Medicare Reimbursement for CPT 15838

This page covers Medicare Physician Fee Schedule (PFS) pricing for CPT code 15838, a procedure code maintained by the AMA. It shows the national Medicare allowed amount for 2026, along with how the figure can vary by locality and by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$599.88	$599.88
ALASKA* (AK)	$730.28	$730.28
ALABAMA (AL)	$543.19	$543.19
ARKANSAS (AR)	$536.16	$536.16
ARIZONA (AZ)	$584.02	$584.02
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$712.55	$712.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$724.21	$724.21
OXNARD-THOUSAND OAKS-VENTURA (CA)	$640.07	$640.07
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$645.87	$645.87
NAPA (CA)	$682.12	$682.12
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$714.23	$714.23
VALLEJO (CA)	$679.70	$679.70
BAKERSFIELD (CA)	$612.72	$612.72
CHICO (CA)	$608.57	$608.57
FRESNO (CA)	$608.57	$608.57
HANFORD-CORCORAN (CA)	$608.57	$608.57
MADERA (CA)	$608.57	$608.57
MERCED (CA)	$608.57	$608.57
MODESTO (CA)	$608.57	$608.57
REDDING (CA)	$608.57	$608.57
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$624.51	$624.51
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$632.56	$632.56
SALINAS (CA)	$630.09	$630.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$731.08	$731.08
SANTA CRUZ-WATSONVILLE (CA)	$643.19	$643.19
SANTA ROSA-PETALUMA (CA)	$649.27	$649.27
STOCKTON (CA)	$608.57	$608.57
VISALIA (CA)	$608.57	$608.57
YUBA CITY (CA)	$608.57	$608.57
EL CENTRO (CA)	$608.82	$608.82
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$640.55	$640.55
SAN LUIS OBISPO-PASO ROBLES (CA)	$620.69	$620.69
SANTA MARIA-SANTA BARBARA (CA)	$631.26	$631.26
REST OF CALIFORNIA (CA)	$608.57	$608.57
COLORADO (CO)	$610.32	$610.32
CONNECTICUT (CT)	$637.34	$637.34
DC + MD/VA SUBURBS (DC)	$670.15	$670.15
DELAWARE (DE)	$592.85	$592.85
FORT LAUDERDALE (FL)	$643.49	$643.49
MIAMI (FL)	$687.02	$687.02
REST OF FLORIDA (FL)	$612.34	$612.34
ATLANTA (GA)	$615.13	$615.13
REST OF GEORGIA (GA)	$578.93	$578.93
HAWAII, GUAM (HI)	$617.69	$617.69
IOWA (IA)	$546.11	$546.11
IDAHO (ID)	$551.28	$551.28
EAST ST. LOUIS (IL)	$627.45	$627.45
SUBURBAN CHICAGO (IL)	$647.53	$647.53
CHICAGO (IL)	$667.19	$667.19
REST OF ILLINOIS (IL)	$603.19	$603.19
INDIANA (IN)	$553.89	$553.89
KANSAS (KS)	$548.30	$548.30
KENTUCKY (KY)	$564.39	$564.39
NEW ORLEANS (LA)	$589.97	$589.97
REST OF LOUISIANA (LA)	$565.39	$565.39
METROPOLITAN BOSTON (MA)	$660.14	$660.14
REST OF MASSACHUSETTS (MA)	$609.08	$609.08
BALTIMORE/SURR. CNTYS (MD)	$636.47	$636.47
REST OF MARYLAND (MD)	$601.89	$601.89
SOUTHERN MAINE (ME)	$579.10	$579.10
REST OF MAINE (ME)	$558.64	$558.64
DETROIT (MI)	$623.92	$623.92
REST OF MICHIGAN (MI)	$581.73	$581.73
MINNESOTA (MN)	$573.25	$573.25
METROPOLITAN ST. LOUIS (MO)	$586.45	$586.45
METROPOLITAN KANSAS CITY (MO)	$581.55	$581.55
REST OF MISSOURI (MO)	$559.69	$559.69
MISSISSIPPI (MS)	$547.79	$547.79
MONTANA** (MT)	$599.78	$599.78
NORTH CAROLINA (NC)	$563.15	$563.15
NORTH DAKOTA** (ND)	$570.52	$570.52
NEBRASKA (NE)	$547.43	$547.43
NEW HAMPSHIRE (NH)	$605.26	$605.26
NORTHERN NJ (NJ)	$665.26	$665.26
REST OF NEW JERSEY (NJ)	$641.35	$641.35
NEW MEXICO (NM)	$586.42	$586.42
NEVADA** (NV)	$591.91	$591.91
MANHATTAN (NY)	$691.70	$691.70
NYC SUBURBS/LONG ISLAND (NY)	$712.71	$712.71
POUGHKPSIE/N NYC SUBURBS (NY)	$649.13	$649.13
QUEENS (NY)	$690.22	$690.22
REST OF NEW YORK (NY)	$571.10	$571.10
OHIO (OH)	$575.75	$575.75
OKLAHOMA (OK)	$558.69	$558.69
PORTLAND (OR)	$622.81	$622.81
REST OF OREGON (OR)	$584.07	$584.07
METROPOLITAN PHILADELPHIA (PA)	$625.81	$625.81
REST OF PENNSYLVANIA (PA)	$574.05	$574.05
PUERTO RICO (PR)	$602.24	$602.24
RHODE ISLAND (RI)	$608.95	$608.95
SOUTH CAROLINA (SC)	$571.04	$571.04
SOUTH DAKOTA** (SD)	$567.06	$567.06
TENNESSEE (TN)	$551.34	$551.34
BRAZORIA (TX)	$588.62	$588.62
DALLAS (TX)	$594.15	$594.15
GALVESTON (TX)	$591.55	$591.55
HOUSTON (TX)	$618.64	$618.64
BEAUMONT (TX)	$571.00	$571.00
FORT WORTH (TX)	$591.97	$591.97
AUSTIN (TX)	$611.13	$611.13
REST OF TEXAS (TX)	$580.71	$580.71
UTAH (UT)	$577.92	$577.92
VIRGINIA (VA)	$580.55	$580.55
VIRGIN ISLANDS (VI)	$602.24	$602.24
VERMONT (VT)	$572.64	$572.64
SEATTLE (KING CNTY) (WA)	$668.25	$668.25
REST OF WASHINGTON (WA)	$606.50	$606.50
WISCONSIN (WI)	$553.83	$553.83
WEST VIRGINIA (WV)	$584.26	$584.26
WYOMING** (WY)	$587.03	$587.03

