Medicare Reimbursement for CPT 15630

CPT 15630 is a procedure code used in professional billing; the specific service it describes is defined by the AMA's CPT code set and is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code at the national level, along with how it can vary by locality and by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$469.95	$311.30
ALASKA* (AK)	$549.05	$380.09
ALABAMA (AL)	$422.25	$283.43
ARKANSAS (AR)	$416.23	$279.94
ARIZONA (AZ)	$457.47	$303.73
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$602.99	$379.29
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$614.69	$385.91
OXNARD-THOUSAND OAKS-VENTURA (CA)	$524.93	$337.40
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$527.71	$340.03
NAPA (CA)	$570.89	$361.78
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$603.60	$379.90
VALLEJO (CA)	$570.00	$360.90
BAKERSFIELD (CA)	$496.05	$322.16
CHICO (CA)	$494.46	$320.58
FRESNO (CA)	$494.46	$320.58
HANFORD-CORCORAN (CA)	$494.46	$320.58
MADERA (CA)	$494.46	$320.58
MERCED (CA)	$494.46	$320.58
MODESTO (CA)	$494.46	$320.58
REDDING (CA)	$494.46	$320.58
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$500.31	$326.43
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$518.36	$333.85
SALINAS (CA)	$516.42	$332.54
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$617.19	$388.41
SANTA CRUZ-WATSONVILLE (CA)	$532.95	$340.19
SANTA ROSA-PETALUMA (CA)	$538.30	$343.47
STOCKTON (CA)	$494.46	$320.58
VISALIA (CA)	$494.46	$320.58
YUBA CITY (CA)	$494.46	$320.58
EL CENTRO (CA)	$494.55	$320.67
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$528.20	$338.45
SAN LUIS OBISPO-PASO ROBLES (CA)	$508.18	$327.47
SANTA MARIA-SANTA BARBARA (CA)	$518.25	$333.26
REST OF CALIFORNIA (CA)	$494.46	$320.58
COLORADO (CO)	$488.01	$319.20
CONNECTICUT (CT)	$500.96	$330.09
DC + MD/VA SUBURBS (DC)	$535.95	$349.05
DELAWARE (DE)	$464.97	$308.22
FORT LAUDERDALE (FL)	$488.67	$327.95
MIAMI (FL)	$510.61	$345.45
REST OF FLORIDA (FL)	$464.99	$313.31
ATLANTA (GA)	$479.08	$317.89
REST OF GEORGIA (GA)	$438.96	$297.44
HAWAII, GUAM (HI)	$506.06	$325.67
IOWA (IA)	$431.96	$286.79
IDAHO (ID)	$434.93	$288.97
EAST ST. LOUIS (IL)	$462.72	$316.76
SUBURBAN CHICAGO (IL)	$493.42	$330.48
CHICAGO (IL)	$495.83	$336.39
REST OF ILLINOIS (IL)	$452.35	$307.50
INDIANA (IN)	$437.39	$290.32
KANSAS (KS)	$430.38	$286.96
KENTUCKY (KY)	$433.01	$291.97
NEW ORLEANS (LA)	$453.58	$304.29
REST OF LOUISIANA (LA)	$432.51	$292.10
METROPOLITAN BOSTON (MA)	$535.30	$345.87
REST OF MASSACHUSETTS (MA)	$485.32	$318.26
BALTIMORE/SURR. CNTYS (MD)	$499.64	$329.40
REST OF MARYLAND (MD)	$473.63	$313.07
SOUTHERN MAINE (ME)	$460.42	$303.20
REST OF MAINE (ME)	$437.61	$291.65
DETROIT (MI)	$471.16	$318.06
REST OF MICHIGAN (MI)	$444.53	$299.67
MINNESOTA (MN)	$466.50	$303.25
METROPOLITAN ST. LOUIS (MO)	$454.68	$303.64
METROPOLITAN KANSAS CITY (MO)	$450.08	$301.10
REST OF MISSOURI (MO)	$425.46	$288.70
MISSISSIPPI (MS)	$420.91	$284.30
MONTANA** (MT)	$469.91	$311.26
NORTH CAROLINA (NC)	$442.07	$294.04
NORTH DAKOTA** (ND)	$459.24	$300.58
NEBRASKA (NE)	$434.17	$287.73
NEW HAMPSHIRE (NH)	$480.77	$315.62
NORTHERN NJ (NJ)	$530.59	$346.55
REST OF NEW JERSEY (NJ)	$506.36	$333.11
NEW MEXICO (NM)	$447.10	$301.61
NEVADA** (NV)	$467.26	$308.44
MANHATTAN (NY)	$540.70	$356.35
NYC SUBURBS/LONG ISLAND (NY)	$554.20	$365.56
POUGHKPSIE/N NYC SUBURBS (NY)	$510.02	$336.30
QUEENS (NY)	$544.48	$356.96
REST OF NEW YORK (NY)	$448.64	$297.92
OHIO (OH)	$442.34	$297.49
OKLAHOMA (OK)	$431.80	$290.12
PORTLAND (OR)	$502.87	$326.60
REST OF OREGON (OR)	$463.32	$305.30
METROPOLITAN PHILADELPHIA (PA)	$488.90	$323.74
REST OF PENNSYLVANIA (PA)	$442.80	$297.16
PUERTO RICO (PR)	$473.19	$312.79
RHODE ISLAND (RI)	$481.05	$317.16
SOUTH CAROLINA (SC)	$443.00	$296.41
SOUTH DAKOTA** (SD)	$457.97	$299.32
TENNESSEE (TN)	$432.57	$288.36
BRAZORIA (TX)	$464.18	$306.95
DALLAS (TX)	$467.31	$309.29
GALVESTON (TX)	$465.68	$308.14
HOUSTON (TX)	$475.56	$318.02
BEAUMONT (TX)	$439.96	$295.59
FORT WORTH (TX)	$464.35	$307.92
AUSTIN (TX)	$486.66	$318.80
REST OF TEXAS (TX)	$451.93	$301.37
UTAH (UT)	$448.97	$299.84
VIRGINIA (VA)	$459.23	$303.27
VIRGIN ISLANDS (VI)	$473.19	$312.79
VERMONT (VT)	$457.85	$300.78
SEATTLE (KING CNTY) (WA)	$545.70	$351.04
REST OF WASHINGTON (WA)	$484.27	$317.21
WISCONSIN (WI)	$444.07	$292.08
WEST VIRGINIA (WV)	$435.94	$298.07
WYOMING** (WY)	$465.26	$306.61

