Medicare Reimbursement for CPT 15788
CPT 15788 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and adjusted for your locality, with separate figures for non-facility (office) and facility (hospital/ASC) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $381.77 | $195.73 |
| ALASKA* (AK) | $432.45 | $234.31 |
| ALABAMA (AL) | $340.30 | $177.51 |
| ARKANSAS (AR) | $335.02 | $175.21 |
| ARIZONA (AZ) | $371.22 | $190.94 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $509.60 | $247.28 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $520.22 | $251.94 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $436.65 | $216.75 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $438.15 | $218.06 |
| NAPA (CA) | $479.85 | $234.64 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $509.85 | $247.53 |
| VALLEJO (CA) | $479.49 | $234.28 |
| BAKERSFIELD (CA) | $409.60 | $205.69 |
| CHICO (CA) | $408.92 | $205.02 |
| FRESNO (CA) | $408.92 | $205.02 |
| HANFORD-CORCORAN (CA) | $408.92 | $205.02 |
| MADERA (CA) | $408.92 | $205.02 |
| MERCED (CA) | $408.92 | $205.02 |
| MODESTO (CA) | $408.92 | $205.02 |
| REDDING (CA) | $408.92 | $205.02 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $411.32 | $207.42 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $430.74 | $214.37 |
| SALINAS (CA) | $429.17 | $213.55 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $521.24 | $252.96 |
| SANTA CRUZ-WATSONVILLE (CA) | $445.65 | $219.60 |
| SANTA ROSA-PETALUMA (CA) | $450.24 | $221.78 |
| STOCKTON (CA) | $408.92 | $205.02 |
| VISALIA (CA) | $408.92 | $205.02 |
| YUBA CITY (CA) | $408.92 | $205.02 |
| EL CENTRO (CA) | $408.96 | $205.06 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $440.48 | $217.98 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $422.09 | $210.19 |
| SANTA MARIA-SANTA BARBARA (CA) | $431.11 | $214.19 |
| REST OF CALIFORNIA (CA) | $408.92 | $205.02 |
| COLORADO (CO) | $400.58 | $202.63 |
| CONNECTICUT (CT) | $408.26 | $207.89 |
| DC + MD/VA SUBURBS (DC) | $440.80 | $221.64 |
| DELAWARE (DE) | $377.70 | $193.88 |
| FORT LAUDERDALE (FL) | $391.69 | $203.23 |
| MIAMI (FL) | $405.57 | $211.89 |
| REST OF FLORIDA (FL) | $371.99 | $194.13 |
| ATLANTA (GA) | $388.35 | $199.33 |
| REST OF GEORGIA (GA) | $350.10 | $184.15 |
| HAWAII, GUAM (HI) | $420.64 | $209.11 |
| IOWA (IA) | $351.31 | $181.08 |
| IDAHO (ID) | $353.40 | $182.24 |
| EAST ST. LOUIS (IL) | $364.72 | $193.56 |
| SUBURBAN CHICAGO (IL) | $396.19 | $205.13 |
| CHICAGO (IL) | $393.30 | $206.32 |
| REST OF ILLINOIS (IL) | $359.26 | $189.41 |
| INDIANA (IN) | $355.64 | $183.17 |
| KANSAS (KS) | $348.72 | $180.54 |
| KENTUCKY (KY) | $347.15 | $181.76 |
| NEW ORLEANS (LA) | $364.70 | $189.63 |
| REST OF LOUISIANA (LA) | $346.24 | $181.59 |
| METROPOLITAN BOSTON (MA) | $443.18 | $221.04 |
| REST OF MASSACHUSETTS (MA) | $397.60 | $201.70 |
| BALTIMORE/SURR. CNTYS (MD) | $406.96 | $207.34 |
| REST OF MARYLAND (MD) | $385.53 | $197.25 |
| SOUTHERN MAINE (ME) | $376.30 | $191.94 |
| REST OF MAINE (ME) | $354.49 | $183.33 |
| DETROIT (MI) | $376.09 | $196.56 |
| REST OF MICHIGAN (MI) | $356.07 | $186.22 |
| MINNESOTA (MN) | $385.48 | $194.04 |
| METROPOLITAN ST. LOUIS (MO) | $367.09 | $189.97 |
| METROPOLITAN KANSAS CITY (MO) | $362.92 | $188.23 |
| REST OF MISSOURI (MO) | $339.31 | $178.94 |
| MISSISSIPPI (MS) | $337.28 | $177.10 |
| MONTANA** (MT) | $381.76 | $195.71 |
| NORTH CAROLINA (NC) | $358.60 | $185.02 |
| NORTH DAKOTA** (ND) | $377.41 | $191.36 |
| NEBRASKA (NE) | $353.62 | $181.90 |
| NEW HAMPSHIRE (NH) | $393.41 | $199.74 |
| NORTHERN NJ (NJ) | $435.57 | $219.76 |
