Medicare Reimbursement for CPT 15823

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 15823, a procedure code defined by the American Medical Association (CPT descriptor not reproduced here). It shows the national PFS estimate as well as non-facility (e.g., office) and facility (e.g., hospital) payment rates, which vary further by locality.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$632.95	$481.64
ALASKA* (AK)	$760.61	$599.47
ALABAMA (AL)	$575.57	$443.17
ARKANSAS (AR)	$568.31	$438.34
ARIZONA (AZ)	$618.01	$471.40
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$803.51	$590.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$818.83	$600.65
OXNARD-THOUSAND OAKS-VENTURA (CA)	$703.16	$524.32
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$707.23	$528.23
NAPA (CA)	$761.98	$562.56
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$804.17	$590.83
VALLEJO (CA)	$761.03	$561.61
BAKERSFIELD (CA)	$667.20	$501.37
CHICO (CA)	$665.34	$499.51
FRESNO (CA)	$665.34	$499.51
HANFORD-CORCORAN (CA)	$665.34	$499.51
MADERA (CA)	$665.34	$499.51
MERCED (CA)	$665.34	$499.51
MODESTO (CA)	$665.34	$499.51
REDDING (CA)	$665.34	$499.51
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$671.70	$505.87
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$695.80	$519.84
SALINAS (CA)	$693.13	$517.76
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$821.53	$603.34
SANTA CRUZ-WATSONVILLE (CA)	$712.85	$529.01
SANTA ROSA-PETALUMA (CA)	$719.94	$534.14
STOCKTON (CA)	$665.34	$499.51
VISALIA (CA)	$665.34	$499.51
YUBA CITY (CA)	$665.34	$499.51
EL CENTRO (CA)	$665.44	$499.61
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$707.52	$526.56
SAN LUIS OBISPO-PASO ROBLES (CA)	$682.19	$509.85
SANTA MARIA-SANTA BARBARA (CA)	$695.21	$518.78
REST OF CALIFORNIA (CA)	$665.34	$499.51
COLORADO (CO)	$656.44	$495.45
CONNECTICUT (CT)	$671.62	$508.66
DC + MD/VA SUBURBS (DC)	$716.85	$538.61
DELAWARE (DE)	$627.40	$477.91
FORT LAUDERDALE (FL)	$653.69	$500.42
MIAMI (FL)	$678.63	$521.12
REST OF FLORIDA (FL)	$625.45	$480.80
ATLANTA (GA)	$643.77	$490.05
REST OF GEORGIA (GA)	$594.35	$459.39
HAWAII, GUAM (HI)	$678.47	$506.43
IOWA (IA)	$587.96	$449.52
IDAHO (ID)	$591.39	$452.19
EAST ST. LOUIS (IL)	$621.25	$482.05
SUBURBAN CHICAGO (IL)	$660.03	$504.64
CHICAGO (IL)	$661.55	$509.48
REST OF ILLINOIS (IL)	$609.77	$471.63
INDIANA (IN)	$594.39	$454.13
KANSAS (KS)	$585.73	$448.95
KENTUCKY (KY)	$587.81	$453.30
NEW ORLEANS (LA)	$612.47	$470.09
REST OF LOUISIANA (LA)	$587.08	$453.17
METROPOLITAN BOSTON (MA)	$715.92	$535.26
REST OF MASSACHUSETTS (MA)	$653.33	$494.00
BALTIMORE/SURR. CNTYS (MD)	$669.69	$507.34
REST OF MARYLAND (MD)	$638.28	$485.16
SOUTHERN MAINE (ME)	$622.27	$472.33
REST OF MAINE (ME)	$594.28	$455.08
DETROIT (MI)	$632.52	$486.51
REST OF MICHIGAN (MI)	$601.36	$463.22
MINNESOTA (MN)	$630.67	$474.98
METROPOLITAN ST. LOUIS (MO)	$614.18	$470.14
METROPOLITAN KANSAS CITY (MO)	$608.60	$466.53
REST OF MISSOURI (MO)	$578.38	$447.95
MISSISSIPPI (MS)	$573.43	$443.16
MONTANA** (MT)	$632.91	$481.60
NORTH CAROLINA (NC)	$599.70	$458.53
NORTH DAKOTA** (ND)	$621.44	$470.13
NEBRASKA (NE)	$590.73	$451.07
NEW HAMPSHIRE (NH)	$646.59	$489.08
NORTHERN NJ (NJ)	$710.92	$535.41
REST OF NEW JERSEY (NJ)	$679.74	$514.52
NEW MEXICO (NM)	$604.32	$465.57
NEVADA** (NV)	$630.10	$478.65
MANHATTAN (NY)	$721.96	$546.15
NYC SUBURBS/LONG ISLAND (NY)	$737.79	$557.89
POUGHKPSIE/N NYC SUBURBS (NY)	$684.22	$518.54
QUEENS (NY)	$727.01	$548.17
REST OF NEW YORK (NY)	$607.60	$463.86
OHIO (OH)	$599.02	$460.87
OKLAHOMA (OK)	$586.71	$451.59
PORTLAND (OR)	$675.03	$506.92
REST OF OREGON (OR)	$625.63	$474.93
METROPOLITAN PHILADELPHIA (PA)	$656.74	$499.23
REST OF PENNSYLVANIA (PA)	$599.75	$460.86
PUERTO RICO (PR)	$636.97	$484.00
RHODE ISLAND (RI)	$648.00	$491.70
SOUTH CAROLINA (SC)	$600.26	$460.46
SOUTH DAKOTA** (SD)	$620.08	$468.78
TENNESSEE (TN)	$588.32	$450.79
BRAZORIA (TX)	$626.93	$476.99
DALLAS (TX)	$630.63	$479.92
GALVESTON (TX)	$628.65	$478.40
HOUSTON (TX)	$639.26	$489.02
BEAUMONT (TX)	$596.31	$458.62
FORT WORTH (TX)	$626.96	$477.77
AUSTIN (TX)	$653.91	$493.82
REST OF TEXAS (TX)	$611.09	$467.50
UTAH (UT)	$607.46	$465.24
VIRGINIA (VA)	$620.59	$471.86
VIRGIN ISLANDS (VI)	$636.97	$484.00
VERMONT (VT)	$619.46	$469.67
SEATTLE (KING CNTY) (WA)	$729.43	$543.78
REST OF WASHINGTON (WA)	$651.97	$492.64
WISCONSIN (WI)	$603.09	$458.13
WEST VIRGINIA (WV)	$589.97	$458.49
WYOMING** (WY)	$627.91	$476.60

