Medicare Reimbursement for CPT 15731

CPT 15731 is a procedure code reported to Medicare and other payers; the exact service it describes is defined by the AMA's CPT codebook, which this page does not reproduce. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and, where available, by locality, broken out separately for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1148.32	$877.44
ALASKA* (AK)	$1389.93	$1101.44
ALABAMA (AL)	$1041.23	$804.21
ARKANSAS (AR)	$1027.85	$795.16
ARIZONA (AZ)	$1119.16	$856.68
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1401.22	$1019.28
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1425.72	$1035.11
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1245.25	$925.06
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1254.87	$934.42
NAPA (CA)	$1336.18	$979.16
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1403.65	$1021.71
VALLEJO (CA)	$1332.68	$975.66
BAKERSFIELD (CA)	$1187.69	$890.81
CHICO (CA)	$1181.54	$884.65
FRESNO (CA)	$1181.54	$884.65
HANFORD-CORCORAN (CA)	$1181.54	$884.65
MADERA (CA)	$1181.54	$884.65
MERCED (CA)	$1181.54	$884.65
MODESTO (CA)	$1181.54	$884.65
REDDING (CA)	$1181.54	$884.65
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1204.67	$907.78
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1231.21	$916.18
SALINAS (CA)	$1226.44	$912.48
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1435.65	$1045.04
SANTA CRUZ-WATSONVILLE (CA)	$1255.83	$926.71
SANTA ROSA-PETALUMA (CA)	$1267.96	$935.32
STOCKTON (CA)	$1181.54	$884.65
VISALIA (CA)	$1181.54	$884.65
YUBA CITY (CA)	$1181.54	$884.65
EL CENTRO (CA)	$1181.90	$885.01
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1248.91	$924.94
SAN LUIS OBISPO-PASO ROBLES (CA)	$1207.71	$899.17
SANTA MARIA-SANTA BARBARA (CA)	$1229.29	$913.44
REST OF CALIFORNIA (CA)	$1181.54	$884.65
COLORADO (CO)	$1177.24	$889.02
CONNECTICUT (CT)	$1219.56	$927.82
DC + MD/VA SUBURBS (DC)	$1290.01	$970.91
DELAWARE (DE)	$1136.14	$868.51
FORT LAUDERDALE (FL)	$1213.99	$939.59
MIAMI (FL)	$1282.56	$1000.58
REST OF FLORIDA (FL)	$1157.50	$898.54
ATLANTA (GA)	$1173.83	$898.62
REST OF GEORGIA (GA)	$1096.32	$854.70
HAWAII, GUAM (HI)	$1201.60	$893.61
IOWA (IA)	$1053.49	$805.64
IDAHO (ID)	$1061.97	$812.76
EAST ST. LOUIS (IL)	$1172.12	$922.91
SUBURBAN CHICAGO (IL)	$1223.21	$945.02
CHICAGO (IL)	$1247.21	$974.97
REST OF ILLINOIS (IL)	$1135.62	$888.31
INDIANA (IN)	$1067.16	$816.05
KANSAS (KS)	$1054.45	$809.57
KENTUCKY (KY)	$1074.70	$833.88
NEW ORLEANS (LA)	$1122.14	$867.24
REST OF LOUISIANA (LA)	$1075.34	$835.61
METROPOLITAN BOSTON (MA)	$1277.72	$954.29
REST OF MASSACHUSETTS (MA)	$1173.56	$888.32
BALTIMORE/SURR. CNTYS (MD)	$1217.18	$926.53
REST OF MARYLAND (MD)	$1154.45	$880.32
SOUTHERN MAINE (ME)	$1116.47	$848.03
REST OF MAINE (ME)	$1072.62	$823.41
DETROIT (MI)	$1176.06	$914.66
REST OF MICHIGAN (MI)	$1104.60	$857.28
MINNESOTA (MN)	$1115.65	$836.91
METROPOLITAN ST. LOUIS (MO)	$1119.25	$861.38
METROPOLITAN KANSAS CITY (MO)	$1109.56	$855.20
REST OF MISSOURI (MO)	$1062.48	$828.98
MISSISSIPPI (MS)	$1045.08	$811.85
MONTANA** (MT)	$1148.18	$877.30
NORTH CAROLINA (NC)	$1081.75	$829.01
NORTH DAKOTA** (ND)	$1105.87	$834.98
NEBRASKA (NE)	$1057.00	$806.98
NEW HAMPSHIRE (NH)	$1164.34	$882.35
NORTHERN NJ (NJ)	$1280.06	$965.83
REST OF NEW JERSEY (NJ)	$1229.98	$934.17
NEW MEXICO (NM)	$1112.18	$863.78
NEVADA** (NV)	$1136.99	$865.84
MANHATTAN (NY)	$1318.77	$1004.00
NYC SUBURBS/LONG ISLAND (NY)	$1354.57	$1032.49
POUGHKPSIE/N NYC SUBURBS (NY)	$1242.22	$945.60
QUEENS (NY)	$1320.64	$1000.46
REST OF NEW YORK (NY)	$1096.67	$839.33
OHIO (OH)	$1095.95	$848.64
OKLAHOMA (OK)	$1067.27	$825.37
PORTLAND (OR)	$1205.07	$904.12
REST OF OREGON (OR)	$1124.66	$854.86
METROPOLITAN PHILADELPHIA (PA)	$1195.50	$913.51
REST OF PENNSYLVANIA (PA)	$1094.49	$845.82
PUERTO RICO (PR)	$1153.94	$880.08
RHODE ISLAND (RI)	$1169.58	$889.76
SOUTH CAROLINA (SC)	$1091.35	$841.06
SOUTH DAKOTA** (SD)	$1100.86	$829.98
TENNESSEE (TN)	$1059.85	$813.62
BRAZORIA (TX)	$1130.87	$862.42
DALLAS (TX)	$1139.95	$870.16
GALVESTON (TX)	$1135.52	$866.53
HOUSTON (TX)	$1174.68	$905.70
BEAUMONT (TX)	$1088.48	$841.98
FORT WORTH (TX)	$1134.80	$867.71
AUSTIN (TX)	$1176.41	$889.82
REST OF TEXAS (TX)	$1110.35	$853.29
UTAH (UT)	$1104.52	$849.89
VIRGINIA (VA)	$1116.96	$850.69
VIRGIN ISLANDS (VI)	$1153.94	$880.08
VERMONT (VT)	$1106.93	$838.75
SEATTLE (KING CNTY) (WA)	$1296.80	$964.43
REST OF WASHINGTON (WA)	$1169.58	$884.34
WISCONSIN (WI)	$1073.30	$813.80
WEST VIRGINIA (WV)	$1099.41	$864.01
WYOMING** (WY)	$1129.74	$858.86

