Medicare Reimbursement for CPT 15920

This page explains the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 15920, a procedure code defined by the American Medical Association. It shows the estimated national payment amount as well as how the amount can vary by locality, and distinguishes between non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$628.27	$628.27
ALASKA* (AK)	$749.42	$749.42
ALABAMA (AL)	$561.18	$561.18
ARKANSAS (AR)	$552.92	$552.92
ARIZONA (AZ)	$609.01	$609.01
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$729.79	$729.79
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$740.97	$740.97
OXNARD-THOUSAND OAKS-VENTURA (CA)	$660.73	$660.73
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$667.48	$667.48
NAPA (CA)	$700.80	$700.80
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$732.24	$732.24
VALLEJO (CA)	$697.27	$697.27
BAKERSFIELD (CA)	$632.67	$632.67
CHICO (CA)	$626.86	$626.86
FRESNO (CA)	$626.86	$626.86
HANFORD-CORCORAN (CA)	$626.86	$626.86
MADERA (CA)	$626.86	$626.86
MERCED (CA)	$626.86	$626.86
MODESTO (CA)	$626.86	$626.86
REDDING (CA)	$626.86	$626.86
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$650.00	$650.00
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$651.17	$651.17
SALINAS (CA)	$648.67	$648.67
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$751.00	$751.00
SANTA CRUZ-WATSONVILLE (CA)	$662.01	$662.01
SANTA ROSA-PETALUMA (CA)	$668.16	$668.16
STOCKTON (CA)	$626.86	$626.86
VISALIA (CA)	$626.86	$626.86
YUBA CITY (CA)	$626.86	$626.86
EL CENTRO (CA)	$627.22	$627.22
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$659.43	$659.43
SAN LUIS OBISPO-PASO ROBLES (CA)	$639.17	$639.17
SANTA MARIA-SANTA BARBARA (CA)	$649.87	$649.87
REST OF CALIFORNIA (CA)	$626.86	$626.86
COLORADO (CO)	$634.03	$634.03
CONNECTICUT (CT)	$670.86	$670.86
DC + MD/VA SUBURBS (DC)	$701.95	$701.95
DELAWARE (DE)	$618.90	$618.90
FORT LAUDERDALE (FL)	$690.29	$690.29
MIAMI (FL)	$750.32	$750.32
REST OF FLORIDA (FL)	$651.97	$651.97
ATLANTA (GA)	$648.16	$648.16
REST OF GEORGIA (GA)	$611.21	$611.21
HAWAII, GUAM (HI)	$637.11	$637.11
IOWA (IA)	$560.44	$560.44
IDAHO (ID)	$567.35	$567.35
EAST ST. LOUIS (IL)	$678.53	$678.53
SUBURBAN CHICAGO (IL)	$693.59	$693.59
CHICAGO (IL)	$725.02	$725.02
REST OF ILLINOIS (IL)	$643.99	$643.99
INDIANA (IN)	$570.29	$570.29
KANSAS (KS)	$565.01	$565.01
KENTUCKY (KY)	$590.37	$590.37
NEW ORLEANS (LA)	$621.19	$621.19
REST OF LOUISIANA (LA)	$592.32	$592.32
METROPOLITAN BOSTON (MA)	$686.93	$686.93
REST OF MASSACHUSETTS (MA)	$633.11	$633.11
BALTIMORE/SURR. CNTYS (MD)	$670.58	$670.58
REST OF MARYLAND (MD)	$628.49	$628.49
SOUTHERN MAINE (ME)	$599.07	$599.07
REST OF MAINE (ME)	$578.10	$578.10
DETROIT (MI)	$667.74	$667.74
REST OF MICHIGAN (MI)	$612.67	$612.67
MINNESOTA (MN)	$585.78	$585.78
METROPOLITAN ST. LOUIS (MO)	$614.68	$614.68
METROPOLITAN KANSAS CITY (MO)	$609.15	$609.15
REST OF MISSOURI (MO)	$586.89	$586.89
MISSISSIPPI (MS)	$569.65	$569.65
MONTANA** (MT)	$628.13	$628.13
NORTH CAROLINA (NC)	$583.05	$583.05
NORTH DAKOTA** (ND)	$585.42	$585.42
NEBRASKA (NE)	$561.36	$561.36
NEW HAMPSHIRE (NH)	$630.99	$630.99
NORTHERN NJ (NJ)	$695.98	$695.98
REST OF NEW JERSEY (NJ)	$672.40	$672.40
NEW MEXICO (NM)	$619.01	$619.01
NEVADA** (NV)	$616.51	$616.51
MANHATTAN (NY)	$734.19	$734.19
NYC SUBURBS/LONG ISLAND (NY)	$761.47	$761.47
POUGHKPSIE/N NYC SUBURBS (NY)	$682.76	$682.76
QUEENS (NY)	$729.53	$729.53
REST OF NEW YORK (NY)	$592.53	$592.53
OHIO (OH)	$603.94	$603.94
OKLAHOMA (OK)	$581.55	$581.55
PORTLAND (OR)	$645.89	$645.89
REST OF OREGON (OR)	$605.70	$605.70
METROPOLITAN PHILADELPHIA (PA)	$658.79	$658.79
REST OF PENNSYLVANIA (PA)	$600.83	$600.83
PUERTO RICO (PR)	$630.34	$630.34
RHODE ISLAND (RI)	$635.05	$635.05
SOUTH CAROLINA (SC)	$595.69	$595.69
SOUTH DAKOTA** (SD)	$580.37	$580.37
TENNESSEE (TN)	$568.82	$568.82
BRAZORIA (TX)	$611.98	$611.98
DALLAS (TX)	$619.31	$619.31
GALVESTON (TX)	$616.02	$616.02
HOUSTON (TX)	$655.55	$655.55
BEAUMONT (TX)	$597.39	$597.39
FORT WORTH (TX)	$617.39	$617.39
AUSTIN (TX)	$637.19	$637.19
REST OF TEXAS (TX)	$606.67	$606.67
UTAH (UT)	$603.74	$603.74
VIRGINIA (VA)	$602.19	$602.19
VIRGIN ISLANDS (VI)	$630.34	$630.34
VERMONT (VT)	$589.77	$589.77
SEATTLE (KING CNTY) (WA)	$693.54	$693.54
REST OF WASHINGTON (WA)	$629.71	$629.71
WISCONSIN (WI)	$566.32	$566.32
WEST VIRGINIA (WV)	$621.87	$621.87
WYOMING** (WY)	$609.51	$609.51

