Medicare Reimbursement for CPT 15789

CPT 15789 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings. Because the CPT descriptor is proprietary to the AMA, it is not reproduced here.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$524.73	$357.72
ALASKA* (AK)	$619.85	$441.99
ALABAMA (AL)	$473.98	$327.85
ARKANSAS (AR)	$467.56	$324.10
ARIZONA (AZ)	$511.53	$349.71
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$673.02	$437.54
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$686.09	$445.27
OXNARD-THOUSAND OAKS-VENTURA (CA)	$586.25	$388.86
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$589.37	$391.80
NAPA (CA)	$637.27	$417.15
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$673.59	$438.11
VALLEJO (CA)	$636.45	$416.34
BAKERSFIELD (CA)	$554.65	$371.61
CHICO (CA)	$553.11	$370.07
FRESNO (CA)	$553.11	$370.07
HANFORD-CORCORAN (CA)	$553.11	$370.07
MADERA (CA)	$553.11	$370.07
MERCED (CA)	$553.11	$370.07
MODESTO (CA)	$553.11	$370.07
REDDING (CA)	$553.11	$370.07
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$558.56	$375.53
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$579.47	$385.24
SALINAS (CA)	$577.28	$383.72
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$688.41	$447.59
SANTA CRUZ-WATSONVILLE (CA)	$595.17	$392.26
SANTA ROSA-PETALUMA (CA)	$601.13	$396.05
STOCKTON (CA)	$553.11	$370.07
VISALIA (CA)	$553.11	$370.07
YUBA CITY (CA)	$553.11	$370.07
EL CENTRO (CA)	$553.19	$370.16
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$590.09	$390.36
SAN LUIS OBISPO-PASO ROBLES (CA)	$568.08	$377.86
SANTA MARIA-SANTA BARBARA (CA)	$579.23	$384.51
REST OF CALIFORNIA (CA)	$553.11	$370.07
COLORADO (CO)	$545.27	$367.57
CONNECTICUT (CT)	$558.23	$378.37
DC + MD/VA SUBURBS (DC)	$597.21	$400.47
DELAWARE (DE)	$519.66	$354.66
FORT LAUDERDALE (FL)	$542.75	$373.57
MIAMI (FL)	$564.53	$390.68
REST OF FLORIDA (FL)	$517.81	$358.16
ATLANTA (GA)	$534.13	$364.46
REST OF GEORGIA (GA)	$490.35	$341.38
HAWAII, GUAM (HI)	$565.38	$375.49
IOWA (IA)	$485.07	$332.27
IDAHO (ID)	$488.08	$334.44
EAST ST. LOUIS (IL)	$513.82	$360.18
SUBURBAN CHICAGO (IL)	$548.14	$376.62
CHICAGO (IL)	$549.22	$381.38
REST OF ILLINOIS (IL)	$503.85	$351.38
INDIANA (IN)	$490.74	$335.92
KANSAS (KS)	$483.03	$332.06
KENTUCKY (KY)	$484.68	$336.21
NEW ORLEANS (LA)	$506.47	$349.31
REST OF LOUISIANA (LA)	$484.00	$336.20
METROPOLITAN BOSTON (MA)	$596.97	$397.57
REST OF MASSACHUSETTS (MA)	$542.34	$366.49
BALTIMORE/SURR. CNTYS (MD)	$556.65	$377.46
REST OF MARYLAND (MD)	$529.14	$360.13
SOUTHERN MAINE (ME)	$515.43	$349.93
REST OF MAINE (ME)	$490.57	$336.93
DETROIT (MI)	$524.00	$362.84
REST OF MICHIGAN (MI)	$496.60	$344.13
MINNESOTA (MN)	$523.06	$351.22
METROPOLITAN ST. LOUIS (MO)	$508.06	$349.07
METROPOLITAN KANSAS CITY (MO)	$503.11	$346.30
REST OF MISSOURI (MO)	$476.26	$332.31
MISSISSIPPI (MS)	$471.99	$328.20
MONTANA** (MT)	$524.69	$357.69
NORTH CAROLINA (NC)	$495.38	$339.57
NORTH DAKOTA** (ND)	$514.81	$347.80
NEBRASKA (NE)	$487.54	$333.40
NEW HAMPSHIRE (NH)	$536.91	$363.06
NORTHERN NJ (NJ)	$591.63	$397.90
REST OF NEW JERSEY (NJ)	$564.77	$382.40
NEW MEXICO (NM)	$499.20	$346.05
NEVADA** (NV)	$522.29	$355.12
MANHATTAN (NY)	$601.14	$407.08
NYC SUBURBS/LONG ISLAND (NY)	$615.06	$416.49
POUGHKPSIE/N NYC SUBURBS (NY)	$568.50	$385.63
QUEENS (NY)	$605.69	$408.29
REST OF NEW YORK (NY)	$502.37	$343.71
OHIO (OH)	$494.58	$342.11
OKLAHOMA (OK)	$483.76	$334.63
PORTLAND (OR)	$561.64	$376.10
REST OF OREGON (OR)	$518.38	$352.04
METROPOLITAN PHILADELPHIA (PA)	$545.10	$371.25
REST OF PENNSYLVANIA (PA)	$495.27	$341.96
PUERTO RICO (PR)	$528.31	$359.46
RHODE ISLAND (RI)	$537.45	$364.93
SOUTH CAROLINA (SC)	$495.77	$341.46
SOUTH DAKOTA** (SD)	$513.64	$346.63
TENNESSEE (TN)	$485.32	$333.52
BRAZORIA (TX)	$519.20	$353.70
DALLAS (TX)	$522.40	$356.07
GALVESTON (TX)	$520.70	$354.86
HOUSTON (TX)	$529.85	$364.02
BEAUMONT (TX)	$492.22	$340.24
FORT WORTH (TX)	$519.14	$354.47
AUSTIN (TX)	$543.33	$366.64
REST OF TEXAS (TX)	$505.36	$346.87
UTAH (UT)	$502.14	$345.16
VIRGINIA (VA)	$513.90	$349.74
VIRGIN ISLANDS (VI)	$528.31	$359.46
VERMONT (VT)	$513.00	$347.66
SEATTLE (KING CNTY) (WA)	$608.68	$403.76
REST OF WASHINGTON (WA)	$541.26	$365.41
WISCONSIN (WI)	$498.55	$338.56
WEST VIRGINIA (WV)	$486.33	$341.21
WYOMING** (WY)	$520.39	$353.38

