Medicare Reimbursement for CPT 15774
CPT 15774 is a procedure code reported to Medicare and other payers; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital outpatient/ASC) settings. All figures are estimates based on current published Medicare rates.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $200.74 | $121.58 |
| ALASKA* (AK) | $240.55 | $156.24 |
| ALABAMA (AL) | $181.02 | $111.76 |
| ARKANSAS (AR) | $178.56 | $110.56 |
| ARIZONA (AZ) | $195.33 | $118.62 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $244.17 | $132.55 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $248.40 | $134.25 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $217.16 | $123.59 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $218.87 | $125.23 |
| NAPA (CA) | $232.93 | $128.59 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $244.66 | $133.04 |
| VALLEJO (CA) | $232.22 | $127.89 |
| BAKERSFIELD (CA) | $206.97 | $120.21 |
| CHICO (CA) | $205.77 | $119.01 |
| FRESNO (CA) | $205.77 | $119.01 |
| HANFORD-CORCORAN (CA) | $205.77 | $119.01 |
| MADERA (CA) | $205.77 | $119.01 |
| MERCED (CA) | $205.77 | $119.01 |
| MODESTO (CA) | $205.77 | $119.01 |
| REDDING (CA) | $205.77 | $119.01 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $210.40 | $123.64 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $214.49 | $122.42 |
| SALINAS (CA) | $213.66 | $121.92 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $250.39 | $136.25 |
| SANTA CRUZ-WATSONVILLE (CA) | $218.92 | $122.74 |
| SANTA ROSA-PETALUMA (CA) | $221.03 | $123.82 |
| STOCKTON (CA) | $205.77 | $119.01 |
| VISALIA (CA) | $205.77 | $119.01 |
| YUBA CITY (CA) | $205.77 | $119.01 |
| EL CENTRO (CA) | $205.84 | $119.08 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $217.66 | $122.99 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $210.41 | $120.24 |
| SANTA MARIA-SANTA BARBARA (CA) | $214.18 | $121.88 |
| REST OF CALIFORNIA (CA) | $205.77 | $119.01 |
| COLORADO (CO) | $205.44 | $121.21 |
| CONNECTICUT (CT) | $213.63 | $128.38 |
| DC + MD/VA SUBURBS (DC) | $225.80 | $132.55 |
| DELAWARE (DE) | $198.39 | $120.18 |
| FORT LAUDERDALE (FL) | $213.75 | $133.56 |
| MIAMI (FL) | $227.12 | $144.72 |
| REST OF FLORIDA (FL) | $203.22 | $127.54 |
| ATLANTA (GA) | $205.59 | $125.16 |
| REST OF GEORGIA (GA) | $191.85 | $121.23 |
| HAWAII, GUAM (HI) | $209.47 | $119.47 |
| IOWA (IA) | $182.91 | $110.48 |
| IDAHO (ID) | $184.54 | $111.71 |
| EAST ST. LOUIS (IL) | $206.67 | $133.84 |
| SUBURBAN CHICAGO (IL) | $215.29 | $133.99 |
| CHICAGO (IL) | $220.43 | $140.87 |
| REST OF ILLINOIS (IL) | $199.44 | $127.17 |
| INDIANA (IN) | $185.48 | $112.10 |
| KANSAS (KS) | $183.26 | $111.70 |
| KENTUCKY (KY) | $187.54 | $117.17 |
| NEW ORLEANS (LA) | $196.33 | $121.84 |
| REST OF LOUISIANA (LA) | $187.73 | $117.67 |
| METROPOLITAN BOSTON (MA) | $223.31 | $128.79 |
| REST OF MASSACHUSETTS (MA) | $204.80 | $121.44 |
| BALTIMORE/SURR. CNTYS (MD) | $213.27 | $128.34 |
| REST OF MARYLAND (MD) | $201.64 | $121.53 |
| SOUTHERN MAINE (ME) | $194.47 | $116.02 |
| REST OF MAINE (ME) | $186.68 | $113.85 |
| DETROIT (MI) | $206.82 | $130.43 |
| REST OF MICHIGAN (MI) | $193.21 | $120.93 |
| MINNESOTA (MN) | $193.76 | $112.30 |
| METROPOLITAN ST. LOUIS (MO) | $195.59 | $120.23 |
| METROPOLITAN KANSAS CITY (MO) | $193.83 | $119.50 |
| REST OF MISSOURI (MO) | $185.48 | $117.24 |
| MISSISSIPPI (MS) | $181.99 | $113.84 |
| MONTANA** (MT) | $200.71 | $121.55 |
| NORTH CAROLINA (NC) | $188.33 | $114.47 |
| NORTH DAKOTA** (ND) | $192.21 | $113.05 |
| NEBRASKA (NE) | $183.50 | $110.43 |
| NEW HAMPSHIRE (NH) | $203.37 | $120.96 |
| NORTHERN NJ (NJ) | $223.92 | $132.10 |
