Medicare Reimbursement for CPT Code 15738

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026. Amounts are displayed at the national level and can vary by locality, with separate figures for non-facility and facility settings. These are estimated allowed amounts before patient cost-sharing is applied.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1148.32	$1148.32
ALASKA* (AK)	$1430.48	$1430.48
ALABAMA (AL)	$1044.91	$1044.91
ARKANSAS (AR)	$1032.22	$1032.22
ARIZONA (AZ)	$1118.28	$1118.28
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1304.76	$1304.76
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1323.72	$1323.72
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1194.26	$1194.26
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1207.68	$1207.68
NAPA (CA)	$1257.47	$1257.47
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1308.87	$1308.87
VALLEJO (CA)	$1251.55	$1251.55
BAKERSFIELD (CA)	$1151.94	$1151.94
CHICO (CA)	$1141.88	$1141.88
FRESNO (CA)	$1141.88	$1141.88
HANFORD-CORCORAN (CA)	$1141.88	$1141.88
MADERA (CA)	$1141.88	$1141.88
MERCED (CA)	$1141.88	$1141.88
MODESTO (CA)	$1141.88	$1141.88
REDDING (CA)	$1141.88	$1141.88
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1180.83	$1180.83
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1180.96	$1180.96
SALINAS (CA)	$1176.23	$1176.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1340.52	$1340.52
SANTA CRUZ-WATSONVILLE (CA)	$1192.85	$1192.85
SANTA ROSA-PETALUMA (CA)	$1203.73	$1203.73
STOCKTON (CA)	$1141.88	$1141.88
VISALIA (CA)	$1141.88	$1141.88
YUBA CITY (CA)	$1141.88	$1141.88
EL CENTRO (CA)	$1142.48	$1142.48
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1191.41	$1191.41
SAN LUIS OBISPO-PASO ROBLES (CA)	$1159.40	$1159.40
SANTA MARIA-SANTA BARBARA (CA)	$1177.22	$1177.22
REST OF CALIFORNIA (CA)	$1141.88	$1141.88
COLORADO (CO)	$1155.36	$1155.36
CONNECTICUT (CT)	$1217.49	$1217.49
DC + MD/VA SUBURBS (DC)	$1268.00	$1268.00
DELAWARE (DE)	$1134.32	$1134.32
FORT LAUDERDALE (FL)	$1251.32	$1251.32
MIAMI (FL)	$1349.90	$1349.90
REST OF FLORIDA (FL)	$1191.21	$1191.21
ATLANTA (GA)	$1181.01	$1181.01
REST OF GEORGIA (GA)	$1127.53	$1127.53
HAWAII, GUAM (HI)	$1153.25	$1153.25
IOWA (IA)	$1040.78	$1040.78
IDAHO (ID)	$1052.00	$1052.00
EAST ST. LOUIS (IL)	$1238.33	$1238.33
SUBURBAN CHICAGO (IL)	$1257.01	$1257.01
CHICAGO (IL)	$1311.28	$1311.28
REST OF ILLINOIS (IL)	$1180.94	$1180.94
INDIANA (IN)	$1056.43	$1056.43
KANSAS (KS)	$1049.23	$1049.23
KENTUCKY (KY)	$1092.81	$1092.81
NEW ORLEANS (LA)	$1140.72	$1140.72
REST OF LOUISIANA (LA)	$1096.38	$1096.38
METROPOLITAN BOSTON (MA)	$1239.49	$1239.49
REST OF MASSACHUSETTS (MA)	$1155.29	$1155.29
BALTIMORE/SURR. CNTYS (MD)	$1216.64	$1216.64
REST OF MARYLAND (MD)	$1149.50	$1149.50
SOUTHERN MAINE (ME)	$1100.04	$1100.04
REST OF MAINE (ME)	$1070.02	$1070.02
DETROIT (MI)	$1217.01	$1217.01
REST OF MICHIGAN (MI)	$1128.47	$1128.47
MINNESOTA (MN)	$1075.02	$1075.02
METROPOLITAN ST. LOUIS (MO)	$1129.01	$1129.01
METROPOLITAN KANSAS CITY (MO)	$1120.69	$1120.69
REST OF MISSOURI (MO)	$1088.95	$1088.95
MISSISSIPPI (MS)	$1060.12	$1060.12
MONTANA** (MT)	$1148.08	$1148.08
NORTH CAROLINA (NC)	$1077.37	$1077.37
NORTH DAKOTA** (ND)	$1076.50	$1076.50
NEBRASKA (NE)	$1041.74	$1041.74
NEW HAMPSHIRE (NH)	$1149.92	$1149.92
NORTHERN NJ (NJ)	$1260.80	$1260.80
REST OF NEW JERSEY (NJ)	$1222.34	$1222.34
NEW MEXICO (NM)	$1138.80	$1138.80
NEVADA** (NV)	$1128.54	$1128.54
MANHATTAN (NY)	$1324.87	$1324.87
NYC SUBURBS/LONG ISLAND (NY)	$1368.63	$1368.63
POUGHKPSIE/N NYC SUBURBS (NY)	$1240.32	$1240.32
QUEENS (NY)	$1315.60	$1315.60
REST OF NEW YORK (NY)	$1092.04	$1092.04
OHIO (OH)	$1113.84	$1113.84
OKLAHOMA (OK)	$1077.76	$1077.76
PORTLAND (OR)	$1172.52	$1172.52
REST OF OREGON (OR)	$1110.78	$1110.78
METROPOLITAN PHILADELPHIA (PA)	$1199.52	$1199.52
REST OF PENNSYLVANIA (PA)	$1108.26	$1108.26
PUERTO RICO (PR)	$1150.99	$1150.99
RHODE ISLAND (RI)	$1160.49	$1160.49
SOUTH CAROLINA (SC)	$1099.22	$1099.22
SOUTH DAKOTA** (SD)	$1068.04	$1068.04
TENNESSEE (TN)	$1055.26	$1055.26
BRAZORIA (TX)	$1123.01	$1123.01
DALLAS (TX)	$1135.10	$1135.10
GALVESTON (TX)	$1129.63	$1129.63
HOUSTON (TX)	$1195.89	$1195.89
BEAUMONT (TX)	$1103.06	$1103.06
FORT WORTH (TX)	$1132.60	$1132.60
AUSTIN (TX)	$1159.41	$1159.41
REST OF TEXAS (TX)	$1115.81	$1115.81
UTAH (UT)	$1111.54	$1111.54
VIRGINIA (VA)	$1105.85	$1105.85
VIRGIN ISLANDS (VI)	$1150.99	$1150.99
VERMONT (VT)	$1084.52	$1084.52
SEATTLE (KING CNTY) (WA)	$1249.69	$1249.69
REST OF WASHINGTON (WA)	$1149.08	$1149.08
WISCONSIN (WI)	$1047.54	$1047.54
WEST VIRGINIA (WV)	$1147.05	$1147.05
WYOMING** (WY)	$1116.89	$1116.89

