Medicare Reimbursement for CPT Code 15769

This page covers Medicare Physician Fee Schedule (PFS) pricing for CPT code 15769, a procedure code maintained by the AMA. It shows the PFS allowed amount at the national level and by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$454.59	$454.59
ALASKA* (AK)	$555.89	$555.89
ALABAMA (AL)	$411.22	$411.22
ARKANSAS (AR)	$405.87	$405.87
ARIZONA (AZ)	$442.21	$442.21
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$528.72	$528.72
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$536.90	$536.90
OXNARD-THOUSAND OAKS-VENTURA (CA)	$479.00	$479.00
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$483.84	$483.84
NAPA (CA)	$507.71	$507.71
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$530.23	$530.23
VALLEJO (CA)	$505.54	$505.54
BAKERSFIELD (CA)	$459.85	$459.85
CHICO (CA)	$456.17	$456.17
FRESNO (CA)	$456.17	$456.17
HANFORD-CORCORAN (CA)	$456.17	$456.17
MADERA (CA)	$456.17	$456.17
MERCED (CA)	$456.17	$456.17
MODESTO (CA)	$456.17	$456.17
REDDING (CA)	$456.17	$456.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$470.47	$470.47
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$473.22	$473.22
SALINAS (CA)	$471.36	$471.36
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$543.08	$543.08
SANTA CRUZ-WATSONVILLE (CA)	$479.98	$479.98
SANTA ROSA-PETALUMA (CA)	$484.44	$484.44
STOCKTON (CA)	$456.17	$456.17
VISALIA (CA)	$456.17	$456.17
YUBA CITY (CA)	$456.17	$456.17
EL CENTRO (CA)	$456.39	$456.39
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$478.54	$478.54
SAN LUIS OBISPO-PASO ROBLES (CA)	$464.46	$464.46
SANTA MARIA-SANTA BARBARA (CA)	$472.05	$472.05
REST OF CALIFORNIA (CA)	$456.17	$456.17
COLORADO (CO)	$459.80	$459.80
CONNECTICUT (CT)	$483.10	$483.10
DC + MD/VA SUBURBS (DC)	$505.65	$505.65
DELAWARE (DE)	$448.87	$448.87
FORT LAUDERDALE (FL)	$492.99	$492.99
MIAMI (FL)	$530.41	$530.41
REST OF FLORIDA (FL)	$468.45	$468.45
ATLANTA (GA)	$467.25	$467.25
REST OF GEORGIA (GA)	$442.30	$442.30
HAWAII, GUAM (HI)	$462.29	$462.29
IOWA (IA)	$411.42	$411.42
IDAHO (ID)	$415.76	$415.76
EAST ST. LOUIS (IL)	$484.21	$484.21
SUBURBAN CHICAGO (IL)	$495.61	$495.61
CHICAGO (IL)	$514.60	$514.60
REST OF ILLINOIS (IL)	$462.83	$462.83
INDIANA (IN)	$417.68	$417.68
KANSAS (KS)	$414.05	$414.05
KENTUCKY (KY)	$429.42	$429.42
NEW ORLEANS (LA)	$449.26	$449.26
REST OF LOUISIANA (LA)	$430.56	$430.56
METROPOLITAN BOSTON (MA)	$496.00	$496.00
REST OF MASSACHUSETTS (MA)	$459.26	$459.26
BALTIMORE/SURR. CNTYS (MD)	$482.66	$482.66
REST OF MARYLAND (MD)	$455.43	$455.43
SOUTHERN MAINE (ME)	$436.46	$436.46
REST OF MAINE (ME)	$422.38	$422.38
DETROIT (MI)	$478.32	$478.32
REST OF MICHIGAN (MI)	$443.55	$443.55
MINNESOTA (MN)	$428.90	$428.90
METROPOLITAN ST. LOUIS (MO)	$445.42	$445.42
METROPOLITAN KANSAS CITY (MO)	$441.81	$441.81
REST OF MISSOURI (MO)	$426.84	$426.84
MISSISSIPPI (MS)	$416.20	$416.20
MONTANA** (MT)	$454.50	$454.50
NORTH CAROLINA (NC)	$425.64	$425.64
NORTH DAKOTA** (ND)	$428.20	$428.20
NEBRASKA (NE)	$412.12	$412.12
NEW HAMPSHIRE (NH)	$456.94	$456.94
NORTHERN NJ (NJ)	$502.14	$502.14
REST OF NEW JERSEY (NJ)	$485.32	$485.32
NEW MEXICO (NM)	$447.52	$447.52
NEVADA** (NV)	$447.36	$447.36
MANHATTAN (NY)	$525.76	$525.76
NYC SUBURBS/LONG ISLAND (NY)	$543.00	$543.00
POUGHKPSIE/N NYC SUBURBS (NY)	$492.01	$492.01
QUEENS (NY)	$523.21	$523.21
REST OF NEW YORK (NY)	$431.76	$431.76
OHIO (OH)	$438.17	$438.17
OKLAHOMA (OK)	$424.06	$424.06
PORTLAND (OR)	$468.09	$468.09
REST OF OREGON (OR)	$440.62	$440.62
METROPOLITAN PHILADELPHIA (PA)	$474.98	$474.98
REST OF PENNSYLVANIA (PA)	$436.34	$436.34
PUERTO RICO (PR)	$456.04	$456.04
RHODE ISLAND (RI)	$460.28	$460.28
SOUTH CAROLINA (SC)	$433.28	$433.28
SOUTH DAKOTA** (SD)	$425.09	$425.09
TENNESSEE (TN)	$416.48	$416.48
BRAZORIA (TX)	$444.82	$444.82
DALLAS (TX)	$449.46	$449.46
GALVESTON (TX)	$447.34	$447.34
HOUSTON (TX)	$471.68	$471.68
BEAUMONT (TX)	$434.09	$434.09
FORT WORTH (TX)	$448.11	$448.11
AUSTIN (TX)	$461.13	$461.13
REST OF TEXAS (TX)	$440.45	$440.45
UTAH (UT)	$438.49	$438.49
VIRGINIA (VA)	$438.25	$438.25
VIRGIN ISLANDS (VI)	$456.04	$456.04
VERMONT (VT)	$430.71	$430.71
SEATTLE (KING CNTY) (WA)	$501.08	$501.08
REST OF WASHINGTON (WA)	$457.01	$457.01
WISCONSIN (WI)	$415.75	$415.75
WEST VIRGINIA (WV)	$448.49	$448.49
WYOMING** (WY)	$443.04	$443.04