| REST OF NEW JERSEY (NJ) | $215.20 | $128.75 |
| NEW MEXICO (NM) | $194.67 | $122.08 |
| NEVADA** (NV) | $198.45 | $119.21 |
| MANHATTAN (NY) | $231.66 | $139.67 |
| NYC SUBURBS/LONG ISLAND (NY) | $238.46 | $144.34 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $217.54 | $130.86 |
| QUEENS (NY) | $231.75 | $138.18 |
| REST OF NEW YORK (NY) | $191.08 | $115.88 |
| OHIO (OH) | $191.47 | $119.20 |
| OKLAHOMA (OK) | $185.99 | $115.30 |
| PORTLAND (OR) | $210.29 | $122.35 |
| REST OF OREGON (OR) | $196.04 | $117.20 |
| METROPOLITAN PHILADELPHIA (PA) | $209.35 | $126.94 |
| REST OF PENNSYLVANIA (PA) | $191.10 | $118.43 |
| PUERTO RICO (PR) | $201.71 | $121.68 |
| RHODE ISLAND (RI) | $204.24 | $122.47 |
| SOUTH CAROLINA (SC) | $190.39 | $117.24 |
| SOUTH DAKOTA** (SD) | $191.20 | $112.04 |
| TENNESSEE (TN) | $184.27 | $112.32 |
| BRAZORIA (TX) | $197.24 | $118.79 |
| DALLAS (TX) | $198.97 | $120.13 |
| GALVESTON (TX) | $198.14 | $119.54 |
| HOUSTON (TX) | $206.01 | $127.41 |
| BEAUMONT (TX) | $190.01 | $117.97 |
| FORT WORTH (TX) | $198.08 | $120.03 |
| AUSTIN (TX) | $205.52 | $121.76 |
| REST OF TEXAS (TX) | $193.84 | $118.72 |
| UTAH (UT) | $192.80 | $118.39 |
| VIRGINIA (VA) | $194.68 | $116.87 |
| VIRGIN ISLANDS (VI) | $201.71 | $121.68 |
| VERMONT (VT) | $192.57 | $114.20 |
| SEATTLE (KING CNTY) (WA) | $226.53 | $129.40 |
| REST OF WASHINGTON (WA) | $204.05 | $120.69 |
| WISCONSIN (WI) | $186.27 | $110.43 |
| WEST VIRGINIA (WV) | $192.80 | $124.01 |
| WYOMING** (WY) | $197.01 | $117.85 |
Look up another code or locality →
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 PFS amount is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice expense RVUs differ between non-facility and facility settings—non-facility PE RVUs are typically higher because the physician's practice absorbs more of the overhead (e.g., supplies, staff time), while facility PE RVUs are lower because the facility bills separately for those costs. This is why the same code can have two different Medicare allowed amounts depending on place of service.
RVUs — work 2.35, practice expense 3.23 (non-facility) / 0.86 (facility), malpractice 0.43 — × 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 patient's Part B deductible is met; the patient or secondary payer is responsible for the remainder.
- Actual payment can vary by locality GPCI, applicable modifiers, multiple-procedure or bilateral payment rules, sequestration, and annual budget-neutrality adjustments.
- Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why is the facility amount lower than the non-facility amount for the same code?
In the facility setting, the facility (hospital or ASC) bills separately for overhead costs like equipment and staff, so the physician's practice expense RVU—and therefore the PFS payment—is lower.
Does this amount reflect what the practice will actually be paid?
No. This is the Medicare PFS allowed amount estimate. Actual payment depends on the patient's deductible status, the 80/20 coinsurance split, modifiers, and any sequestration or local adjustments.
Why does the amount change by locality?
Each locality has its own GPCI values for work, practice expense, and malpractice, reflecting regional cost-of-living and practice-cost differences, which shift the final calculated amount up or down from the national figure.
Will this rate change next year?
Yes. The conversion factor and RVUs are updated annually (and sometimes RVUs are revised mid-cycle), so amounts shown here apply to the stated year only.
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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