Medicare Reimbursement for CPT 15793
CPT 15793 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) allowed amount for 2026, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $470.62 | $317.98 |
| ALASKA* (AK) | $549.57 | $387.00 |
| ALABAMA (AL) | $423.26 | $289.70 |
| ARKANSAS (AR) | $417.27 | $286.15 |
| ARIZONA (AZ) | $458.33 | $310.42 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $608.16 | $392.93 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $620.12 | $400.01 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $528.01 | $347.59 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $530.63 | $350.06 |
| NAPA (CA) | $575.22 | $374.04 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $608.67 | $393.44 |
| VALLEJO (CA) | $574.49 | $373.31 |
| BAKERSFIELD (CA) | $498.55 | $331.26 |
| CHICO (CA) | $497.20 | $329.90 |
| FRESNO (CA) | $497.20 | $329.90 |
| HANFORD-CORCORAN (CA) | $497.20 | $329.90 |
| MADERA (CA) | $497.20 | $329.90 |
| MERCED (CA) | $497.20 | $329.90 |
| MODESTO (CA) | $497.20 | $329.90 |
| REDDING (CA) | $497.20 | $329.90 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $502.09 | $334.79 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $521.53 | $344.01 |
| SALINAS (CA) | $519.58 | $342.67 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $622.21 | $402.10 |
| SANTA CRUZ-WATSONVILLE (CA) | $536.58 | $351.12 |
| SANTA ROSA-PETALUMA (CA) | $541.99 | $354.55 |
| STOCKTON (CA) | $497.20 | $329.90 |
| VISALIA (CA) | $497.20 | $329.90 |
| YUBA CITY (CA) | $497.20 | $329.90 |
| EL CENTRO (CA) | $497.27 | $329.98 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $531.63 | $349.07 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $511.24 | $337.38 |
| SANTA MARIA-SANTA BARBARA (CA) | $521.48 | $343.50 |
| REST OF CALIFORNIA (CA) | $497.20 | $329.90 |
| COLORADO (CO) | $489.78 | $327.37 |
| CONNECTICUT (CT) | $501.51 | $337.11 |
| DC + MD/VA SUBURBS (DC) | $537.42 | $357.61 |
| DELAWARE (DE) | $465.83 | $315.01 |
| FORT LAUDERDALE (FL) | $487.01 | $332.38 |
| MIAMI (FL) | $506.99 | $348.09 |
| REST OF FLORIDA (FL) | $463.81 | $317.88 |
| ATLANTA (GA) | $479.25 | $324.17 |
| REST OF GEORGIA (GA) | $438.23 | $302.07 |
| HAWAII, GUAM (HI) | $509.04 | $335.49 |
| IOWA (IA) | $433.79 | $294.12 |
| IDAHO (ID) | $436.56 | $296.13 |
| EAST ST. LOUIS (IL) | $459.73 | $319.30 |
| SUBURBAN CHICAGO (IL) | $491.94 | $335.18 |
| CHICAGO (IL) | $492.62 | $339.21 |
| REST OF ILLINOIS (IL) | $450.66 | $311.30 |
| INDIANA (IN) | $439.05 | $297.55 |
| KANSAS (KS) | $431.80 | $293.82 |
| KENTUCKY (KY) | $433.08 | $297.38 |
| NEW ORLEANS (LA) | $453.39 | $309.75 |
| REST OF LOUISIANA (LA) | $432.42 | $297.33 |
| METROPOLITAN BOSTON (MA) | $537.62 | $355.37 |
| REST OF MASSACHUSETTS (MA) | $486.94 | $326.21 |
| BALTIMORE/SURR. CNTYS (MD) | $500.09 | $336.30 |
| REST OF MARYLAND (MD) | $474.60 | $320.12 |
| SOUTHERN MAINE (ME) | $462.13 | $310.86 |
| REST OF MAINE (ME) | $438.80 | $298.37 |
| DETROIT (MI) | $469.50 | $322.20 |
| REST OF MICHIGAN (MI) | $444.14 | $304.78 |
| MINNESOTA (MN) | $469.51 | $312.44 |
| METROPOLITAN ST. LOUIS (MO) | $454.97 | $309.65 |
| METROPOLITAN KANSAS CITY (MO) | $450.35 | $307.02 |
| REST OF MISSOURI (MO) | $425.15 | $293.57 |
| MISSISSIPPI (MS) | $421.29 | $289.87 |
| MONTANA** (MT) | $470.59 | $317.95 |
| NORTH CAROLINA (NC) | $443.31 | $300.89 |
| NORTH DAKOTA** (ND) | $461.69 | $309.05 |
| NEBRASKA (NE) | $436.12 | $295.23 |
| NEW HAMPSHIRE (NH) | $482.13 | $323.23 |
| NORTHERN NJ (NJ) | $532.03 | $354.96 |
