Medicare Reimbursement for CPT 15240

CPT 15240 is a procedure code used in Medicare billing; the full code descriptor is proprietary to 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 adjusted by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$937.56	$698.08
ALASKA* (AK)	$1123.14	$868.09
ALABAMA (AL)	$849.02	$639.47
ARKANSAS (AR)	$837.89	$632.17
ARIZONA (AZ)	$913.99	$681.93
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1171.42	$833.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1192.99	$847.65
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1031.16	$748.09
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1037.94	$754.63
NAPA (CA)	$1113.28	$797.64
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1172.93	$835.25
VALLEJO (CA)	$1111.10	$795.46
BAKERSFIELD (CA)	$979.83	$717.36
CHICO (CA)	$975.91	$713.43
FRESNO (CA)	$975.91	$713.43
HANFORD-CORCORAN (CA)	$975.91	$713.43
MADERA (CA)	$975.91	$713.43
MERCED (CA)	$975.91	$713.43
MODESTO (CA)	$975.91	$713.43
REDDING (CA)	$975.91	$713.43
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$990.33	$727.86
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1019.48	$740.96
SALINAS (CA)	$1015.57	$738.00
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1199.16	$853.83
SANTA CRUZ-WATSONVILLE (CA)	$1043.21	$752.23
SANTA ROSA-PETALUMA (CA)	$1053.46	$759.37
STOCKTON (CA)	$975.91	$713.43
VISALIA (CA)	$975.91	$713.43
YUBA CITY (CA)	$975.91	$713.43
EL CENTRO (CA)	$976.13	$713.66
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1036.00	$749.57
SAN LUIS OBISPO-PASO ROBLES (CA)	$999.74	$726.96
SANTA MARIA-SANTA BARBARA (CA)	$1018.43	$739.19
REST OF CALIFORNIA (CA)	$975.91	$713.43
COLORADO (CO)	$967.37	$712.56
CONNECTICUT (CT)	$996.34	$738.42
DC + MD/VA SUBURBS (DC)	$1059.52	$777.41
DELAWARE (DE)	$928.12	$691.51
FORT LAUDERDALE (FL)	$980.66	$738.06
MIAMI (FL)	$1028.21	$778.90
REST OF FLORIDA (FL)	$935.53	$706.58
ATLANTA (GA)	$956.38	$713.06
REST OF GEORGIA (GA)	$886.25	$672.63
HAWAII, GUAM (HI)	$994.78	$722.48
IOWA (IA)	$863.68	$644.55
IDAHO (ID)	$869.82	$649.50
EAST ST. LOUIS (IL)	$938.28	$717.95
SUBURBAN CHICAGO (IL)	$989.19	$743.24
CHICAGO (IL)	$1000.24	$759.55
REST OF ILLINOIS (IL)	$914.37	$695.72
INDIANA (IN)	$874.28	$652.28
KANSAS (KS)	$862.33	$645.84
KENTUCKY (KY)	$872.28	$659.38
NEW ORLEANS (LA)	$910.91	$685.56
REST OF LOUISIANA (LA)	$871.97	$660.03
METROPOLITAN BOSTON (MA)	$1054.08	$768.13
REST OF MASSACHUSETTS (MA)	$963.34	$711.16
BALTIMORE/SURR. CNTYS (MD)	$993.97	$737.00
REST OF MARYLAND (MD)	$943.96	$701.60
SOUTHERN MAINE (ME)	$916.18	$678.85
REST OF MAINE (ME)	$876.44	$656.12
DETROIT (MI)	$948.64	$717.54
REST OF MICHIGAN (MI)	$895.09	$676.44
MINNESOTA (MN)	$922.36	$675.93
METROPOLITAN ST. LOUIS (MO)	$911.05	$683.07
METROPOLITAN KANSAS CITY (MO)	$902.74	$677.86
REST OF MISSOURI (MO)	$859.94	$653.50
MISSISSIPPI (MS)	$848.95	$642.75
MONTANA** (MT)	$937.47	$697.99
NORTH CAROLINA (NC)	$884.40	$660.96
NORTH DAKOTA** (ND)	$911.18	$671.69
NEBRASKA (NE)	$867.26	$646.22
NEW HAMPSHIRE (NH)	$954.73	$705.43
NORTHERN NJ (NJ)	$1050.60	$772.80
REST OF NEW JERSEY (NJ)	$1006.41	$744.90
NEW MEXICO (NM)	$900.50	$680.89
NEVADA** (NV)	$930.70	$690.97
MANHATTAN (NY)	$1075.06	$796.78
NYC SUBURBS/LONG ISLAND (NY)	$1102.06	$817.31
POUGHKPSIE/N NYC SUBURBS (NY)	$1014.79	$752.55
QUEENS (NY)	$1079.75	$796.67
REST OF NEW YORK (NY)	$896.66	$669.15
OHIO (OH)	$889.71	$671.06
OKLAHOMA (OK)	$868.37	$654.51
PORTLAND (OR)	$993.12	$727.06
REST OF OREGON (OR)	$922.15	$683.63
METROPOLITAN PHILADELPHIA (PA)	$974.96	$725.65
REST OF PENNSYLVANIA (PA)	$889.68	$669.84
PUERTO RICO (PR)	$942.99	$700.87
RHODE ISLAND (RI)	$957.49	$710.11
SOUTH CAROLINA (SC)	$888.79	$667.50
SOUTH DAKOTA** (SD)	$908.07	$668.58
TENNESSEE (TN)	$866.57	$648.88
BRAZORIA (TX)	$925.52	$688.19
DALLAS (TX)	$932.09	$693.56
GALVESTON (TX)	$928.76	$690.95
HOUSTON (TX)	$953.10	$715.29
BEAUMONT (TX)	$884.54	$666.61
FORT WORTH (TX)	$927.13	$690.99
AUSTIN (TX)	$965.32	$711.94
REST OF TEXAS (TX)	$904.99	$677.72
UTAH (UT)	$899.78	$674.67
VIRGINIA (VA)	$915.08	$679.67
VIRGIN ISLANDS (VI)	$942.99	$700.87
VERMONT (VT)	$910.08	$672.99
SEATTLE (KING CNTY) (WA)	$1072.17	$778.32
REST OF WASHINGTON (WA)	$960.72	$708.54
WISCONSIN (WI)	$883.55	$654.12
WEST VIRGINIA (WV)	$884.12	$676.01
WYOMING** (WY)	$926.01	$686.53