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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 PFS amounts are built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. 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. Non-facility and facility payments differ mainly because the practice-expense RVU is lower when the service is performed in a facility, since the facility — not the physician's practice — bears more of the overhead cost. The same work and malpractice RVUs generally apply in both settings, but the total allowed amount changes based on which practice-expense RVU is used.

RVUs — work 4.79, practice expense 10.42 (non-facility) / 5.42 (facility), malpractice 0.5 — × 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 their deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claims-processing adjustments, sequestration, and annual budget-neutrality changes to RVUs or the conversion factor.
Always verify the final allowed amount with your Medicare Administrative Contractor (MAC) and current fee schedule files before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 15789?

The practice-expense RVU is lower in the facility setting because the facility absorbs more of the overhead and supply costs, while the physician work and malpractice RVUs typically stay the same.

Why might the amount I see on a remittance advice differ from the estimate on this page?

Remittance amounts reflect the specific locality GPCIs, any modifiers applied, sequestration, secondary payer adjustments, and possible mid-year or annual rule changes that aren't captured in a generic national estimate.

Does this page tell me whether CPT 15789 requires prior authorization or documentation?

No. This page only addresses the Medicare Physician Fee Schedule pricing methodology; coverage, medical necessity, and documentation requirements should be checked against your MAC's Local Coverage Determination (LCD) and current CPT guidelines.

Can I use this estimate to predict my exact reimbursement?

No. It's a planning estimate based on national RVUs and the conversion factor; actual payment depends on your specific locality, patient benefits, and claim-specific factors.

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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.