Medicare Reimbursement for CPT 15277
CPT 15277 is a procedure code reported to Medicare for physician and outpatient billing; 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 separately for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $361.06 | $197.40 |
| ALASKA* (AK) | $429.01 | $254.71 |
| ALABAMA (AL) | $324.89 | $181.68 |
| ARKANSAS (AR) | $320.36 | $179.78 |
| ARIZONA (AZ) | $351.23 | $192.64 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $444.71 | $213.94 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $452.62 | $216.62 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $393.46 | $200.01 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $396.33 | $202.72 |
| NAPA (CA) | $423.46 | $207.75 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $445.51 | $214.75 |
| VALLEJO (CA) | $422.29 | $206.58 |
| BAKERSFIELD (CA) | $374.15 | $194.77 |
| CHICO (CA) | $372.15 | $192.78 |
| FRESNO (CA) | $372.15 | $192.78 |
| HANFORD-CORCORAN (CA) | $372.15 | $192.78 |
| MADERA (CA) | $372.15 | $192.78 |
| MERCED (CA) | $372.15 | $192.78 |
| MODESTO (CA) | $372.15 | $192.78 |
| REDDING (CA) | $372.15 | $192.78 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $379.80 | $200.43 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $388.50 | $198.16 |
| SALINAS (CA) | $387.02 | $197.34 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $455.92 | $219.92 |
| SANTA CRUZ-WATSONVILLE (CA) | $397.32 | $198.47 |
| SANTA ROSA-PETALUMA (CA) | $401.18 | $200.20 |
| STOCKTON (CA) | $372.15 | $192.78 |
| VISALIA (CA) | $372.15 | $192.78 |
| YUBA CITY (CA) | $372.15 | $192.78 |
| EL CENTRO (CA) | $372.27 | $192.90 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $394.70 | $198.96 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $381.06 | $194.65 |
| SANTA MARIA-SANTA BARBARA (CA) | $388.08 | $197.25 |
| REST OF CALIFORNIA (CA) | $372.15 | $192.78 |
| COLORADO (CO) | $370.69 | $196.55 |
| CONNECTICUT (CT) | $384.59 | $208.33 |
| DC + MD/VA SUBURBS (DC) | $407.64 | $214.84 |
| DELAWARE (DE) | $356.83 | $195.13 |
| FORT LAUDERDALE (FL) | $382.92 | $217.13 |
| MIAMI (FL) | $405.81 | $235.44 |
| REST OF FLORIDA (FL) | $363.88 | $207.42 |
| ATLANTA (GA) | $369.53 | $203.25 |
| REST OF GEORGIA (GA) | $343.25 | $197.26 |
| HAWAII, GUAM (HI) | $379.45 | $193.36 |
| IOWA (IA) | $329.16 | $179.41 |
| IDAHO (ID) | $332.00 | $181.43 |
| EAST ST. LOUIS (IL) | $368.54 | $217.97 |
| SUBURBAN CHICAGO (IL) | $385.87 | $217.79 |
| CHICAGO (IL) | $393.72 | $229.24 |
| REST OF ILLINOIS (IL) | $356.40 | $206.97 |
| INDIANA (IN) | $333.76 | $182.04 |
| KANSAS (KS) | $329.42 | $181.47 |
| KENTUCKY (KY) | $336.06 | $190.56 |
| NEW ORLEANS (LA) | $352.07 | $198.06 |
| REST OF LOUISIANA (LA) | $336.25 | $191.41 |
| METROPOLITAN BOSTON (MA) | $403.97 | $208.56 |
| REST OF MASSACHUSETTS (MA) | $369.31 | $196.97 |
| BALTIMORE/SURR. CNTYS (MD) | $383.89 | $208.27 |
| REST OF MARYLAND (MD) | $362.91 | $197.28 |
| SOUTHERN MAINE (ME) | $350.45 | $188.26 |
| REST OF MAINE (ME) | $335.53 | $184.96 |
| DETROIT (MI) | $370.08 | $212.15 |
| REST OF MICHIGAN (MI) | $346.11 | $196.68 |
| MINNESOTA (MN) | $350.37 | $181.96 |
| METROPOLITAN ST. LOUIS (MO) | $351.17 | $195.36 |
| METROPOLITAN KANSAS CITY (MO) | $347.89 | $194.21 |
| REST OF MISSOURI (MO) | $331.87 | $190.79 |
| MISSISSIPPI (MS) | $326.09 | $185.17 |
| MONTANA** (MT) | $361.02 | $197.35 |
| NORTH CAROLINA (NC) | $338.63 | $185.93 |
| NORTH DAKOTA** (ND) | $346.98 | $183.31 |
| NEBRASKA (NE) | $330.37 | $179.31 |
