TX)	$132.19	$57.10
AUSTIN (TX)	$138.39	$57.82
REST OF TEXAS (TX)	$128.78	$56.51
UTAH (UT)	$127.95	$56.36
VIRGINIA (VA)	$130.47	$55.61
VIRGIN ISLANDS (VI)	$134.81	$57.82
VERMONT (VT)	$129.75	$54.36
SEATTLE (KING CNTY) (WA)	$154.74	$61.30
REST OF WASHINGTON (WA)	$137.54	$57.35
WISCONSIN (WI)	$125.60	$52.64
WEST VIRGINIA (WV)	$125.22	$59.04
WYOMING** (WY)	$132.20	$56.05

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 9 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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is billed. These locality-adjusted RVUs are summed and then multiplied by the annual Conversion Factor (CF) to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the same code can have two different allowed amounts depending on place of service.

RVUs — work 1.16, practice expense 2.65 (non-facility) / 0.37 (facility), malpractice 0.2 — × 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 generally responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Figures shown are national/locality PFS estimates — always confirm the exact amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount for the same code?

Facility and non-facility rates use different practice-expense RVUs, reflecting the fact that overhead costs (equipment, supplies, staff time) are typically borne by the facility rather than the billing physician when a service is performed in a hospital or other facility setting.

Is the amount shown what Medicare will actually pay?

No. It's an estimated allowed amount based on standard PFS calculations. Medicare generally reimburses 80% of the allowed amount after the deductible, and actual payment can be affected by modifiers, sequestration, and locality-specific adjustments.

Why isn't the CPT code description shown?

CPT code descriptors are copyrighted by the American Medical Association (AMA) and cannot be reproduced here. Billers should refer to their CPT codebook or EHR system for the official descriptor.

Why do allowed amounts vary by locality?

Medicare adjusts payment for geographic differences in the cost of practicing medicine using GPCIs, which affect the work, practice expense, and malpractice RVU components differently in each locality.

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.