Medicare Reimbursement for CPT 15770
CPT 15770 is a procedure code reported to Medicare for physician and outpatient services; the specific clinical descriptor is licensed by the AMA and is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted for locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $606.23 | $606.23 |
| ALASKA* (AK) | $748.41 | $748.41 |
| ALABAMA (AL) | $552.39 | $552.39 |
| ARKANSAS (AR) | $545.71 | $545.71 |
| ARIZONA (AZ) | $591.16 | $591.16 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $716.43 | $716.43 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $728.05 | $728.05 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $645.28 | $645.28 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $651.27 | $651.27 |
| NAPA (CA) | $686.42 | $686.42 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $718.04 | $718.04 |
| VALLEJO (CA) | $684.11 | $684.11 |
| BAKERSFIELD (CA) | $619.01 | $619.01 |
| CHICO (CA) | $614.99 | $614.99 |
| FRESNO (CA) | $614.99 | $614.99 |
| HANFORD-CORCORAN (CA) | $614.99 | $614.99 |
| MADERA (CA) | $614.99 | $614.99 |
| MERCED (CA) | $614.99 | $614.99 |
| MODESTO (CA) | $614.99 | $614.99 |
| REDDING (CA) | $614.99 | $614.99 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $630.21 | $630.21 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $638.44 | $638.44 |
| SALINAS (CA) | $635.91 | $635.91 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $734.59 | $734.59 |
| SANTA CRUZ-WATSONVILLE (CA) | $647.95 | $647.95 |
| SANTA ROSA-PETALUMA (CA) | $654.06 | $654.06 |
| STOCKTON (CA) | $614.99 | $614.99 |
| VISALIA (CA) | $614.99 | $614.99 |
| YUBA CITY (CA) | $614.99 | $614.99 |
| EL CENTRO (CA) | $615.22 | $615.22 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $645.79 | $645.79 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $626.48 | $626.48 |
| SANTA MARIA-SANTA BARBARA (CA) | $636.90 | $636.90 |
| REST OF CALIFORNIA (CA) | $614.99 | $614.99 |
| COLORADO (CO) | $616.52 | $616.52 |
| CONNECTICUT (CT) | $642.53 | $642.53 |
| DC + MD/VA SUBURBS (DC) | $674.87 | $674.87 |
| DELAWARE (DE) | $599.72 | $599.72 |
| FORT LAUDERDALE (FL) | $647.75 | $647.75 |
| MIAMI (FL) | $689.19 | $689.19 |
| REST OF FLORIDA (FL) | $618.16 | $618.16 |
| ATLANTA (GA) | $620.84 | $620.84 |
| REST OF GEORGIA (GA) | $586.41 | $586.41 |
| HAWAII, GUAM (HI) | $623.01 | $623.01 |
| IOWA (IA) | $555.12 | $555.12 |
| IDAHO (ID) | $560.03 | $560.03 |
| EAST ST. LOUIS (IL) | $632.60 | $632.60 |
| SUBURBAN CHICAGO (IL) | $651.84 | $651.84 |
| CHICAGO (IL) | $670.59 | $670.59 |
| REST OF ILLINOIS (IL) | $609.49 | $609.49 |
| INDIANA (IN) | $562.51 | $562.51 |
| KANSAS (KS) | $557.22 | $557.22 |
| KENTUCKY (KY) | $572.56 | $572.56 |
| NEW ORLEANS (LA) | $596.87 | $596.87 |
| REST OF LOUISIANA (LA) | $573.52 | $573.52 |
| METROPOLITAN BOSTON (MA) | $664.85 | $664.85 |
| REST OF MASSACHUSETTS (MA) | $615.50 | $615.50 |
| BALTIMORE/SURR. CNTYS (MD) | $641.56 | $641.56 |
| REST OF MARYLAND (MD) | $608.49 | $608.49 |
| SOUTHERN MAINE (ME) | $586.44 | $586.44 |
| REST OF MAINE (ME) | $567.05 | $567.05 |
| DETROIT (MI) | $629.18 | $629.18 |
| REST OF MICHIGAN (MI) | $589.05 | $589.05 |
| MINNESOTA (MN) | $580.82 | $580.82 |
| METROPOLITAN ST. LOUIS (MO) | $593.49 | $593.49 |
| METROPOLITAN KANSAS CITY (MO) | $588.84 | $588.84 |
| REST OF MISSOURI (MO) | $568.13 | $568.13 |
| MISSISSIPPI (MS) | $556.79 | $556.79 |
| MONTANA** (MT) | $606.13 | $606.13 |
| NORTH CAROLINA (NC) | $571.32 | $571.32 |
| NORTH DAKOTA** (ND) | $578.25 | $578.25 |
| NEBRASKA (NE) | $556.36 | $556.36 |
| NEW HAMPSHIRE (NH) | $611.29 | $611.29 |
| NORTHERN NJ (NJ) | $670.57 | $670.57 |
| REST OF NEW JERSEY (NJ) | $647.05 | $647.05 |
| NEW MEXICO (NM) | $593.51 | $593.51 |