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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: Clinical. 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) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting regional differences in cost of living and practice costs. The adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar-per-RVU figure set by CMS) to produce the allowed amount. Non-facility and facility rates can differ because practice-expense RVUs are typically higher in non-facility settings, where the provider bears more overhead costs directly.

RVUs — work 8.08, practice expense 8.57 (non-facility) / 8.57 (facility), malpractice 2.16 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement depends on your specific Medicare Administrative Contractor (MAC), locality, and claim details.
Medicare typically pays 80% of the allowed amount after the patient's annual deductible is met; the patient or secondary insurer is generally responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can increase or decrease the final paid amount.
CMS updates RVUs and the conversion factor annually, and mid-year budget-neutrality adjustments can also affect amounts.
Always verify current rates and coverage policy with your MAC before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount?

Facility and non-facility rates can differ because the practice-expense RVU component is calculated differently depending on where the service is performed — non-facility (e.g., physician office) rates generally account for more overhead the provider absorbs directly, while facility rates assume the facility bears some of those costs.

Is this the amount Medicare will actually pay?

No. This is the Medicare PFS allowed amount estimate. Medicare generally pays 80% of this amount after the deductible is met, and the final paid amount can be affected by modifiers, sequestration, and locality adjustments.

Why might the amount for my locality differ from the national figure shown here?

The national amount uses a standardized GPCI of 1.0 for comparison purposes, while actual payments are adjusted using the GPCIs specific to the provider's practice locality, which can raise or lower the amount.

Where can I find the official, binding fee schedule amount for my area?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules and is the authoritative source for the exact allowed amount applicable to your claims.

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.