| REST OF NEW JERSEY (NJ) | $413.39 | $210.23 |
| NEW MEXICO (NM) | $357.83 | $187.23 |
| NEVADA** (NV) | $380.85 | $194.62 |
| MANHATTAN (NY) | $440.06 | $223.88 |
| NYC SUBURBS/LONG ISLAND (NY) | $450.32 | $229.11 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $415.48 | $211.76 |
| QUEENS (NY) | $445.13 | $225.22 |
| REST OF NEW YORK (NY) | $364.28 | $187.53 |
| OHIO (OH) | $355.18 | $185.33 |
| OKLAHOMA (OK) | $347.36 | $181.22 |
| PORTLAND (OR) | $414.98 | $208.29 |
| REST OF OREGON (OR) | $378.36 | $193.07 |
| METROPOLITAN PHILADELPHIA (PA) | $396.97 | $203.30 |
| REST OF PENNSYLVANIA (PA) | $356.25 | $185.47 |
| PUERTO RICO (PR) | $385.03 | $196.94 |
| RHODE ISLAND (RI) | $392.38 | $200.20 |
| SOUTH CAROLINA (SC) | $357.39 | $185.49 |
| SOUTH DAKOTA** (SD) | $376.89 | $190.85 |
| TENNESSEE (TN) | $350.50 | $181.38 |
| BRAZORIA (TX) | $377.94 | $193.58 |
| DALLAS (TX) | $380.12 | $194.82 |
| GALVESTON (TX) | $378.91 | $194.17 |
| HOUSTON (TX) | $382.94 | $198.20 |
| BEAUMONT (TX) | $353.68 | $184.39 |
| FORT WORTH (TX) | $377.15 | $193.71 |
| AUSTIN (TX) | $398.84 | $202.00 |
| REST OF TEXAS (TX) | $365.44 | $188.88 |
| UTAH (UT) | $362.65 | $187.77 |
| VIRGINIA (VA) | $374.41 | $191.52 |
| VIRGIN ISLANDS (VI) | $385.03 | $196.94 |
| VERMONT (VT) | $375.08 | $190.90 |
| SEATTLE (KING CNTY) (WA) | $453.36 | $225.09 |
| REST OF WASHINGTON (WA) | $397.14 | $201.23 |
| WISCONSIN (WI) | $363.82 | $185.59 |
| WEST VIRGINIA (WV) | $344.82 | $183.14 |
| WYOMING** (WY) | $379.86 | $193.82 |
Look up another code or locality →
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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. These locality-adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital outpatient, ASC) settings, which is why the same code can show two different allowed amounts depending on place of service. The conversion factor and RVU values are updated annually and can shift due to budget-neutrality adjustments.
RVUs — work 2.04, practice expense 9.17 (non-facility) / 3.6 (facility), malpractice 0.22 — × 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.
- Modifiers, multiple-procedure reductions, bilateral billing, and sequestration can change the final payment.
- Annual budget-neutrality adjustments and locality GPCI updates can change these figures year to year.
- Always confirm actual payment and coverage policy with your Medicare Administrative Contractor (MAC).
Frequently asked
Why does CPT 15788 show two different Medicare amounts?
The non-facility amount applies when the service is performed in a setting like a physician's office, and the facility amount applies when it's performed in a hospital or ambulatory surgical center. The practice-expense RVU component is lower in facility settings because the facility, not the physician's practice, bears more of the overhead cost.
Does this amount reflect what the patient will actually pay?
No. The figures shown are the Medicare-allowed amount. The patient's out-of-pocket responsibility depends on deductible status, coinsurance, and any secondary insurance.
Will this amount be the same in every state?
No. The national figures are adjusted by locality-specific GPCIs, so the actual allowed amount can be higher or lower depending on where the service is billed.
Why might my MAC pay a different amount than shown here?
Differences can arise from modifiers, claim-specific adjustments, sequestration, incorrect place-of-service coding, or annual fee schedule updates not yet reflected 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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