Medicare Reimbursement for CPT Code 15261

This page covers a CPT procedure code (descriptor omitted due to AMA licensing restrictions) and shows its Medicare Physician Fee Schedule allowed amount for 2026. Figures are presented at the national level and can be adjusted for locality, with separate rates for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$207.75	$112.56
ALASKA* (AK)	$247.64	$146.26
ALABAMA (AL)	$187.75	$104.45
ARKANSAS (AR)	$185.23	$103.46
ARIZONA (AZ)	$202.43	$110.19
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$260.23	$126.01
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$265.05	$127.78
OXNARD-THOUSAND OAKS-VENTURA (CA)	$228.80	$116.28
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$230.28	$117.67
NAPA (CA)	$247.22	$121.76
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$260.57	$126.35
VALLEJO (CA)	$246.73	$121.27
BAKERSFIELD (CA)	$217.24	$112.91
CHICO (CA)	$216.36	$112.03
FRESNO (CA)	$216.36	$112.03
HANFORD-CORCORAN (CA)	$216.36	$112.03
MADERA (CA)	$216.36	$112.03
MERCED (CA)	$216.36	$112.03
MODESTO (CA)	$216.36	$112.03
REDDING (CA)	$216.36	$112.03
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$219.61	$115.28
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$226.13	$115.42
SALINAS (CA)	$225.27	$114.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$266.44	$129.17
SANTA CRUZ-WATSONVILLE (CA)	$231.56	$115.90
SANTA ROSA-PETALUMA (CA)	$233.84	$116.94
STOCKTON (CA)	$216.36	$112.03
VISALIA (CA)	$216.36	$112.03
YUBA CITY (CA)	$216.36	$112.03
EL CENTRO (CA)	$216.41	$112.08
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$229.89	$116.04
SAN LUIS OBISPO-PASO ROBLES (CA)	$221.75	$113.32
SANTA MARIA-SANTA BARBARA (CA)	$225.93	$114.93
REST OF CALIFORNIA (CA)	$216.36	$112.03
COLORADO (CO)	$214.45	$113.16
CONNECTICUT (CT)	$220.95	$118.43
DC + MD/VA SUBURBS (DC)	$235.09	$122.96
DELAWARE (DE)	$205.60	$111.55
FORT LAUDERDALE (FL)	$217.48	$121.05
MIAMI (FL)	$228.21	$129.11
REST OF FLORIDA (FL)	$207.28	$116.28
ATLANTA (GA)	$211.99	$115.27
REST OF GEORGIA (GA)	$196.15	$111.24
HAWAII, GUAM (HI)	$220.69	$112.46
IOWA (IA)	$191.06	$103.96
IDAHO (ID)	$192.45	$104.88
EAST ST. LOUIS (IL)	$207.89	$120.32
SUBURBAN CHICAGO (IL)	$219.38	$121.62
CHICAGO (IL)	$221.86	$126.19
REST OF ILLINOIS (IL)	$202.50	$115.59
INDIANA (IN)	$193.46	$105.22
KANSAS (KS)	$190.76	$104.71
KENTUCKY (KY)	$193.00	$108.37
NEW ORLEANS (LA)	$201.73	$112.15
REST OF LOUISIANA (LA)	$192.93	$108.68
METROPOLITAN BOSTON (MA)	$233.92	$120.26
REST OF MASSACHUSETTS (MA)	$213.52	$113.28
BALTIMORE/SURR. CNTYS (MD)	$220.43	$118.29
REST OF MARYLAND (MD)	$209.16	$112.82
SOUTHERN MAINE (ME)	$202.93	$108.59
REST OF MAINE (ME)	$193.95	$106.37
DETROIT (MI)	$210.24	$118.38
REST OF MICHIGAN (MI)	$198.15	$111.24
MINNESOTA (MN)	$204.33	$106.38
METROPOLITAN ST. LOUIS (MO)	$201.76	$111.14
METROPOLITAN KANSAS CITY (MO)	$199.88	$110.50
REST OF MISSOURI (MO)	$190.21	$108.15
MISSISSIPPI (MS)	$187.73	$105.77
MONTANA** (MT)	$207.73	$112.54
NORTH CAROLINA (NC)	$195.74	$106.93
NORTH DAKOTA** (ND)	$201.80	$106.61
NEBRASKA (NE)	$191.88	$104.01
NEW HAMPSHIRE (NH)	$211.64	$112.54
NORTHERN NJ (NJ)	$233.04	$122.62
REST OF NEW JERSEY (NJ)	$223.15	$119.20
NEW MEXICO (NM)	$199.37	$112.08
NEVADA** (NV)	$206.21	$110.92
MANHATTAN (NY)	$238.56	$127.94
NYC SUBURBS/LONG ISLAND (NY)	$244.65	$131.47
POUGHKPSIE/N NYC SUBURBS (NY)	$225.02	$120.78
QUEENS (NY)	$239.62	$127.10
REST OF NEW YORK (NY)	$198.51	$108.08
OHIO (OH)	$196.94	$110.03
OKLAHOMA (OK)	$192.12	$107.11
PORTLAND (OR)	$220.25	$114.49
REST OF OREGON (OR)	$204.28	$109.46
METROPOLITAN PHILADELPHIA (PA)	$216.13	$117.03
REST OF PENNSYLVANIA (PA)	$196.93	$109.54
PUERTO RICO (PR)	$208.98	$112.74
RHODE ISLAND (RI)	$212.18	$113.85
SOUTH CAROLINA (SC)	$196.73	$108.77
SOUTH DAKOTA** (SD)	$201.10	$105.91
TENNESSEE (TN)	$191.72	$105.19
BRAZORIA (TX)	$205.00	$110.67
DALLAS (TX)	$206.48	$111.67
GALVESTON (TX)	$205.73	$111.21
HOUSTON (TX)	$211.22	$116.70
BEAUMONT (TX)	$195.77	$109.14
FORT WORTH (TX)	$205.36	$111.50
AUSTIN (TX)	$214.02	$113.31
REST OF TEXAS (TX)	$200.39	$110.06
UTAH (UT)	$199.22	$109.74
VIRGINIA (VA)	$202.68	$109.10
VIRGIN ISLANDS (VI)	$208.98	$112.74
VERMONT (VT)	$201.55	$107.31
SEATTLE (KING CNTY) (WA)	$237.98	$121.18
REST OF WASHINGTON (WA)	$212.94	$112.70
WISCONSIN (WI)	$195.56	$104.36
WEST VIRGINIA (WV)	$195.66	$112.94
WYOMING** (WY)	$205.15	$109.96