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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

Each CPT/HCPCS code is assigned three Relative Value Units (RVUs) — work, practice expense (PE), and malpractice (MP) — reflecting physician effort, overhead, and liability risk. These RVUs are each adjusted by locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences, then summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility PE RVUs apply when the service is furnished in a physician office setting, while facility PE RVUs apply when furnished in a hospital, ASC, or other facility setting where the facility bears some overhead costs, which can result in different allowed amounts for the same code.

RVUs — work 6.51, practice expense 5.77 (non-facility) / 5.77 (facility), malpractice 1.33 — × 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 annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the allowed amount differ between non-facility and facility settings?

The practice expense RVU component changes depending on setting, since in facility settings (e.g., hospital, ASC) some overhead costs are borne by the facility rather than the billing provider.

Why might the amount shown differ from what I see on my Medicare remittance?

Remittances reflect your specific locality GPCIs, any applicable modifiers, sequestration, and other adjustments that are not captured in a national reference figure.

Can I use this figure to predict exact patient responsibility?

No. Patient responsibility depends on deductible status, secondary coverage, and the 20% coinsurance applied to the actual allowed amount determined by your MAC.

Is the conversion factor the same every year?

No. CMS updates the conversion factor annually, and RVUs can also be revised, so allowed amounts can change year to year even if the code description stays the same.

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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.