| NEW HAMPSHIRE (NH) | $366.59 | $196.22 |
| NORTHERN NJ (NJ) | $404.02 | $214.17 |
| REST OF NEW JERSEY (NJ) | $387.63 | $208.90 |
| NEW MEXICO (NM) | $348.64 | $198.56 |
| NEVADA** (NV) | $357.31 | $193.48 |
| MANHATTAN (NY) | $416.85 | $226.67 |
| NYC SUBURBS/LONG ISLAND (NY) | $428.86 | $234.27 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $391.58 | $212.37 |
| QUEENS (NY) | $417.57 | $224.12 |
| REST OF NEW YORK (NY) | $343.67 | $188.19 |
| OHIO (OH) | $343.24 | $193.81 |
| OKLAHOMA (OK) | $333.62 | $187.46 |
| PORTLAND (OR) | $380.06 | $198.23 |
| REST OF OREGON (OR) | $353.19 | $190.18 |
| METROPOLITAN PHILADELPHIA (PA) | $376.48 | $206.10 |
| REST OF PENNSYLVANIA (PA) | $342.78 | $192.53 |
| PUERTO RICO (PR) | $362.99 | $197.52 |
| RHODE ISLAND (RI) | $367.81 | $198.75 |
| SOUTH CAROLINA (SC) | $341.77 | $190.54 |
| SOUTH DAKOTA** (SD) | $345.32 | $181.65 |
| TENNESSEE (TN) | $331.24 | $182.47 |
| BRAZORIA (TX) | $355.02 | $192.83 |
| DALLAS (TX) | $358.04 | $195.03 |
| GALVESTON (TX) | $356.58 | $194.06 |
| HOUSTON (TX) | $369.57 | $207.05 |
| BEAUMONT (TX) | $340.74 | $191.81 |
| FORT WORTH (TX) | $356.28 | $194.90 |
| AUSTIN (TX) | $370.63 | $197.47 |
| REST OF TEXAS (TX) | $348.20 | $192.88 |
| UTAH (UT) | $346.22 | $192.38 |
| VIRGINIA (VA) | $350.57 | $189.69 |
| VIRGIN ISLANDS (VI) | $362.99 | $197.52 |
| VERMONT (VT) | $347.28 | $185.25 |
| SEATTLE (KING CNTY) (WA) | $410.25 | $209.43 |
| REST OF WASHINGTON (WA) | $368.06 | $195.73 |
| WISCONSIN (WI) | $335.96 | $179.17 |
| WEST VIRGINIA (WV) | $344.16 | $201.93 |
| WYOMING** (WY) | $354.90 | $191.23 |
Look up another code or locality →
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) assigned to a 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 billed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar estimate. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why two separate national and locality amounts are shown.
RVUs — work 3.9, practice expense 6.2 (non-facility) / 1.3 (facility), malpractice 0.71 — × 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 annual Part B deductible; the beneficiary or secondary insurance is generally responsible for the rest.
- Modifiers, place-of-service rules, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
- Locality-specific GPCIs mean actual payment can differ from the national figure shown here.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why are there two amounts for facility and non-facility?
Practice expense RVUs differ because overhead costs (equipment, staff, supplies) are typically lower when a service is performed in a facility setting like a hospital, where the facility bills separately for those costs.
Why does the fee vary by locality?
Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust the work, practice expense, and malpractice RVUs for regional differences in wages, rent, and other costs before applying the conversion factor.
Does this amount reflect what the patient owes?
No. The figure shown is the Medicare-allowed amount; after the deductible, Medicare generally pays 80% and the patient or supplemental insurance covers the remaining 20%, subject to any applicable modifiers or adjustments.
Will this exact amount be paid on every claim?
Not necessarily. Modifiers, multiple-procedure reductions, sequestration, and yearly budget-neutrality changes can all affect the final reimbursement for a specific claim.
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.
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