Medicare Reimbursement for CPT 15278

This page covers Medicare Physician Fee Schedule (PFS) estimated payment amounts for this procedure code (CPT descriptors are AMA-licensed and not reproduced here). Amounts are shown at the national level and can vary by locality, and are broken out by non-facility (e.g., office) versus facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$101.20	$48.77
ALASKA* (AK)	$118.59	$62.74
ALABAMA (AL)	$90.58	$44.70
ARKANSAS (AR)	$89.25	$44.21
ARIZONA (AZ)	$98.33	$47.51
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$125.81	$51.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$128.09	$52.47
OXNARD-THOUSAND OAKS-VENTURA (CA)	$110.85	$48.87
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$111.61	$49.57
NAPA (CA)	$119.63	$50.51
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$126.03	$52.10
VALLEJO (CA)	$119.30	$50.19
BAKERSFIELD (CA)	$105.15	$47.67
CHICO (CA)	$104.59	$47.12
FRESNO (CA)	$104.59	$47.12
HANFORD-CORCORAN (CA)	$104.59	$47.12
MADERA (CA)	$104.59	$47.12
MERCED (CA)	$104.59	$47.12
MODESTO (CA)	$104.59	$47.12
REDDING (CA)	$104.59	$47.12
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$106.74	$49.27
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$109.36	$48.37
SALINAS (CA)	$108.94	$48.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$129.02	$53.40
SANTA CRUZ-WATSONVILLE (CA)	$112.08	$48.36
SANTA ROSA-PETALUMA (CA)	$113.18	$48.78
STOCKTON (CA)	$104.59	$47.12
VISALIA (CA)	$104.59	$47.12
YUBA CITY (CA)	$104.59	$47.12
EL CENTRO (CA)	$104.63	$47.15
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$111.24	$48.52
SAN LUIS OBISPO-PASO ROBLES (CA)	$107.25	$47.52
SANTA MARIA-SANTA BARBARA (CA)	$109.28	$48.13
REST OF CALIFORNIA (CA)	$104.59	$47.12
COLORADO (CO)	$104.09	$48.29
CONNECTICUT (CT)	$108.02	$51.54
DC + MD/VA SUBURBS (DC)	$114.73	$52.95
DELAWARE (DE)	$99.95	$48.14
FORT LAUDERDALE (FL)	$107.41	$54.28
MIAMI (FL)	$113.95	$59.36
REST OF FLORIDA (FL)	$101.85	$51.71
ATLANTA (GA)	$103.63	$50.36
REST OF GEORGIA (GA)	$95.81	$49.04
HAWAII, GUAM (HI)	$106.86	$47.23
IOWA (IA)	$91.92	$43.94
IDAHO (ID)	$92.74	$44.50
EAST ST. LOUIS (IL)	$103.04	$54.79
SUBURBAN CHICAGO (IL)	$108.26	$54.40
CHICAGO (IL)	$110.39	$57.69
REST OF ILLINOIS (IL)	$99.59	$51.71
INDIANA (IN)	$93.26	$44.65
KANSAS (KS)	$91.96	$44.55
KENTUCKY (KY)	$93.78	$47.16
NEW ORLEANS (LA)	$98.47	$49.12
REST OF LOUISIANA (LA)	$93.82	$47.41
METROPOLITAN BOSTON (MA)	$113.80	$51.19
REST OF MASSACHUSETTS (MA)	$103.65	$48.43
BALTIMORE/SURR. CNTYS (MD)	$107.82	$51.55
REST OF MARYLAND (MD)	$101.73	$48.66
SOUTHERN MAINE (ME)	$98.18	$46.22
REST OF MAINE (ME)	$93.74	$45.49
DETROIT (MI)	$103.62	$53.02
REST OF MICHIGAN (MI)	$96.69	$48.81
MINNESOTA (MN)	$98.29	$44.33
METROPOLITAN ST. LOUIS (MO)	$98.25	$48.33
METROPOLITAN KANSAS CITY (MO)	$97.28	$48.04
REST OF MISSOURI (MO)	$92.50	$47.30
MISSISSIPPI (MS)	$90.87	$45.72
MONTANA** (MT)	$101.19	$48.75
NORTH CAROLINA (NC)	$94.65	$45.73
NORTH DAKOTA** (ND)	$97.24	$44.80
NEBRASKA (NE)	$92.29	$43.89
NEW HAMPSHIRE (NH)	$102.90	$48.31
NORTHERN NJ (NJ)	$113.61	$52.78
REST OF NEW JERSEY (NJ)	$108.85	$51.58
NEW MEXICO (NM)	$97.42	$49.33
NEVADA** (NV)	$100.15	$47.66
MANHATTAN (NY)	$117.22	$56.29
NYC SUBURBS/LONG ISLAND (NY)	$120.70	$58.35
POUGHKPSIE/N NYC SUBURBS (NY)	$109.95	$52.53
QUEENS (NY)	$117.50	$55.51
REST OF NEW YORK (NY)	$96.13	$46.31
OHIO (OH)	$95.88	$48.01
OKLAHOMA (OK)	$93.10	$46.27
PORTLAND (OR)	$106.88	$48.62
REST OF OREGON (OR)	$98.97	$46.74
METROPOLITAN PHILADELPHIA (PA)	$105.62	$51.03
REST OF PENNSYLVANIA (PA)	$95.77	$47.63
PUERTO RICO (PR)	$101.78	$48.77
RHODE ISLAND (RI)	$103.14	$48.97
SOUTH CAROLINA (SC)	$95.51	$47.05
SOUTH DAKOTA** (SD)	$96.77	$44.33
TENNESSEE (TN)	$92.49	$44.82
BRAZORIA (TX)	$99.44	$47.47
DALLAS (TX)	$100.30	$48.07
GALVESTON (TX)	$99.89	$47.81
HOUSTON (TX)	$103.55	$51.47
BEAUMONT (TX)	$95.17	$47.45
FORT WORTH (TX)	$99.77	$48.07
AUSTIN (TX)	$104.09	$48.61
REST OF TEXAS (TX)	$97.41	$47.64
UTAH (UT)	$96.82	$47.52
VIRGINIA (VA)	$98.19	$46.64
VIRGIN ISLANDS (VI)	$101.78	$48.77
VERMONT (VT)	$97.29	$45.37
SEATTLE (KING CNTY) (WA)	$115.65	$51.30
REST OF WASHINGTON (WA)	$103.31	$48.09
WISCONSIN (WI)	$93.99	$43.75
WEST VIRGINIA (WV)	$95.99	$50.42
WYOMING** (WY)	$99.47	$47.03

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 15 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 pricing for this code starts with three Relative Value Units (RVUs): 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, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates differ primarily because practice-expense RVUs are lower in facility settings, where the facility itself bears more of the overhead cost.

RVUs — work 0.98, practice expense 1.85 (non-facility) / 0.28 (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's deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment varies by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The facility rate uses a lower practice-expense RVU because the facility (e.g., hospital) is assumed to absorb overhead costs like equipment, staff, and supplies, whereas the non-facility rate assumes the physician's practice bears those costs.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-allowed amount before the 80/20 split, deductible application, sequestration, and any locality-specific GPCI adjustments, so actual reimbursement may differ.

Why isn't the CPT code description shown here?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page refers to the code generically rather than reproducing the descriptor.

Will this amount change next year?

Yes, potentially. The conversion factor, RVUs, and GPCIs are updated annually by CMS and can shift due to budget-neutrality requirements and policy changes.

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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.