Medicare Reimbursement for CPT 15851

CPT 15851 is a procedure code defined by the AMA; this page shows the Medicare Physician Fee Schedule (PFS) allowed amount for it, both as a national average and adjusted for locality, with separate figures for non-facility and facility settings. These figures reflect what Medicare's standard formula estimates as the allowed amount before any deductible or coinsurance is applied.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$58.45	$58.45
ALASKA* (AK)	$75.57	$75.57
ALABAMA (AL)	$54.27	$54.27
ARKANSAS (AR)	$53.76	$53.76
ARIZONA (AZ)	$57.26	$57.26
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$66.88	$66.88
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$67.88	$67.88
OXNARD-THOUSAND OAKS-VENTURA (CA)	$61.16	$61.16
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$61.82	$61.82
NAPA (CA)	$64.41	$64.41
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$67.03	$67.03
VALLEJO (CA)	$64.20	$64.20
BAKERSFIELD (CA)	$59.20	$59.20
CHICO (CA)	$58.81	$58.81
FRESNO (CA)	$58.81	$58.81
HANFORD-CORCORAN (CA)	$58.81	$58.81
MADERA (CA)	$58.81	$58.81
MERCED (CA)	$58.81	$58.81
MODESTO (CA)	$58.81	$58.81
REDDING (CA)	$58.81	$58.81
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$60.22	$60.22
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$60.72	$60.72
SALINAS (CA)	$60.47	$60.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$68.49	$68.49
SANTA CRUZ-WATSONVILLE (CA)	$61.14	$61.14
SANTA ROSA-PETALUMA (CA)	$61.70	$61.70
STOCKTON (CA)	$58.81	$58.81
VISALIA (CA)	$58.81	$58.81
YUBA CITY (CA)	$58.81	$58.81
EL CENTRO (CA)	$58.83	$58.83
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$61.14	$61.14
SAN LUIS OBISPO-PASO ROBLES (CA)	$59.60	$59.60
SANTA MARIA-SANTA BARBARA (CA)	$60.49	$60.49
REST OF CALIFORNIA (CA)	$58.81	$58.81
COLORADO (CO)	$59.11	$59.11
CONNECTICUT (CT)	$61.49	$61.49
DC + MD/VA SUBURBS (DC)	$64.14	$64.14
DELAWARE (DE)	$57.97	$57.97
FORT LAUDERDALE (FL)	$62.20	$62.20
MIAMI (FL)	$65.84	$65.84
REST OF FLORIDA (FL)	$59.83	$59.83
ATLANTA (GA)	$59.73	$59.73
REST OF GEORGIA (GA)	$57.30	$57.30
HAWAII, GUAM (HI)	$59.14	$59.14
IOWA (IA)	$54.27	$54.27
IDAHO (ID)	$54.69	$54.69
EAST ST. LOUIS (IL)	$61.38	$61.38
SUBURBAN CHICAGO (IL)	$62.55	$62.55
CHICAGO (IL)	$64.42	$64.42
REST OF ILLINOIS (IL)	$59.30	$59.30
INDIANA (IN)	$54.88	$54.88
KANSAS (KS)	$54.53	$54.53
KENTUCKY (KY)	$56.04	$56.04
NEW ORLEANS (LA)	$57.96	$57.96
REST OF LOUISIANA (LA)	$56.16	$56.16
METROPOLITAN BOSTON (MA)	$63.00	$63.00
REST OF MASSACHUSETTS (MA)	$59.12	$59.12
BALTIMORE/SURR. CNTYS (MD)	$61.39	$61.39
REST OF MARYLAND (MD)	$58.67	$58.67
SOUTHERN MAINE (ME)	$56.68	$56.68
REST OF MAINE (ME)	$55.34	$55.34
DETROIT (MI)	$60.79	$60.79
REST OF MICHIGAN (MI)	$57.41	$57.41
MINNESOTA (MN)	$55.93	$55.93
METROPOLITAN ST. LOUIS (MO)	$57.58	$57.58
METROPOLITAN KANSAS CITY (MO)	$57.23	$57.23
REST OF MISSOURI (MO)	$55.80	$55.80
MISSISSIPPI (MS)	$54.76	$54.76
MONTANA** (MT)	$58.44	$58.44
NORTH CAROLINA (NC)	$55.65	$55.65
NORTH DAKOTA** (ND)	$55.87	$55.87
NEBRASKA (NE)	$54.34	$54.34
NEW HAMPSHIRE (NH)	$58.66	$58.66
NORTHERN NJ (NJ)	$63.94	$63.94
REST OF NEW JERSEY (NJ)	$61.99	$61.99
NEW MEXICO (NM)	$57.80	$57.80
NEVADA** (NV)	$57.74	$57.74
MANHATTAN (NY)	$66.26	$66.26
NYC SUBURBS/LONG ISLAND (NY)	$67.93	$67.93
POUGHKPSIE/N NYC SUBURBS (NY)	$62.72	$62.72
QUEENS (NY)	$66.00	$66.00
REST OF NEW YORK (NY)	$56.24	$56.24
OHIO (OH)	$56.89	$56.89
OKLAHOMA (OK)	$55.52	$55.52
PORTLAND (OR)	$59.95	$59.95
REST OF OREGON (OR)	$57.09	$57.09
METROPOLITAN PHILADELPHIA (PA)	$60.69	$60.69
REST OF PENNSYLVANIA (PA)	$56.71	$56.71
PUERTO RICO (PR)	$58.59	$58.59
RHODE ISLAND (RI)	$59.27	$59.27
SOUTH CAROLINA (SC)	$56.40	$56.40
SOUTH DAKOTA** (SD)	$55.57	$55.57
TENNESSEE (TN)	$54.77	$54.77
BRAZORIA (TX)	$57.62	$57.62
DALLAS (TX)	$58.08	$58.08
GALVESTON (TX)	$57.86	$57.86
HOUSTON (TX)	$60.24	$60.24
BEAUMONT (TX)	$56.49	$56.49
FORT WORTH (TX)	$57.96	$57.96
AUSTIN (TX)	$59.09	$59.09
REST OF TEXAS (TX)	$57.09	$57.09
UTAH (UT)	$56.91	$56.91
VIRGINIA (VA)	$56.86	$56.86
VIRGIN ISLANDS (VI)	$58.59	$58.59
VERMONT (VT)	$56.12	$56.12
SEATTLE (KING CNTY) (WA)	$63.61	$63.61
REST OF WASHINGTON (WA)	$58.85	$58.85
WISCONSIN (WI)	$54.68	$54.68
WEST VIRGINIA (WV)	$57.92	$57.92
WYOMING** (WY)	$57.32	$57.32