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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) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific 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 settings (like a physician office, where the practice bears more overhead) and facility settings (like a hospital, where the facility bills separately for overhead), which is why the two amounts differ.

RVUs — work 6.64, practice expense 11.73 (non-facility) / 7.2 (facility), malpractice 0.58 — × 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 the annual Part B deductible; the patient or secondary insurer is generally responsible for the remainder.
Actual payment can vary by locality, modifiers appended to the code, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always confirm the exact allowed amount with your Medicare Administrative Contractor (MAC) or current fee schedule lookup tool before billing or appealing a denial.

Frequently asked

Why is the non-facility amount higher than the facility amount?

In the non-facility setting, the physician practice typically incurs more overhead costs (staff, supplies, equipment), so the practice-expense RVU — and therefore the total payment — is higher. In a facility, the facility itself bills separately for overhead, so the physician's practice-expense RVU is lower.

Does this amount apply everywhere in the country?

No. The national amount shown is before locality adjustment. The actual Medicare-allowed amount depends on the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service was rendered.

Will Medicare pay this full amount?

No. Medicare generally reimburses 80% of the allowed amount after the Part B deductible is met. Modifiers, secondary payers, and other adjustments can further change the final payment.

Why might my payment differ from this estimate?

Differences can arise from locality GPCI adjustments, applied modifiers, claim-specific edits, sequestration cuts, and annual budget-neutrality changes to RVUs or the conversion factor.

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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.