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 6 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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to this code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice expense RVUs differ depending on whether the service is reported in a non-facility setting (such as a physician's office) or a facility setting (such as a hospital), which is why two separate national and locality-specific amounts are typically shown. Work and malpractice RVUs generally stay the same across settings, while practice expense RVUs account for most of the non-facility versus facility difference.

RVUs — work 2.17, practice expense 3.75 (non-facility) / 0.9 (facility), malpractice 0.3 — × 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 beneficiary or secondary insurer is generally responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, sequestration reductions, 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 claim.

Frequently asked

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

The practice expense RVU component is lower in the facility setting because Medicare assumes the facility (e.g., hospital) absorbs certain overhead costs, whereas in a non-facility setting the billing practice bears those costs directly.

Why might the amount I'm paid differ from the national figure shown here?

The national amount uses a standard geographic adjustment; actual payment is recalculated using the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service was furnished, which can raise or lower the amount.

Does this amount reflect what Medicare will actually pay?

No. It reflects the allowed amount under the fee schedule before patient responsibility, deductible status, modifiers, sequestration, and other claim-specific adjustments are applied.

Why do fee schedule amounts change from year to year?

Medicare updates RVUs periodically and recalculates the conversion factor annually to maintain budget neutrality, which can shift allowed amounts even if the RVUs for a code stay the same.

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.