Medicare Reimbursement for CPT 15786
This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and displays its Medicare Physician Fee Schedule allowed amount. Amounts are shown both nationally and adjustable by locality, and separately for non-facility and facility settings, since practice expense differs between the two.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $232.14 | $118.91 |
| ALASKA* (AK) | $273.29 | $152.70 |
| ALABAMA (AL) | $209.53 | $110.46 |
| ARKANSAS (AR) | $206.67 | $109.40 |
| ARIZONA (AZ) | $226.29 | $116.57 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $299.37 | $139.72 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $305.25 | $141.97 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $260.21 | $126.37 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $261.52 | $127.57 |
| NAPA (CA) | $283.25 | $134.02 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $299.60 | $139.95 |
| VALLEJO (CA) | $282.93 | $133.69 |
| BAKERSFIELD (CA) | $245.95 | $121.85 |
| CHICO (CA) | $245.32 | $121.22 |
| FRESNO (CA) | $245.32 | $121.22 |
| HANFORD-CORCORAN (CA) | $245.32 | $121.22 |
| MADERA (CA) | $245.32 | $121.22 |
| MERCED (CA) | $245.32 | $121.22 |
| MODESTO (CA) | $245.32 | $121.22 |
| REDDING (CA) | $245.32 | $121.22 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $247.51 | $123.41 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $257.17 | $125.49 |
| SALINAS (CA) | $256.21 | $124.97 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $306.18 | $142.90 |
| SANTA CRUZ-WATSONVILLE (CA) | $264.36 | $126.78 |
| SANTA ROSA-PETALUMA (CA) | $267.02 | $127.97 |
| STOCKTON (CA) | $245.32 | $121.22 |
| VISALIA (CA) | $245.32 | $121.22 |
| YUBA CITY (CA) | $245.32 | $121.22 |
| EL CENTRO (CA) | $245.36 | $121.26 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $262.01 | $126.59 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $252.10 | $123.14 |
| SANTA MARIA-SANTA BARBARA (CA) | $257.11 | $125.08 |
| REST OF CALIFORNIA (CA) | $245.32 | $121.22 |
| COLORADO (CO) | $241.58 | $121.10 |
| CONNECTICUT (CT) | $247.03 | $125.09 |
| DC + MD/VA SUBURBS (DC) | $264.61 | $131.23 |
| DELAWARE (DE) | $229.91 | $118.04 |
| FORT LAUDERDALE (FL) | $239.58 | $124.88 |
| MIAMI (FL) | $248.81 | $130.94 |
| REST OF FLORIDA (FL) | $228.56 | $120.31 |
| ATLANTA (GA) | $236.20 | $121.16 |
| REST OF GEORGIA (GA) | $216.39 | $115.39 |
| HAWAII, GUAM (HI) | $250.92 | $122.18 |
| IOWA (IA) | $214.71 | $111.10 |
| IDAHO (ID) | $216.00 | $111.83 |
| EAST ST. LOUIS (IL) | $226.30 | $122.13 |
| SUBURBAN CHICAGO (IL) | $242.02 | $125.74 |
| CHICAGO (IL) | $242.05 | $128.25 |
| REST OF ILLINOIS (IL) | $222.18 | $118.80 |
| INDIANA (IN) | $217.19 | $112.23 |
| KANSAS (KS) | $213.69 | $111.33 |
| KENTUCKY (KY) | $214.07 | $113.41 |
| NEW ORLEANS (LA) | $223.74 | $117.19 |
| REST OF LOUISIANA (LA) | $213.73 | $113.52 |
| METROPOLITAN BOSTON (MA) | $264.77 | $129.57 |
| REST OF MASSACHUSETTS (MA) | $240.22 | $120.99 |
| BALTIMORE/SURR. CNTYS (MD) | $246.31 | $124.82 |
| REST OF MARYLAND (MD) | $234.16 | $119.57 |
| SOUTHERN MAINE (ME) | $228.25 | $116.04 |
| REST OF MAINE (ME) | $217.00 | $112.83 |
| DETROIT (MI) | $231.20 | $121.93 |
| REST OF MICHIGAN (MI) | $219.28 | $115.90 |
| MINNESOTA (MN) | $232.01 | $115.49 |
| METROPOLITAN ST. LOUIS (MO) | $224.58 | $116.79 |
| METROPOLITAN KANSAS CITY (MO) | $222.37 | $116.04 |
| REST OF MISSOURI (MO) | $210.21 | $112.60 |
| MISSISSIPPI (MS) | $208.48 | $110.99 |
| MONTANA** (MT) | $232.12 | $118.89 |
| NORTH CAROLINA (NC) | $219.16 | $113.52 |
