Medicare Reimbursement for CPT 15272
CPT 15272 is a procedure code used for physician billing under Medicare Part B; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and by locality, broken out by non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $25.72 | $14.70 |
| ALASKA* (AK) | $31.18 | $19.44 |
| ALABAMA (AL) | $23.32 | $13.68 |
| ARKANSAS (AR) | $23.02 | $13.56 |
| ARIZONA (AZ) | $25.06 | $14.38 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $31.25 | $15.71 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $31.79 | $15.90 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $27.82 | $14.79 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $28.04 | $15.00 |
| NAPA (CA) | $29.82 | $15.29 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $31.31 | $15.77 |
| VALLEJO (CA) | $29.74 | $15.21 |
| BAKERSFIELD (CA) | $26.55 | $14.47 |
| CHICO (CA) | $26.41 | $14.33 |
| FRESNO (CA) | $26.41 | $14.33 |
| HANFORD-CORCORAN (CA) | $26.41 | $14.33 |
| MADERA (CA) | $26.41 | $14.33 |
| MERCED (CA) | $26.41 | $14.33 |
| MODESTO (CA) | $26.41 | $14.33 |
| REDDING (CA) | $26.41 | $14.33 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $26.95 | $14.87 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $27.51 | $14.69 |
| SALINAS (CA) | $27.40 | $14.62 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $32.02 | $16.13 |
| SANTA CRUZ-WATSONVILLE (CA) | $28.04 | $14.65 |
| SANTA ROSA-PETALUMA (CA) | $28.31 | $14.78 |
| STOCKTON (CA) | $26.41 | $14.33 |
| VISALIA (CA) | $26.41 | $14.33 |
| YUBA CITY (CA) | $26.41 | $14.33 |
| EL CENTRO (CA) | $26.42 | $14.34 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $27.89 | $14.71 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $26.98 | $14.43 |
| SANTA MARIA-SANTA BARBARA (CA) | $27.46 | $14.61 |
| REST OF CALIFORNIA (CA) | $26.41 | $14.33 |
| COLORADO (CO) | $26.34 | $14.61 |
| CONNECTICUT (CT) | $27.31 | $15.44 |
| DC + MD/VA SUBURBS (DC) | $28.86 | $15.88 |
| DELAWARE (DE) | $25.44 | $14.55 |
| FORT LAUDERDALE (FL) | $27.24 | $16.08 |
| MIAMI (FL) | $28.82 | $17.35 |
| REST OF FLORIDA (FL) | $25.97 | $15.43 |
| ATLANTA (GA) | $26.30 | $15.10 |
| REST OF GEORGIA (GA) | $24.60 | $14.76 |
| HAWAII, GUAM (HI) | $26.85 | $14.31 |
| IOWA (IA) | $23.58 | $13.49 |
| IDAHO (ID) | $23.77 | $13.63 |
| EAST ST. LOUIS (IL) | $26.34 | $16.20 |
| SUBURBAN CHICAGO (IL) | $27.44 | $16.12 |
| CHICAGO (IL) | $28.02 | $16.95 |
| REST OF ILLINOIS (IL) | $25.50 | $15.43 |
| INDIANA (IN) | $23.88 | $13.67 |
| KANSAS (KS) | $23.61 | $13.64 |
| KENTUCKY (KY) | $24.09 | $14.29 |
| NEW ORLEANS (LA) | $25.16 | $14.79 |
| REST OF LOUISIANA (LA) | $24.11 | $14.36 |
| METROPOLITAN BOSTON (MA) | $28.57 | $15.40 |
| REST OF MASSACHUSETTS (MA) | $26.26 | $14.65 |
| BALTIMORE/SURR. CNTYS (MD) | $27.26 | $15.43 |
| REST OF MARYLAND (MD) | $25.85 | $14.69 |
| SOUTHERN MAINE (ME) | $24.98 | $14.06 |
| REST OF MAINE (ME) | $24.02 | $13.88 |
| DETROIT (MI) | $26.40 | $15.76 |
| REST OF MICHIGAN (MI) | $24.77 | $14.71 |
| MINNESOTA (MN) | $24.93 | $13.59 |
| METROPOLITAN ST. LOUIS (MO) | $25.08 | $14.59 |
| METROPOLITAN KANSAS CITY (MO) | $24.87 | $14.52 |
| REST OF MISSOURI (MO) | $23.83 | $14.33 |
| MISSISSIPPI (MS) | $23.43 | $13.94 |
| MONTANA** (MT) | $25.72 | $14.69 |
| NORTH CAROLINA (NC) | $24.22 | $13.94 |
| NORTH DAKOTA** (ND) | $24.73 | $13.70 |
| NEBRASKA (NE) | $23.65 | $13.48 |