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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 schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to account for regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility amounts differ because the practice-expense RVU is typically lower in facility settings, since the facility (not the physician's office) bears certain overhead costs. The resulting allowed amount is Medicare's estimate of fair payment for the service; actual payment depends on additional factors.

RVUs — work 1.07, practice expense 0.55 (non-facility) / 0.55 (facility), malpractice 0.13 — × 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 payer is responsible for the remainder.
Amounts shown use national GPCI/locality inputs as computed and may not reflect your exact locality, carrier adjustments, or sequestration reductions.
Modifiers (e.g., bilateral, multiple procedure, professional/technical component) can increase or decrease the final paid amount.
Annual budget-neutrality adjustments and conversion factor updates change these amounts each year.
Always confirm final allowed amounts and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why do the non-facility and facility amounts differ for this code?

They differ when the practice-expense RVU changes between settings, usually because overhead costs are borne by the facility rather than the physician's office.

Does this amount include what the patient will owe?

No. The figure shown is the total allowed amount; Medicare generally pays 80% after the deductible, and the patient or secondary insurance is responsible for the rest.

Will my locality's actual payment match the amount shown?

It may differ, since the final amount depends on the specific locality's GPCI values, any applicable modifiers, and current-year adjustments like sequestration.

Can I use this figure to bill the patient directly?

No. This page is an informational estimate; actual billing and reimbursement should be verified with your MAC and payer contracts.

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.