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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: 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 PFS amount is built from three Relative Value Units (RVUs) assigned to the 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 furnished, to account for regional cost differences. The geographically adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility and facility rates differ mainly because the practice-expense RVU is lower in facility settings, since the facility (not the billing physician) absorbs certain overhead costs there.

RVUs — work 14.02, practice expense 18.22 (non-facility) / 10.11 (facility), malpractice 2.14 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral billing rules, and site-of-service differentials can change the amount actually paid.
Annual budget-neutrality adjustments, sequestration, and other federal payment policies can alter the final reimbursement.
Actual payment varies by Medicare Administrative Contractor (MAC) and locality; always verify current rates with your MAC 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 is lower when the code is billed in a facility setting because the facility, rather than the physician's office, bears the overhead and supply costs for the procedure.

Does this amount reflect what my specific Medicare contractor will pay?

Not exactly. This is a national PFS calculation; your Medicare Administrative Contractor applies the same formula but using your specific locality's GPCIs, and may apply additional edits, modifiers, or local coverage policies.

Why did this code's fee change from last year?

PFS amounts are recalculated annually based on updated RVUs, revised GPCIs, and a new conversion factor, plus any budget-neutrality adjustments CMS applies across the fee schedule.

Can this fee help me resolve a Medicare denial for this code?

It can help you confirm whether the billed or paid amount is in the expected range, but a denial itself usually stems from coverage, coding, or documentation issues that this fee estimate does not address.

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.