| NEVADA** (NV) | $598.63 | $598.63 |
| MANHATTAN (NY) | $695.79 | $695.79 |
| NYC SUBURBS/LONG ISLAND (NY) | $715.77 | $715.77 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $654.64 | $654.64 |
| QUEENS (NY) | $694.36 | $694.36 |
| REST OF NEW YORK (NY) | $578.88 | $578.88 |
| OHIO (OH) | $583.36 | $583.36 |
| OKLAHOMA (OK) | $567.13 | $567.13 |
| PORTLAND (OR) | $628.50 | $628.50 |
| REST OF OREGON (OR) | $591.17 | $591.17 |
| METROPOLITAN PHILADELPHIA (PA) | $631.53 | $631.53 |
| REST OF PENNSYLVANIA (PA) | $581.73 | $581.73 |
| PUERTO RICO (PR) | $608.46 | $608.46 |
| RHODE ISLAND (RI) | $615.50 | $615.50 |
| SOUTH CAROLINA (SC) | $578.85 | $578.85 |
| SOUTH DAKOTA** (SD) | $574.96 | $574.96 |
| TENNESSEE (TN) | $560.11 | $560.11 |
| BRAZORIA (TX) | $595.80 | $595.80 |
| DALLAS (TX) | $601.10 | $601.10 |
| GALVESTON (TX) | $598.59 | $598.59 |
| HOUSTON (TX) | $624.40 | $624.40 |
| BEAUMONT (TX) | $578.83 | $578.83 |
| FORT WORTH (TX) | $599.04 | $599.04 |
| AUSTIN (TX) | $616.94 | $616.94 |
| REST OF TEXAS (TX) | $588.03 | $588.03 |
| UTAH (UT) | $585.39 | $585.39 |
| VIRGINIA (VA) | $587.84 | $587.84 |
| VIRGIN ISLANDS (VI) | $608.46 | $608.46 |
| VERMONT (VT) | $580.29 | $580.29 |
| SEATTLE (KING CNTY) (WA) | $672.86 | $672.86 |
| REST OF WASHINGTON (WA) | $612.93 | $612.93 |
| WISCONSIN (WI) | $562.41 | $562.41 |
| WEST VIRGINIA (WV) | $591.52 | $591.52 |
| WYOMING** (WY) | $593.98 | $593.98 |
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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 PFS amount is built from three Relative Value Units (RVUs) assigned to each 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, reflecting regional cost differences. The 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 amounts can differ because the practice-expense RVU is typically higher when the service is performed in a physician's office versus a hospital or facility setting, since facility overhead is billed separately by the facility. For CPT 15770, the non-facility and facility PE RVUs shown here are equal, so the resulting allowed amounts match in this case.
RVUs — work 8.74, practice expense 8 (non-facility) / 8 (facility), malpractice 1.41 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This figure is an estimate only, not a guarantee of payment.
- Medicare typically pays 80% of the allowed amount after the patient meets the annual deductible; the beneficiary or secondary payer is responsible for the remainder.
- Actual payment can vary by locality, applicable modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
- Always verify current rates and policies with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the amount differ by locality?
CMS applies Geographic Practice Cost Indices (GPCIs) to the work, practice expense, and malpractice RVUs to reflect differences in local labor, rent, and other costs, which changes the final allowed amount by region.
Why are the non-facility and facility amounts the same for this code?
The practice-expense RVU, which usually differs between settings, is listed as equal for both non-facility and facility for CPT 15770, so both calculations produce the same allowed amount.
Does this amount include what the patient owes?
No. The figure shown is the total Medicare-allowed amount. Medicare generally pays 80% after the deductible is met, with the patient or secondary insurance responsible for the remaining 20%.
Can modifiers change this amount?
Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple-procedure discounting can increase or decrease the final reimbursement relative to the base PFS amount shown here.
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.
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