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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 PFS amount is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility settings often differ because practice-expense RVUs account for whether overhead costs (like supplies and staff) are borne by the physician's office or by a facility such as a hospital.

RVUs — work 8.04, practice expense 8.44 (non-facility) / 8.44 (facility), malpractice 1.48 — × 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 locality, carrier-specific pricing, and local coverage determinations.
Modifiers (e.g., bilateral, multiple procedure, assistant surgeon) can increase or decrease the final payment.
Sequestration and annual budget-neutrality adjustments may change the effective amount paid.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the reimbursement amount differ between non-facility and facility settings?

The practice-expense RVU differs by setting because overhead costs are allocated differently depending on whether the service is performed in a physician's office (non-facility) or a hospital/facility setting where the facility bears some costs.

Does this amount reflect what the patient will owe?

No. The figure shown is the Medicare-allowed amount. After the deductible is met, Medicare generally pays 80% of this amount, and the patient or secondary payer is responsible for the remaining 20%, subject to any applicable modifiers or coverage rules.

Why might my MAC's actual payment differ from this estimate?

Payments can be affected by locality-specific GPCI adjustments, modifiers appended to the claim, multiple-procedure payment reductions, sequestration, and annual budget-neutrality changes to the conversion factor.

Is the conversion factor the same every year?

No. The national conversion factor is updated annually by CMS and can change due to legislative adjustments, budget-neutrality requirements, and other regulatory factors affecting the Physician Fee Schedule.

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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.