Medicare Reimbursement for CPT 15820

CPT 15820 is a procedure code used in Medicare billing; the exact clinical description is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$588.19	$450.58
ALASKA* (AK)	$706.96	$560.40
ALABAMA (AL)	$535.22	$414.81
ARKANSAS (AR)	$528.52	$410.31
ARIZONA (AZ)	$574.47	$441.13
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$749.27	$555.24
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$763.66	$565.23
OXNARD-THOUSAND OAKS-VENTURA (CA)	$654.85	$492.19
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$658.53	$495.73
NAPA (CA)	$710.21	$528.84
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$749.82	$555.78
VALLEJO (CA)	$709.42	$528.05
BAKERSFIELD (CA)	$621.13	$470.31
CHICO (CA)	$619.56	$468.73
FRESNO (CA)	$619.56	$468.73
HANFORD-CORCORAN (CA)	$619.56	$468.73
MADERA (CA)	$619.56	$468.73
MERCED (CA)	$619.56	$468.73
MODESTO (CA)	$619.56	$468.73
REDDING (CA)	$619.56	$468.73
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$624.84	$474.02
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$648.09	$488.05
SALINAS (CA)	$645.60	$486.11
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$765.89	$567.45
SANTA CRUZ-WATSONVILLE (CA)	$664.17	$496.97
SANTA ROSA-PETALUMA (CA)	$670.79	$501.81
STOCKTON (CA)	$619.56	$468.73
VISALIA (CA)	$619.56	$468.73
YUBA CITY (CA)	$619.56	$468.73
EL CENTRO (CA)	$619.64	$468.81
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$659.11	$494.53
SAN LUIS OBISPO-PASO ROBLES (CA)	$635.38	$478.64
SANTA MARIA-SANTA BARBARA (CA)	$647.57	$487.11
REST OF CALIFORNIA (CA)	$619.56	$468.73
COLORADO (CO)	$610.68	$464.27
CONNECTICUT (CT)	$623.98	$475.77
DC + MD/VA SUBURBS (DC)	$666.54	$504.43
DELAWARE (DE)	$583.17	$447.21
FORT LAUDERDALE (FL)	$605.93	$466.53
MIAMI (FL)	$627.79	$484.54
REST OF FLORIDA (FL)	$580.06	$448.50
ATLANTA (GA)	$597.91	$458.10
REST OF GEORGIA (GA)	$551.52	$428.77
HAWAII, GUAM (HI)	$631.87	$475.40
IOWA (IA)	$547.24	$421.32
IDAHO (ID)	$550.29	$423.69
EAST ST. LOUIS (IL)	$575.00	$448.40
SUBURBAN CHICAGO (IL)	$611.93	$470.61
CHICAGO (IL)	$612.22	$473.92
REST OF ILLINOIS (IL)	$565.19	$439.55
INDIANA (IN)	$553.08	$425.51
KANSAS (KS)	$544.90	$420.50
KENTUCKY (KY)	$545.97	$423.63
NEW ORLEANS (LA)	$568.65	$439.16
REST OF LOUISIANA (LA)	$545.19	$423.40
METROPOLITAN BOSTON (MA)	$666.20	$501.89
REST OF MASSACHUSETTS (MA)	$607.71	$462.80
BALTIMORE/SURR. CNTYS (MD)	$622.12	$474.47
REST OF MARYLAND (MD)	$593.33	$454.07
SOUTHERN MAINE (ME)	$578.96	$442.59
REST OF MAINE (ME)	$552.68	$426.08
DETROIT (MI)	$586.31	$453.51
REST OF MICHIGAN (MI)	$558.24	$432.60
MINNESOTA (MN)	$587.58	$445.97
METROPOLITAN ST. LOUIS (MO)	$570.55	$439.55
METROPOLITAN KANSAS CITY (MO)	$565.37	$436.15
REST OF MISSOURI (MO)	$536.98	$418.36
MISSISSIPPI (MS)	$532.84	$414.36
MONTANA** (MT)	$588.16	$450.55
NORTH CAROLINA (NC)	$557.74	$429.35
NORTH DAKOTA** (ND)	$578.67	$441.05
NEBRASKA (NE)	$549.88	$422.86
NEW HAMPSHIRE (NH)	$601.28	$458.02
NORTHERN NJ (NJ)	$661.03	$501.40
REST OF NEW JERSEY (NJ)	$631.77	$481.50
NEW MEXICO (NM)	$560.86	$434.67
NEVADA** (NV)	$585.88	$448.13
MANHATTAN (NY)	$670.27	$510.37
NYC SUBURBS/LONG ISLAND (NY)	$684.56	$520.94
POUGHKPSIE/N NYC SUBURBS (NY)	$635.71	$485.02
QUEENS (NY)	$675.33	$512.67
REST OF NEW YORK (NY)	$565.02	$434.29
OHIO (OH)	$556.30	$430.66
OKLAHOMA (OK)	$545.23	$422.34
PORTLAND (OR)	$628.21	$475.32
REST OF OREGON (OR)	$581.96	$444.89
METROPOLITAN PHILADELPHIA (PA)	$610.05	$466.79
REST OF PENNSYLVANIA (PA)	$557.13	$430.80
PUERTO RICO (PR)	$592.00	$452.87
RHODE ISLAND (RI)	$602.48	$460.33
SOUTH CAROLINA (SC)	$557.81	$430.66
SOUTH DAKOTA** (SD)	$577.54	$439.93
TENNESSEE (TN)	$547.27	$422.18
BRAZORIA (TX)	$582.98	$446.61
DALLAS (TX)	$586.28	$449.22
GALVESTON (TX)	$584.49	$447.84
HOUSTON (TX)	$593.27	$456.63
BEAUMONT (TX)	$553.92	$428.70
FORT WORTH (TX)	$582.81	$447.12
AUSTIN (TX)	$608.12	$462.53
REST OF TEXAS (TX)	$567.86	$437.27
UTAH (UT)	$564.47	$435.11
VIRGINIA (VA)	$577.22	$441.95
VIRGIN ISLANDS (VI)	$592.00	$452.87
VERMONT (VT)	$576.59	$440.35
SEATTLE (KING CNTY) (WA)	$679.01	$510.16
REST OF WASHINGTON (WA)	$606.52	$461.61
WISCONSIN (WI)	$561.64	$429.80
WEST VIRGINIA (WV)	$546.88	$427.30
WYOMING** (WY)	$584.02	$446.41

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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 fee for each procedure is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice risk. Each RVU component is adjusted using Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost differences. The 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., office) and facility (e.g., hospital) settings, which is why the two allowed amounts differ, even though work and malpractice RVUs stay the same.

RVUs — work 6.11, practice expense 11.02 (non-facility) / 6.9 (facility), malpractice 0.48 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure 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 insurer is responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Always verify the current allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 15820?

The facility rate uses lower practice-expense RVUs because Medicare assumes the facility (not the physician's office) incurs certain overhead costs like equipment and supplies.

Does this amount apply to every state or locality?

No. The national figure is a baseline; actual Medicare payment is adjusted by locality-specific GPCIs, so amounts can be higher or lower depending on where the service is billed.

Can I use this number to predict exact reimbursement for a denied claim?

No. This is a calculated estimate based on standard PFS inputs. Denials and actual payment amounts depend on additional factors such as modifiers, coverage policy, and claims-specific adjustments.

Why can't you show the CPT code description?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page references the code generically rather than reproducing the official descriptor.

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.