Medicare Reimbursement for CPT Code 15821

This page covers CPT code 15821, a surgical procedure code recognized under the Medicare Physician Fee Schedule (PFS). It displays the national Medicare allowed amount for 2026 as well as how that amount is adjusted for your locality, shown separately for non-facility (e.g., office) and facility (e.g., hospital, ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$634.28	$483.65
ALASKA* (AK)	$761.26	$600.83
ALABAMA (AL)	$576.14	$444.33
ARKANSAS (AR)	$568.79	$439.40
ARIZONA (AZ)	$619.07	$473.11
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$802.78	$590.38
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$817.98	$600.76
OXNARD-THOUSAND OAKS-VENTURA (CA)	$703.28	$525.22
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$707.45	$529.25
NAPA (CA)	$761.59	$563.05
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$803.52	$591.12
VALLEJO (CA)	$760.53	$561.98
BAKERSFIELD (CA)	$667.45	$502.35
CHICO (CA)	$665.42	$500.32
FRESNO (CA)	$665.42	$500.32
HANFORD-CORCORAN (CA)	$665.42	$500.32
MADERA (CA)	$665.42	$500.32
MERCED (CA)	$665.42	$500.32
MODESTO (CA)	$665.42	$500.32
REDDING (CA)	$665.42	$500.32
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$672.52	$507.42
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$695.77	$520.57
SALINAS (CA)	$693.09	$518.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$821.00	$603.78
SANTA CRUZ-WATSONVILLE (CA)	$712.69	$529.67
SANTA ROSA-PETALUMA (CA)	$719.76	$534.78
STOCKTON (CA)	$665.42	$500.32
VISALIA (CA)	$665.42	$500.32
YUBA CITY (CA)	$665.42	$500.32
EL CENTRO (CA)	$665.52	$500.43
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$707.42	$527.26
SAN LUIS OBISPO-PASO ROBLES (CA)	$682.18	$510.60
SANTA MARIA-SANTA BARBARA (CA)	$695.15	$519.51
REST OF CALIFORNIA (CA)	$665.42	$500.32
COLORADO (CO)	$657.15	$496.87
CONNECTICUT (CT)	$673.31	$511.07
DC + MD/VA SUBURBS (DC)	$718.15	$540.70
DELAWARE (DE)	$628.53	$479.70
FORT LAUDERDALE (FL)	$656.89	$504.30
MIAMI (FL)	$683.46	$526.65
REST OF FLORIDA (FL)	$628.05	$484.04
ATLANTA (GA)	$645.55	$492.50
REST OF GEORGIA (GA)	$596.35	$461.99
HAWAII, GUAM (HI)	$678.54	$507.27
IOWA (IA)	$588.06	$450.23
IDAHO (ID)	$591.66	$453.07
EAST ST. LOUIS (IL)	$625.11	$486.53
SUBURBAN CHICAGO (IL)	$663.13	$508.42
CHICAGO (IL)	$665.91	$514.52
REST OF ILLINOIS (IL)	$612.59	$475.06
INDIANA (IN)	$594.67	$455.03
KANSAS (KS)	$586.09	$449.92
KENTUCKY (KY)	$589.17	$455.25
NEW ORLEANS (LA)	$614.24	$472.49
REST OF LOUISIANA (LA)	$588.55	$455.23
METROPOLITAN BOSTON (MA)	$716.65	$536.79
REST OF MASSACHUSETTS (MA)	$654.10	$495.48
BALTIMORE/SURR. CNTYS (MD)	$671.45	$509.81
REST OF MARYLAND (MD)	$639.41	$486.96
SOUTHERN MAINE (ME)	$622.76	$473.48
REST OF MAINE (ME)	$594.89	$456.31
DETROIT (MI)	$635.53	$490.17
REST OF MICHIGAN (MI)	$603.17	$465.64
MINNESOTA (MN)	$630.30	$475.30
METROPOLITAN ST. LOUIS (MO)	$615.62	$472.21
METROPOLITAN KANSAS CITY (MO)	$610.01	$468.56
REST OF MISSOURI (MO)	$579.93	$450.08
MISSISSIPPI (MS)	$574.44	$444.74
MONTANA** (MT)	$634.24	$483.60
NORTH CAROLINA (NC)	$600.33	$459.78
NORTH DAKOTA** (ND)	$621.39	$470.75
NEBRASKA (NE)	$590.77	$451.73
NEW HAMPSHIRE (NH)	$647.55	$490.74
NORTHERN NJ (NJ)	$712.16	$537.42
REST OF NEW JERSEY (NJ)	$681.16	$516.66
NEW MEXICO (NM)	$606.29	$468.16
NEVADA** (NV)	$631.05	$480.26
MANHATTAN (NY)	$724.41	$549.37
NYC SUBURBS/LONG ISLAND (NY)	$740.82	$561.71
POUGHKPSIE/N NYC SUBURBS (NY)	$685.90	$520.95
QUEENS (NY)	$729.08	$551.02
REST OF NEW YORK (NY)	$608.35	$465.24
OHIO (OH)	$600.55	$463.01
OKLAHOMA (OK)	$587.73	$453.21
PORTLAND (OR)	$675.56	$508.20
REST OF OREGON (OR)	$626.28	$476.24
METROPOLITAN PHILADELPHIA (PA)	$658.46	$501.65
REST OF PENNSYLVANIA (PA)	$601.13	$462.84
PUERTO RICO (PR)	$638.25	$485.95
RHODE ISLAND (RI)	$649.03	$493.43
SOUTH CAROLINA (SC)	$601.40	$462.21
SOUTH DAKOTA** (SD)	$619.87	$469.23
TENNESSEE (TN)	$588.76	$451.83
BRAZORIA (TX)	$627.78	$478.50
DALLAS (TX)	$631.65	$481.61
GALVESTON (TX)	$629.60	$480.02
HOUSTON (TX)	$641.50	$491.92
BEAUMONT (TX)	$597.66	$460.58
FORT WORTH (TX)	$628.03	$479.50
AUSTIN (TX)	$654.86	$495.49
REST OF TEXAS (TX)	$612.30	$469.34
UTAH (UT)	$608.68	$467.08
VIRGINIA (VA)	$621.27	$473.20
VIRGIN ISLANDS (VI)	$638.25	$485.95
VERMONT (VT)	$619.66	$470.53
SEATTLE (KING CNTY) (WA)	$729.93	$545.10
REST OF WASHINGTON (WA)	$652.65	$494.03
WISCONSIN (WI)	$602.89	$458.58
WEST VIRGINIA (WV)	$592.58	$461.67
WYOMING** (WY)	$628.64	$478.00

