Medicare Reimbursement for CPT 15275

CPT 15275 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, 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)	$160.32	$84.17
ALASKA* (AK)	$193.17	$112.07
ALABAMA (AL)	$145.65	$79.02
ARKANSAS (AR)	$143.80	$78.39
ARIZONA (AZ)	$156.44	$82.65
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$200.75	$93.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$204.47	$94.65
OXNARD-THOUSAND OAKS-VENTURA (CA)	$176.61	$86.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$177.75	$87.66
NAPA (CA)	$190.74	$90.36
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$200.98	$93.60
VALLEJO (CA)	$190.41	$90.04
BAKERSFIELD (CA)	$167.88	$84.42
CHICO (CA)	$167.28	$83.81
FRESNO (CA)	$167.28	$83.81
HANFORD-CORCORAN (CA)	$167.28	$83.81
MADERA (CA)	$167.28	$83.81
MERCED (CA)	$167.28	$83.81
MODESTO (CA)	$167.28	$83.81
REDDING (CA)	$167.28	$83.81
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$169.45	$85.99
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$174.72	$86.15
SALINAS (CA)	$174.04	$85.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$205.40	$95.58
SANTA CRUZ-WATSONVILLE (CA)	$178.72	$86.20
SANTA ROSA-PETALUMA (CA)	$180.48	$86.97
STOCKTON (CA)	$167.28	$83.81
VISALIA (CA)	$167.28	$83.81
YUBA CITY (CA)	$167.28	$83.81
EL CENTRO (CA)	$167.31	$83.85
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$177.51	$86.43
SAN LUIS OBISPO-PASO ROBLES (CA)	$171.33	$84.59
SANTA MARIA-SANTA BARBARA (CA)	$174.53	$85.73
REST OF CALIFORNIA (CA)	$167.28	$83.81
COLORADO (CO)	$165.60	$84.58
CONNECTICUT (CT)	$170.17	$88.15
DC + MD/VA SUBURBS (DC)	$181.06	$91.35
DELAWARE (DE)	$158.82	$83.58
FORT LAUDERDALE (FL)	$166.95	$89.80
MIAMI (FL)	$174.40	$95.12
REST OF FLORIDA (FL)	$159.54	$86.74
ATLANTA (GA)	$163.35	$85.98
REST OF GEORGIA (GA)	$151.43	$83.50
HAWAII, GUAM (HI)	$170.42	$83.83
IOWA (IA)	$148.29	$78.61
IDAHO (ID)	$149.27	$79.21
EAST ST. LOUIS (IL)	$159.56	$89.50
SUBURBAN CHICAGO (IL)	$168.44	$90.23
CHICAGO (IL)	$169.86	$93.33
REST OF ILLINOIS (IL)	$155.89	$86.36
INDIANA (IN)	$150.01	$79.42
KANSAS (KS)	$147.97	$79.13
KENTUCKY (KY)	$149.30	$81.60
NEW ORLEANS (LA)	$155.68	$84.01
REST OF LOUISIANA (LA)	$149.21	$81.82
METROPOLITAN BOSTON (MA)	$180.30	$89.37
REST OF MASSACHUSETTS (MA)	$164.91	$84.72
BALTIMORE/SURR. CNTYS (MD)	$169.73	$88.02
REST OF MARYLAND (MD)	$161.50	$84.43
SOUTHERN MAINE (ME)	$157.01	$81.54
REST OF MAINE (ME)	$150.26	$80.20
DETROIT (MI)	$161.61	$88.12
REST OF MICHIGAN (MI)	$152.99	$83.46
MINNESOTA (MN)	$158.35	$79.99
METROPOLITAN ST. LOUIS (MO)	$155.82	$83.32
METROPOLITAN KANSAS CITY (MO)	$154.43	$82.92
REST OF MISSOURI (MO)	$147.15	$81.51
MISSISSIPPI (MS)	$145.49	$79.92
MONTANA** (MT)	$160.31	$84.16
NORTH CAROLINA (NC)	$151.60	$80.55
NORTH DAKOTA** (ND)	$156.36	$80.20
NEBRASKA (NE)	$148.92	$78.63
NEW HAMPSHIRE (NH)	$163.35	$84.07
NORTHERN NJ (NJ)	$179.59	$91.26
REST OF NEW JERSEY (NJ)	$172.02	$88.86
NEW MEXICO (NM)	$153.85	$84.02
NEVADA** (NV)	$159.30	$83.07
MANHATTAN (NY)	$183.30	$94.81
NYC SUBURBS/LONG ISLAND (NY)	$187.66	$97.11
POUGHKPSIE/N NYC SUBURBS (NY)	$173.35	$89.96
QUEENS (NY)	$184.22	$94.21
REST OF NEW YORK (NY)	$153.63	$81.28
OHIO (OH)	$152.18	$82.65
OKLAHOMA (OK)	$148.76	$80.75
PORTLAND (OR)	$170.02	$85.41
REST OF OREGON (OR)	$157.96	$82.11
METROPOLITAN PHILADELPHIA (PA)	$166.55	$87.27
REST OF PENNSYLVANIA (PA)	$152.23	$82.32
PUERTO RICO (PR)	$161.26	$84.27
RHODE ISLAND (RI)	$163.84	$85.17
SOUTH CAROLINA (SC)	$152.16	$81.80
SOUTH DAKOTA** (SD)	$155.89	$79.73
TENNESSEE (TN)	$148.66	$79.44
BRAZORIA (TX)	$158.48	$83.01
DALLAS (TX)	$159.53	$83.68
GALVESTON (TX)	$158.99	$83.37
HOUSTON (TX)	$162.65	$87.03
BEAUMONT (TX)	$151.37	$82.07
FORT WORTH (TX)	$158.68	$83.59
AUSTIN (TX)	$165.14	$84.57
REST OF TEXAS (TX)	$154.87	$82.60
UTAH (UT)	$153.99	$82.41
VIRGINIA (VA)	$156.76	$81.90
VIRGIN ISLANDS (VI)	$161.26	$84.27
VERMONT (VT)	$156.08	$80.69
SEATTLE (KING CNTY) (WA)	$183.46	$90.01
REST OF WASHINGTON (WA)	$164.49	$84.30
WISCONSIN (WI)	$151.75	$78.79
WEST VIRGINIA (WV)	$150.86	$84.69
WYOMING** (WY)	$158.59	$82.43

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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 PFS amount is 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) specific to the locality where the service is furnished, reflecting local cost-of-living and practice-cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, since overhead costs differ by site of service, which is why the two allowed amounts differ.

RVUs — work 1.78, practice expense 2.82 (non-facility) / 0.54 (facility), malpractice 0.2 — × 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 the Part B deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by specific locality, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality changes to RVUs or the conversion factor.
Always verify final allowed amounts and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (not the physician's office) is absorbing certain overhead and equipment costs when the service is performed there.

Does this amount reflect what my specific locality will be paid?

No — the national figure is a baseline. The locality-specific amount applies the GPCI adjustments for that area and is the more accurate reference for claims processing.

Will modifiers change this amount?

Yes, modifiers (e.g., bilateral, multiple procedure, or reduced services) can increase or decrease the allowed amount, and these adjustments are not reflected in the base RVU calculation shown here.

Why might the amount differ from what my MAC pays?

Sequestration, mid-year legislative changes, local coverage determinations, and budget-neutrality adjustments can cause actual payments to differ slightly from the standard PFS calculation.

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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.