Medicare Reimbursement for CPT 15260

CPT 15260 is a procedure code reported to Medicare and other payers for a specific physician or practitioner service. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1001.02	$727.47
ALASKA* (AK)	$1208.51	$917.18
ALABAMA (AL)	$909.76	$670.40
ARKANSAS (AR)	$898.28	$663.30
ARIZONA (AZ)	$976.80	$711.73
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1248.93	$863.22
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1271.89	$877.43
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1100.37	$777.03
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1107.67	$784.06
NAPA (CA)	$1187.24	$826.70
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1250.42	$864.71
VALLEJO (CA)	$1185.09	$824.55
BAKERSFIELD (CA)	$1046.62	$746.81
CHICO (CA)	$1042.67	$742.86
FRESNO (CA)	$1042.67	$742.86
HANFORD-CORCORAN (CA)	$1042.67	$742.86
MADERA (CA)	$1042.67	$742.86
MERCED (CA)	$1042.67	$742.86
MODESTO (CA)	$1042.67	$742.86
REDDING (CA)	$1042.67	$742.86
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1056.92	$757.11
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1088.61	$770.47
SALINAS (CA)	$1084.40	$767.36
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1277.97	$883.51
SANTA CRUZ-WATSONVILLE (CA)	$1112.99	$780.62
SANTA ROSA-PETALUMA (CA)	$1123.92	$787.99
STOCKTON (CA)	$1042.67	$742.86
VISALIA (CA)	$1042.67	$742.86
YUBA CITY (CA)	$1042.67	$742.86
EL CENTRO (CA)	$1042.89	$743.08
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1105.68	$778.51
SAN LUIS OBISPO-PASO ROBLES (CA)	$1067.53	$755.96
SANTA MARIA-SANTA BARBARA (CA)	$1087.31	$768.35
REST OF CALIFORNIA (CA)	$1042.67	$742.86
COLORADO (CO)	$1032.99	$741.93
CONNECTICUT (CT)	$1062.31	$767.70
DC + MD/VA SUBURBS (DC)	$1129.35	$807.11
DELAWARE (DE)	$991.56	$721.29
FORT LAUDERDALE (FL)	$1043.90	$766.79
MIAMI (FL)	$1091.63	$806.86
REST OF FLORIDA (FL)	$997.59	$736.08
ATLANTA (GA)	$1020.21	$742.28
REST OF GEORGIA (GA)	$946.98	$702.97
HAWAII, GUAM (HI)	$1061.81	$750.78
IOWA (IA)	$925.50	$675.19
IDAHO (ID)	$931.71	$680.04
EAST ST. LOUIS (IL)	$999.14	$747.47
SUBURBAN CHICAGO (IL)	$1053.07	$772.13
CHICAGO (IL)	$1063.23	$788.31
REST OF ILLINOIS (IL)	$975.36	$725.60
INDIANA (IN)	$936.33	$682.74
KANSAS (KS)	$923.82	$676.53
KENTUCKY (KY)	$933.13	$689.94
NEW ORLEANS (LA)	$972.86	$715.45
REST OF LOUISIANA (LA)	$932.70	$690.60
METROPOLITAN BOSTON (MA)	$1123.92	$797.30
REST OF MASSACHUSETTS (MA)	$1028.85	$740.80
BALTIMORE/SURR. CNTYS (MD)	$1059.67	$766.14
REST OF MARYLAND (MD)	$1008.17	$731.33
SOUTHERN MAINE (ME)	$979.68	$708.58
REST OF MAINE (ME)	$938.23	$686.56
DETROIT (MI)	$1010.81	$746.83
REST OF MICHIGAN (MI)	$956.37	$706.61
MINNESOTA (MN)	$986.99	$705.50
METROPOLITAN ST. LOUIS (MO)	$973.36	$712.94
METROPOLITAN KANSAS CITY (MO)	$964.75	$707.88
REST OF MISSOURI (MO)	$920.10	$684.30
MISSISSIPPI (MS)	$909.24	$673.71
MONTANA** (MT)	$1000.94	$727.38
NORTH CAROLINA (NC)	$946.49	$691.27
NORTH DAKOTA** (ND)	$975.03	$701.48
NEBRASKA (NE)	$929.29	$676.80
NEW HAMPSHIRE (NH)	$1019.26	$734.49
NORTHERN NJ (NJ)	$1120.39	$803.07
REST OF NEW JERSEY (NJ)	$1073.62	$774.90
NEW MEXICO (NM)	$961.83	$710.98
NEVADA** (NV)	$994.30	$720.47
MANHATTAN (NY)	$1144.59	$826.72
NYC SUBURBS/LONG ISLAND (NY)	$1172.06	$846.80
POUGHKPSIE/N NYC SUBURBS (NY)	$1082.20	$782.66
QUEENS (NY)	$1149.85	$826.51
REST OF NEW YORK (NY)	$959.12	$699.25
OHIO (OH)	$951.07	$701.32
OKLAHOMA (OK)	$929.40	$685.12
PORTLAND (OR)	$1060.07	$756.15
REST OF OREGON (OR)	$985.72	$713.26
METROPOLITAN PHILADELPHIA (PA)	$1040.00	$755.23
REST OF PENNSYLVANIA (PA)	$951.21	$700.09
PUERTO RICO (PR)	$1006.73	$730.17
RHODE ISLAND (RI)	$1022.58	$740.00
SOUTH CAROLINA (SC)	$950.52	$697.76
SOUTH DAKOTA** (SD)	$971.97	$698.42
TENNESSEE (TN)	$928.15	$679.49
BRAZORIA (TX)	$989.23	$718.14
DALLAS (TX)	$995.91	$723.45
GALVESTON (TX)	$992.48	$720.85
HOUSTON (TX)	$1016.46	$744.82
BEAUMONT (TX)	$945.88	$696.95
FORT WORTH (TX)	$990.70	$720.97
AUSTIN (TX)	$1030.33	$740.91
REST OF TEXAS (TX)	$967.29	$707.69
UTAH (UT)	$961.87	$704.73
VIRGINIA (VA)	$978.33	$709.43
VIRGIN ISLANDS (VI)	$1006.73	$730.17
VERMONT (VT)	$973.63	$702.81
SEATTLE (KING CNTY) (WA)	$1143.22	$807.57
REST OF WASHINGTON (WA)	$1026.14	$738.09
WISCONSIN (WI)	$946.46	$684.40
WEST VIRGINIA (WV)	$944.14	$706.43
WYOMING** (WY)	$989.65	$716.10

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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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the dollar amount. Practice expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which is why two separate allowed amounts are shown.

RVUs — work 11.35, practice expense 17.31 (non-facility) / 9.12 (facility), malpractice 1.31 — × 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 their deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claims-processing adjustments, and sequestration.
Annual updates to RVUs, GPCIs, and the conversion factor, along with budget-neutrality adjustments, can change this amount year to year.
Always verify the current amount and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The facility amount uses lower practice expense RVUs because Medicare assumes the facility (not the billing practitioner) incurs certain overhead costs like equipment and supplies.

Does this amount apply to my locality?

The national amount is a baseline; the locality-specific amount applies the GPCI adjustments for where the service was furnished, which can raise or lower the payment compared to the national figure.

Will modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or assistant-at-surgery can increase or decrease the base PFS amount shown here.

Is this the amount Medicare will actually pay?

No. This is an estimated allowed amount. Medicare generally pays 80% of it after the deductible is met, and factors like sequestration or claim-specific edits can further adjust the final payment.

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.