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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 allowed amount for this procedure code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice risk. Each RVU component is multiplied by a corresponding Geographic Practice Cost Index (GPCI) specific to the service locality, reflecting regional cost differences. The adjusted RVUs are summed and then multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility amounts differ primarily because the practice-expense RVU is lower in facility settings, since the facility (not the physician's office) bears certain overhead costs.

RVUs — work 6.67, practice expense 11.67 (non-facility) / 7.16 (facility), malpractice 0.65 — × 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 insurer is responsible for the remainder.
Actual payment can vary by specific locality, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

In facility settings, the practice-expense RVU is reduced because overhead costs like equipment, supplies, and staff are typically borne by the facility rather than the billing physician.

Does this amount reflect what my locality will actually pay?

No. The national amount is a baseline; your locality-specific GPCIs adjust the work, practice-expense, and malpractice RVUs, which can raise or lower the final allowed amount relative to the national figure.

Will Medicare pay the full allowed amount shown here?

No. Medicare generally reimburses 80% of the allowed amount after the patient meets the Part B deductible; the remaining portion is the patient's or secondary payer's responsibility.

Can modifiers change the reimbursement for this code?

Yes. Certain modifiers (e.g., bilateral, multiple procedure, or reduced services) can increase or decrease the allowed amount from the base rate shown 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.