| NORTH DAKOTA** (ND) | $228.17 | $114.94 |
| NEBRASKA (NE) | $215.84 | $111.33 |
| NEW HAMPSHIRE (NH) | $237.76 | $119.89 |
| NORTHERN NJ (NJ) | $262.09 | $130.74 |
| REST OF NEW JERSEY (NJ) | $250.00 | $126.35 |
| NEW MEXICO (NM) | $220.39 | $116.56 |
| NEVADA** (NV) | $231.18 | $117.84 |
| MANHATTAN (NY) | $265.93 | $134.36 |
| NYC SUBURBS/LONG ISLAND (NY) | $272.00 | $137.37 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $251.57 | $127.58 |
| QUEENS (NY) | $268.12 | $134.28 |
| REST OF NEW YORK (NY) | $222.27 | $114.70 |
| OHIO (OH) | $218.47 | $115.10 |
| OKLAHOMA (OK) | $213.78 | $112.66 |
| PORTLAND (OR) | $249.01 | $123.21 |
| REST OF OREGON (OR) | $229.52 | $116.75 |
| METROPOLITAN PHILADELPHIA (PA) | $241.11 | $123.24 |
| REST OF PENNSYLVANIA (PA) | $218.84 | $114.90 |
| PUERTO RICO (PR) | $233.77 | $119.30 |
| RHODE ISLAND (RI) | $237.91 | $120.94 |
| SOUTH CAROLINA (SC) | $219.15 | $114.53 |
| SOUTH DAKOTA** (SD) | $227.70 | $114.47 |
| TENNESSEE (TN) | $214.70 | $111.77 |
| BRAZORIA (TX) | $229.79 | $117.58 |
| DALLAS (TX) | $231.17 | $118.39 |
| GALVESTON (TX) | $230.43 | $117.99 |
| HOUSTON (TX) | $234.09 | $121.65 |
| BEAUMONT (TX) | $217.47 | $114.43 |
| FORT WORTH (TX) | $229.68 | $118.03 |
| AUSTIN (TX) | $240.65 | $120.86 |
| REST OF TEXAS (TX) | $223.45 | $115.99 |
| UTAH (UT) | $222.00 | $115.56 |
| VIRGINIA (VA) | $227.49 | $116.19 |
| VIRGIN ISLANDS (VI) | $233.77 | $119.30 |
| VERMONT (VT) | $227.26 | $115.16 |
| SEATTLE (KING CNTY) (WA) | $270.09 | $131.16 |
| REST OF WASHINGTON (WA) | $239.78 | $120.55 |
| WISCONSIN (WI) | $220.89 | $112.42 |
| WEST VIRGINIA (WV) | $214.36 | $115.97 |
| WYOMING** (WY) | $230.40 | $117.17 |
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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: Policy. 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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice expense RVUs differ depending on whether the service is reported in a non-facility setting (like a physician's office) versus a facility setting (like a hospital), which is why two separate allowed amounts are typically shown. The conversion factor and RVU values are updated annually by CMS and can shift due to budget-neutrality adjustments.
RVUs — work 2.03, practice expense 4.72 (non-facility) / 1.33 (facility), malpractice 0.2 — × 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 meets the Part B deductible.
- Actual payment can vary by locality, GPCI adjustments, applicable modifiers, sequestration, and annual budget-neutrality changes.
- Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why are there two different amounts for this code?
Practice expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, reflecting the overhead costs incurred in each setting, which results in different allowed amounts.
Why can't the CPT descriptor be shown here?
CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page refers to the code generically rather than reproducing the official description.
Will my locality's payment match the national amount shown?
Not necessarily. The national amount uses a standard set of GPCIs, while your actual locality-specific GPCIs may raise or lower the final allowed amount.
Does this amount reflect what Medicare will actually pay?
No. The allowed amount is the basis for payment, but Medicare generally reimburses 80% of it after the deductible, with the remainder typically owed by the patient or secondary insurance.
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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