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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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is multiplied by a corresponding Geographic Practice Cost Index (GPCI) for the specific locality to account for regional cost differences, and the results are summed. That locality-adjusted RVU total is then multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility amounts differ mainly because the practice-expense RVU is lower in facility settings, reflecting that the facility (not the physician's office) bears certain overhead costs.

RVUs — work 10.15, practice expense 16.59 (non-facility) / 9.42 (facility), malpractice 1.33 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual Medicare payment can differ based on your specific locality, applicable modifiers, and claim-level adjustments.
Medicare typically pays 80% of the allowed amount after the patient meets their annual Part B deductible; the beneficiary or secondary insurance is responsible for the remainder.
Figures shown are subject to sequestration reductions and annual budget-neutrality adjustments finalized by CMS.
Always confirm current-year rates and locality-specific pricing 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 this code?

The facility rate uses a lower practice-expense RVU because overhead costs like equipment, supplies, and staff are assumed to be borne by the facility rather than the physician's practice.

Does this fee schedule amount guarantee what I'll be paid?

No. It's a national/locality estimate based on standard RVUs and the conversion factor. Actual payment depends on your MAC's locality pricing, claim modifiers, patient coverage, and any applicable reductions.

Can I use this amount to dispute a denial or underpayment?

It can serve as a reference point, but you should compare it against the specific locality-adjusted amount from your MAC's published fee schedule and review the claim for modifiers or coverage determinations that may affect payment.

Why is the CPT descriptor not shown on this page?

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

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.