Medicare Reimbursement for CPT 15274

CPT 15274 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$86.84	$39.08
ALASKA* (AK)	$100.90	$50.03
ALABAMA (AL)	$77.49	$35.70
ARKANSAS (AR)	$76.32	$35.29
ARIZONA (AZ)	$84.32	$38.03
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$108.65	$41.30
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$110.64	$41.77
OXNARD-THOUSAND OAKS-VENTURA (CA)	$95.46	$39.01
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$96.09	$39.58
NAPA (CA)	$103.22	$40.26
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$108.84	$41.49
VALLEJO (CA)	$102.94	$39.99
BAKERSFIELD (CA)	$90.41	$38.06
CHICO (CA)	$89.94	$37.59
FRESNO (CA)	$89.94	$37.59
HANFORD-CORCORAN (CA)	$89.94	$37.59
MADERA (CA)	$89.94	$37.59
MERCED (CA)	$89.94	$37.59
MODESTO (CA)	$89.94	$37.59
REDDING (CA)	$89.94	$37.59
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$91.77	$39.42
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$94.13	$38.58
SALINAS (CA)	$93.78	$38.42
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$111.43	$42.56
SANTA CRUZ-WATSONVILLE (CA)	$96.60	$38.57
SANTA ROSA-PETALUMA (CA)	$97.55	$38.90
STOCKTON (CA)	$89.94	$37.59
VISALIA (CA)	$89.94	$37.59
YUBA CITY (CA)	$89.94	$37.59
EL CENTRO (CA)	$89.97	$37.62
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$95.83	$38.70
SAN LUIS OBISPO-PASO ROBLES (CA)	$92.31	$37.91
SANTA MARIA-SANTA BARBARA (CA)	$94.09	$38.39
REST OF CALIFORNIA (CA)	$89.94	$37.59
COLORADO (CO)	$89.44	$38.62
CONNECTICUT (CT)	$92.80	$41.36
DC + MD/VA SUBURBS (DC)	$98.70	$42.44
DELAWARE (DE)	$85.74	$38.55
FORT LAUDERDALE (FL)	$92.15	$43.76
MIAMI (FL)	$97.78	$48.06
REST OF FLORIDA (FL)	$87.27	$41.61
ATLANTA (GA)	$88.94	$40.42
REST OF GEORGIA (GA)	$81.98	$39.38
HAWAII, GUAM (HI)	$92.00	$37.70
IOWA (IA)	$78.73	$35.03
IDAHO (ID)	$79.44	$35.50
EAST ST. LOUIS (IL)	$88.19	$44.25
SUBURBAN CHICAGO (IL)	$92.90	$43.84
CHICAGO (IL)	$94.65	$46.65
REST OF ILLINOIS (IL)	$85.24	$41.64
INDIANA (IN)	$79.90	$35.62
KANSAS (KS)	$78.74	$35.56
KENTUCKY (KY)	$80.24	$37.78
NEW ORLEANS (LA)	$84.36	$39.42
REST OF LOUISIANA (LA)	$80.27	$38.00
METROPOLITAN BOSTON (MA)	$97.98	$40.95
REST OF MASSACHUSETTS (MA)	$89.03	$38.73
BALTIMORE/SURR. CNTYS (MD)	$92.63	$41.38
REST OF MARYLAND (MD)	$87.30	$38.96
SOUTHERN MAINE (ME)	$84.25	$36.92
REST OF MAINE (ME)	$80.29	$36.34
DETROIT (MI)	$88.81	$42.72
REST OF MICHIGAN (MI)	$82.78	$39.17
MINNESOTA (MN)	$84.44	$35.29
METROPOLITAN ST. LOUIS (MO)	$84.21	$38.74
METROPOLITAN KANSAS CITY (MO)	$83.35	$38.50
REST OF MISSOURI (MO)	$79.09	$37.92
MISSISSIPPI (MS)	$77.70	$36.58
MONTANA** (MT)	$86.83	$39.07
NORTH CAROLINA (NC)	$81.10	$36.54
NORTH DAKOTA** (ND)	$83.47	$35.71
NEBRASKA (NE)	$79.07	$34.98
NEW HAMPSHIRE (NH)	$88.39	$38.67
NORTHERN NJ (NJ)	$97.69	$42.28
REST OF NEW JERSEY (NJ)	$93.51	$41.35
NEW MEXICO (NM)	$83.41	$39.61
NEVADA** (NV)	$85.95	$38.14
MANHATTAN (NY)	$100.77	$45.26
NYC SUBURBS/LONG ISLAND (NY)	$103.79	$47.00
POUGHKPSIE/N NYC SUBURBS (NY)	$94.44	$42.14
QUEENS (NY)	$101.05	$44.59
REST OF NEW YORK (NY)	$82.40	$37.03
OHIO (OH)	$82.09	$38.49
OKLAHOMA (OK)	$79.68	$37.03
PORTLAND (OR)	$91.92	$38.86
REST OF OREGON (OR)	$84.94	$37.36
METROPOLITAN PHILADELPHIA (PA)	$90.67	$40.95
REST OF PENNSYLVANIA (PA)	$82.01	$38.16
PUERTO RICO (PR)	$87.36	$39.07
RHODE ISLAND (RI)	$88.54	$39.20
SOUTH CAROLINA (SC)	$81.80	$37.67
SOUTH DAKOTA** (SD)	$83.07	$35.31
TENNESSEE (TN)	$79.20	$35.78
BRAZORIA (TX)	$85.31	$37.97
DALLAS (TX)	$86.05	$38.48
GALVESTON (TX)	$85.69	$38.26
HOUSTON (TX)	$88.80	$41.37
BEAUMONT (TX)	$81.48	$38.01
FORT WORTH (TX)	$85.57	$38.48
AUSTIN (TX)	$89.44	$38.91
REST OF TEXAS (TX)	$83.48	$38.15
UTAH (UT)	$82.96	$38.06
VIRGINIA (VA)	$84.24	$37.28
VIRGIN ISLANDS (VI)	$87.36	$39.07
VERMONT (VT)	$83.49	$36.20
SEATTLE (KING CNTY) (WA)	$99.62	$41.01
REST OF WASHINGTON (WA)	$88.74	$38.45
WISCONSIN (WI)	$80.60	$34.84
WEST VIRGINIA (WV)	$82.07	$40.56
WYOMING** (WY)	$85.37	$37.60

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 60 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 PFS amounts are built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) that reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility settings (e.g., a physician's office, where the practice bears more overhead) and facility settings (e.g., a hospital, where the facility bears overhead), which is why the two amounts differ. The conversion factor and RVUs are updated annually and can change due to legislation or budget-neutrality adjustments.

RVUs — work 0.78, practice expense 1.65 (non-facility) / 0.22 (facility), malpractice 0.17 — × 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 insurance may be responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount?

In facility settings, the facility (e.g., hospital) incurs most of the overhead costs, so the practice-expense RVU used for the physician's payment is lower than when the service is performed in a non-facility setting like an office.

Will my locality's payment match the national amount shown here?

Not necessarily. The national amount uses a standard GPCI baseline; actual payment in your area depends on the GPCIs assigned to your specific Medicare locality.

Does this amount include the patient's coinsurance?

No. The figure shown is the total allowed amount. Medicare generally pays 80% of it after the deductible, with the remaining 20% typically billed as coinsurance.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple procedures can increase or decrease the final payment relative to the base PFS amount.

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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.