Medicare Reimbursement for CPT 15931

CPT 15931 is a surgical procedure code; the exact clinical description is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with non-facility and facility rate comparisons where applicable.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$673.36	$673.36
ALASKA* (AK)	$818.43	$818.43
ALABAMA (AL)	$605.32	$605.32
ARKANSAS (AR)	$596.97	$596.97
ARIZONA (AZ)	$653.56	$653.56
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$766.83	$766.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$777.97	$777.97
OXNARD-THOUSAND OAKS-VENTURA (CA)	$700.41	$700.41
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$708.23	$708.23
NAPA (CA)	$738.65	$738.65
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$769.57	$769.57
VALLEJO (CA)	$734.71	$734.71
BAKERSFIELD (CA)	$673.55	$673.55
CHICO (CA)	$667.02	$667.02
FRESNO (CA)	$667.02	$667.02
HANFORD-CORCORAN (CA)	$667.02	$667.02
MADERA (CA)	$667.02	$667.02
MERCED (CA)	$667.02	$667.02
MODESTO (CA)	$667.02	$667.02
REDDING (CA)	$667.02	$667.02
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$692.86	$692.86
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$690.99	$690.99
SALINAS (CA)	$688.29	$688.29
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$789.16	$789.16
SANTA CRUZ-WATSONVILLE (CA)	$699.85	$699.85
SANTA ROSA-PETALUMA (CA)	$706.24	$706.24
STOCKTON (CA)	$667.02	$667.02
VISALIA (CA)	$667.02	$667.02
YUBA CITY (CA)	$667.02	$667.02
EL CENTRO (CA)	$667.42	$667.42
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$698.25	$698.25
SAN LUIS OBISPO-PASO ROBLES (CA)	$678.40	$678.40
SANTA MARIA-SANTA BARBARA (CA)	$689.16	$689.16
REST OF CALIFORNIA (CA)	$667.02	$667.02
COLORADO (CO)	$676.62	$676.62
CONNECTICUT (CT)	$717.22	$717.22
DC + MD/VA SUBURBS (DC)	$747.32	$747.32
DELAWARE (DE)	$663.69	$663.69
FORT LAUDERDALE (FL)	$741.85	$741.85
MIAMI (FL)	$807.30	$807.30
REST OF FLORIDA (FL)	$702.20	$702.20
ATLANTA (GA)	$694.76	$694.76
REST OF GEORGIA (GA)	$660.21	$660.21
HAWAII, GUAM (HI)	$675.76	$675.76
IOWA (IA)	$602.31	$602.31
IDAHO (ID)	$609.75	$609.75
EAST ST. LOUIS (IL)	$733.80	$733.80
SUBURBAN CHICAGO (IL)	$744.95	$744.95
CHICAGO (IL)	$781.23	$781.23
REST OF ILLINOIS (IL)	$695.64	$695.64
INDIANA (IN)	$612.65	$612.65
KANSAS (KS)	$608.01	$608.01
KENTUCKY (KY)	$637.12	$637.12
NEW ORLEANS (LA)	$668.68	$668.68
REST OF LOUISIANA (LA)	$639.52	$639.52
METROPOLITAN BOSTON (MA)	$729.34	$729.34
REST OF MASSACHUSETTS (MA)	$676.31	$676.31
BALTIMORE/SURR. CNTYS (MD)	$717.02	$717.02
REST OF MARYLAND (MD)	$673.22	$673.22
SOUTHERN MAINE (ME)	$641.28	$641.28
REST OF MAINE (ME)	$621.75	$621.75
DETROIT (MI)	$719.31	$719.31
REST OF MICHIGAN (MI)	$660.70	$660.70
MINNESOTA (MN)	$624.37	$624.37
METROPOLITAN ST. LOUIS (MO)	$660.81	$660.81
METROPOLITAN KANSAS CITY (MO)	$655.35	$655.35
REST OF MISSOURI (MO)	$634.72	$634.72
MISSISSIPPI (MS)	$615.54	$615.54
MONTANA** (MT)	$673.20	$673.20
NORTH CAROLINA (NC)	$626.56	$626.56
NORTH DAKOTA** (ND)	$625.55	$625.55
NEBRASKA (NE)	$602.90	$602.90
NEW HAMPSHIRE (NH)	$674.16	$674.16
NORTHERN NJ (NJ)	$741.88	$741.88
REST OF NEW JERSEY (NJ)	$718.66	$718.66
NEW MEXICO (NM)	$667.56	$667.56
NEVADA** (NV)	$660.18	$660.18
MANHATTAN (NY)	$784.43	$784.43
NYC SUBURBS/LONG ISLAND (NY)	$813.40	$813.40
POUGHKPSIE/N NYC SUBURBS (NY)	$730.19	$730.19
QUEENS (NY)	$778.14	$778.14
REST OF NEW YORK (NY)	$636.21	$636.21
OHIO (OH)	$650.96	$650.96
OKLAHOMA (OK)	$627.07	$627.07
PORTLAND (OR)	$687.40	$687.40
REST OF OREGON (OR)	$648.40	$648.40
METROPOLITAN PHILADELPHIA (PA)	$705.66	$705.66
REST OF PENNSYLVANIA (PA)	$647.22	$647.22
PUERTO RICO (PR)	$675.07	$675.07
RHODE ISLAND (RI)	$679.64	$679.64
SOUTH CAROLINA (SC)	$641.16	$641.16
SOUTH DAKOTA** (SD)	$619.91	$619.91
TENNESSEE (TN)	$611.99	$611.99
BRAZORIA (TX)	$655.89	$655.89
DALLAS (TX)	$663.82	$663.82
GALVESTON (TX)	$660.29	$660.29
HOUSTON (TX)	$704.40	$704.40
BEAUMONT (TX)	$643.81	$643.81
FORT WORTH (TX)	$662.22	$662.22
AUSTIN (TX)	$680.20	$680.20
REST OF TEXAS (TX)	$652.05	$652.05
UTAH (UT)	$649.26	$649.26
VIRGINIA (VA)	$645.19	$645.19
VIRGIN ISLANDS (VI)	$675.07	$675.07
VERMONT (VT)	$630.95	$630.95
SEATTLE (KING CNTY) (WA)	$735.16	$735.16
REST OF WASHINGTON (WA)	$672.43	$672.43
WISCONSIN (WI)	$606.53	$606.53
WEST VIRGINIA (WV)	$673.36	$673.36
WYOMING** (WY)	$652.43	$652.43

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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) — 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 national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can have different practice-expense RVUs, which is why allowed amounts may differ between the two settings for the same code.

RVUs — work 9.82, practice expense 7.93 (non-facility) / 7.93 (facility), malpractice 2.41 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on the national or locality-adjusted PFS formula — actual payment may differ.
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.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

Facility rates generally use lower practice-expense RVUs because overhead costs (equipment, supplies, staff) are assumed to be borne by the facility rather than the billing provider.

Why might the amount I was paid differ from the national rate shown here?

Local GPCI adjustments, applied modifiers, claim-specific reductions, and sequestration can all cause the actual paid amount to vary from the national baseline.

Does this amount represent what Medicare will pay in full?

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

Where can I find the official descriptor for CPT 15931?

CPT code descriptors are copyrighted by the American Medical Association. Consult your current CPT codebook or AMA-licensed coding software for the official language.

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.