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 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 allowed amount for this code is built from 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, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility settings can have different practice-expense RVUs because the resources assumed to be furnished by the physician's practice differ depending on where the service is rendered (e.g., office vs. hospital). For this code, the practice-expense RVU is the same in both settings, so the national non-facility and facility amounts shown are identical. Local wage and cost differences mean the final payment can differ from the national figure once GPCIs for a specific locality are applied.

RVUs — work 18.56, practice expense 12.2 (non-facility) / 12.2 (facility), malpractice 3.62 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement can differ.
Medicare typically pays 80% of the allowed amount after the Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPICs can raise or lower the amount shown here from the national figure.
Always confirm current-year rates and any applicable edits with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the fee schedule amount differ from what my MAC actually pays?

The published PFS amount is a national or locality-adjusted estimate. Actual payment can be affected by sequestration, secondary payer rules, claim-specific modifiers, and any local coverage determinations that apply to the claim.

Why are the non-facility and facility amounts the same for this code?

When the practice-expense RVU is identical in both settings, the calculated allowed amount is the same whether the service is billed as performed in a facility or non-facility setting.

Does this amount reflect what the patient will owe?

No. This figure is the Medicare-allowed amount before cost-sharing. After the deductible is met, Medicare generally pays 80%, leaving the patient or a secondary payer responsible for the remaining 20%.

Will this rate change during the year?

The conversion factor and RVUs are typically set annually, but mid-year corrections, budget-neutrality adjustments, or legislative changes can occasionally modify the amount.

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.