| REST OF NEW JERSEY (NJ) | $507.29 | $340.60 |
| NEW MEXICO (NM) | $446.53 | $306.55 |
| NEVADA** (NV) | $468.44 | $315.64 |
| MANHATTAN (NY) | $540.60 | $363.23 |
| NYC SUBURBS/LONG ISLAND (NY) | $553.49 | $372.00 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $510.61 | $343.47 |
| QUEENS (NY) | $544.97 | $364.54 |
| REST OF NEW YORK (NY) | $449.82 | $304.81 |
| OHIO (OH) | $442.32 | $302.96 |
| OKLAHOMA (OK) | $432.31 | $296.00 |
| PORTLAND (OR) | $505.09 | $335.51 |
| REST OF OREGON (OR) | $464.85 | $312.82 |
| METROPOLITAN PHILADELPHIA (PA) | $489.23 | $330.33 |
| REST OF PENNSYLVANIA (PA) | $443.01 | $302.88 |
| PUERTO RICO (PR) | $473.99 | $319.67 |
| RHODE ISLAND (RI) | $482.22 | $324.55 |
| SOUTH CAROLINA (SC) | $443.54 | $302.50 |
| SOUTH DAKOTA** (SD) | $460.64 | $308.00 |
| TENNESSEE (TN) | $433.93 | $295.18 |
| BRAZORIA (TX) | $465.40 | $314.14 |
| DALLAS (TX) | $468.34 | $316.31 |
| GALVESTON (TX) | $466.78 | $315.20 |
| HOUSTON (TX) | $475.01 | $323.44 |
| BEAUMONT (TX) | $440.15 | $301.25 |
| FORT WORTH (TX) | $465.27 | $314.76 |
| AUSTIN (TX) | $488.11 | $326.61 |
| REST OF TEXAS (TX) | $452.50 | $307.64 |
| UTAH (UT) | $449.49 | $306.00 |
| VIRGINIA (VA) | $460.65 | $310.60 |
| VIRGIN ISLANDS (VI) | $473.99 | $319.67 |
| VERMONT (VT) | $459.93 | $308.81 |
| SEATTLE (KING CNTY) (WA) | $548.47 | $361.17 |
| REST OF WASHINGTON (WA) | $486.02 | $325.28 |
| WISCONSIN (WI) | $446.50 | $300.27 |
| WEST VIRGINIA (WV) | $434.30 | $301.66 |
| WYOMING** (WY) | $466.71 | $314.07 |
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: 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 a code: physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific Medicare locality where the service is performed, reflecting local cost differences. 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 (e.g., physician office) and facility (e.g., hospital outpatient, ASC) settings, which is why the two allowed amounts differ — non-facility PE RVUs are typically higher since the practice bears more overhead cost.
RVUs — work 3.86, practice expense 9.78 (non-facility) / 5.21 (facility), malpractice 0.45 — × 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 Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
- Actual payment can vary by locality, applicable modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
- Always verify the current rate with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.
Frequently asked
Why is the facility amount lower than the non-facility amount for CPT 15793?
Facility rates use lower practice-expense RVUs because the facility (e.g., hospital) is separately reimbursed for its overhead and supply costs, whereas non-facility rates assume the billing practice bears those costs directly.
Does this amount apply to all states or localities?
No. The national figures shown are before locality adjustment. Actual payment depends on the GPCI values for the specific Medicare locality where the service was rendered.
Can I use this figure to predict my exact Medicare payment?
No. This is an estimate based on published RVUs, GPCIs, and the conversion factor. Final payment can be affected by modifiers, claim edits, sequestration, and other factors specific to the claim.
Why can't you show the CPT code's description?
CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so this page references the code generically without reproducing the official language.
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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