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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 Physician Fee Schedule 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 performed, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the same code can have two different national amounts depending on where it's billed.

RVUs — work 3.98, practice expense 9.55 (non-facility) / 4.8 (facility), malpractice 0.54 — × 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 approved amount after the patient's deductible is met; the patient or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Actual payment varies by Medicare Administrative Contractor (MAC) locality and plan type (Original Medicare vs. Medicare Advantage).
Always verify current rates and coverage rules with your MAC or the official CMS Physician Fee Schedule lookup tool before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount for this code?

The practice-expense RVU component changes based on site of service, since Medicare assumes different overhead costs when a service is performed in a facility (like a hospital) versus a non-facility setting (like a physician's office).

Why might the amount I was paid differ from the national figure shown here?

Local GPCIs adjust the RVUs for geographic cost differences, so the final allowed amount in a specific locality can be higher or lower than the national average shown on this page.

Does this amount reflect what the patient will owe?

No. This figure is the Medicare-approved amount before cost-sharing. Patients typically owe 20% of this amount after their deductible, unless they have supplemental coverage.

Can modifiers change this estimate?

Yes. Modifiers (such as bilateral, multiple-procedure, or reduced-service modifiers) can increase, decrease, or otherwise adjust the final paid amount relative to the base fee schedule figure.

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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.