| NEW HAMPSHIRE (NH) | $26.06 | $14.58 |
| NORTHERN NJ (NJ) | $28.64 | $15.86 |
| REST OF NEW JERSEY (NJ) | $27.54 | $15.50 |
| NEW MEXICO (NM) | $24.95 | $14.84 |
| NEVADA** (NV) | $25.45 | $14.42 |
| MANHATTAN (NY) | $29.55 | $16.74 |
| NYC SUBURBS/LONG ISLAND (NY) | $30.36 | $17.25 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $27.82 | $15.75 |
| QUEENS (NY) | $29.57 | $16.54 |
| REST OF NEW YORK (NY) | $24.55 | $14.08 |
| OHIO (OH) | $24.57 | $14.51 |
| OKLAHOMA (OK) | $23.92 | $14.07 |
| PORTLAND (OR) | $26.95 | $14.70 |
| REST OF OREGON (OR) | $25.17 | $14.19 |
| METROPOLITAN PHILADELPHIA (PA) | $26.78 | $15.31 |
| REST OF PENNSYLVANIA (PA) | $24.53 | $14.41 |
| PUERTO RICO (PR) | $25.84 | $14.70 |
| RHODE ISLAND (RI) | $26.18 | $14.80 |
| SOUTH CAROLINA (SC) | $24.45 | $14.27 |
| SOUTH DAKOTA** (SD) | $24.61 | $13.59 |
| TENNESSEE (TN) | $23.73 | $13.71 |
| BRAZORIA (TX) | $25.32 | $14.39 |
| DALLAS (TX) | $25.52 | $14.55 |
| GALVESTON (TX) | $25.42 | $14.48 |
| HOUSTON (TX) | $26.34 | $15.39 |
| BEAUMONT (TX) | $24.40 | $14.37 |
| FORT WORTH (TX) | $25.41 | $14.54 |
| AUSTIN (TX) | $26.32 | $14.66 |
| REST OF TEXAS (TX) | $24.88 | $14.42 |
| UTAH (UT) | $24.75 | $14.39 |
| VIRGINIA (VA) | $25.00 | $14.17 |
| VIRGIN ISLANDS (VI) | $25.84 | $14.70 |
| VERMONT (VT) | $24.76 | $13.85 |
| SEATTLE (KING CNTY) (WA) | $28.98 | $15.46 |
| REST OF WASHINGTON (WA) | $26.17 | $14.56 |
| WISCONSIN (WI) | $24.00 | $13.44 |
| WEST VIRGINIA (WV) | $24.69 | $15.11 |
| WYOMING** (WY) | $25.28 | $14.26 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 3 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) assigned to the 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 conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings typically have different practice-expense RVUs, since facility settings shift certain overhead costs to the facility itself, which usually results in a lower facility rate.
RVUs — work 0.32, practice expense 0.4 (non-facility) / 0.07 (facility), malpractice 0.05 — × 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 Part B deductible is met; the beneficiary or secondary payer covers the remainder.
- Actual payment can vary by locality, applicable modifiers, place of service, sequestration, and annual budget-neutrality adjustments.
- Always verify the current rate and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why is the facility amount lower than the non-facility amount?
The facility rate uses a lower practice-expense RVU because the facility, rather than the billing physician, bears certain overhead costs such as equipment and supplies.
Does this amount reflect what Medicare will actually pay?
No. It's an estimated allowed amount before the 80/20 split, deductible, modifiers, sequestration, and locality-specific adjustments are applied.
Why does the amount differ by locality?
Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs to reflect regional cost differences before the conversion factor is applied.
Where can I find the official rate for my area?
Check your Medicare Administrative Contractor's fee schedule lookup tool or the CMS Physician Fee Schedule Look-Up Tool for the current, locality-specific rate.
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.
Bill accurately, get paid faster
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free