Medicare Reimbursement for CPT 15935

CPT 15935 is a procedure code reported to Medicare for physician and outpatient billing. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, including the national average and how it is derived from RVUs, geographic adjustments, and the conversion factor. Amounts are shown for both non-facility and facility settings where applicable.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1045.11	$1045.11
ALASKA* (AK)	$1287.55	$1287.55
ALABAMA (AL)	$949.21	$949.21
ARKANSAS (AR)	$937.37	$937.37
ARIZONA (AZ)	$1017.86	$1017.86
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1217.59	$1217.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1236.57	$1236.57
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1102.76	$1102.76
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1113.80	$1113.80
NAPA (CA)	$1169.00	$1169.00
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1220.84	$1220.84
VALLEJO (CA)	$1164.32	$1164.32
BAKERSFIELD (CA)	$1059.34	$1059.34
CHICO (CA)	$1051.34	$1051.34
FRESNO (CA)	$1051.34	$1051.34
HANFORD-CORCORAN (CA)	$1051.34	$1051.34
MADERA (CA)	$1051.34	$1051.34
MERCED (CA)	$1051.34	$1051.34
MODESTO (CA)	$1051.34	$1051.34
REDDING (CA)	$1051.34	$1051.34
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1082.14	$1082.14
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1090.29	$1090.29
SALINAS (CA)	$1085.98	$1085.98
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1249.85	$1249.85
SANTA CRUZ-WATSONVILLE (CA)	$1105.23	$1105.23
SANTA ROSA-PETALUMA (CA)	$1115.52	$1115.52
STOCKTON (CA)	$1051.34	$1051.34
VISALIA (CA)	$1051.34	$1051.34
YUBA CITY (CA)	$1051.34	$1051.34
EL CENTRO (CA)	$1051.82	$1051.82
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1102.15	$1102.15
SAN LUIS OBISPO-PASO ROBLES (CA)	$1070.07	$1070.07
SANTA MARIA-SANTA BARBARA (CA)	$1087.48	$1087.48
REST OF CALIFORNIA (CA)	$1051.34	$1051.34
COLORADO (CO)	$1058.24	$1058.24
CONNECTICUT (CT)	$1108.99	$1108.99
DC + MD/VA SUBURBS (DC)	$1161.19	$1161.19
DELAWARE (DE)	$1032.81	$1032.81
FORT LAUDERDALE (FL)	$1127.96	$1127.96
MIAMI (FL)	$1209.03	$1209.03
REST OF FLORIDA (FL)	$1074.00	$1074.00
ATLANTA (GA)	$1072.83	$1072.83
REST OF GEORGIA (GA)	$1016.42	$1016.42
HAWAII, GUAM (HI)	$1064.57	$1064.57
IOWA (IA)	$950.49	$950.49
IDAHO (ID)	$959.93	$959.93
EAST ST. LOUIS (IL)	$1107.13	$1107.13
SUBURBAN CHICAGO (IL)	$1134.22	$1134.22
CHICAGO (IL)	$1174.60	$1174.60
REST OF ILLINOIS (IL)	$1061.00	$1061.00
INDIANA (IN)	$964.22	$964.22
KANSAS (KS)	$955.92	$955.92
KENTUCKY (KY)	$988.65	$988.65
NEW ORLEANS (LA)	$1032.41	$1032.41
REST OF LOUISIANA (LA)	$991.01	$991.01
METROPOLITAN BOSTON (MA)	$1140.18	$1140.18
REST OF MASSACHUSETTS (MA)	$1057.03	$1057.03
BALTIMORE/SURR. CNTYS (MD)	$1107.77	$1107.77
REST OF MARYLAND (MD)	$1047.65	$1047.65
SOUTHERN MAINE (ME)	$1005.94	$1005.94
REST OF MAINE (ME)	$974.16	$974.16
DETROIT (MI)	$1095.40	$1095.40
REST OF MICHIGAN (MI)	$1019.54	$1019.54
MINNESOTA (MN)	$990.49	$990.49
METROPOLITAN ST. LOUIS (MO)	$1024.40	$1024.40
METROPOLITAN KANSAS CITY (MO)	$1016.35	$1016.35
REST OF MISSOURI (MO)	$982.52	$982.52
MISSISSIPPI (MS)	$959.64	$959.64
MONTANA** (MT)	$1044.92	$1044.92
NORTH CAROLINA (NC)	$981.45	$981.45
NORTH DAKOTA** (ND)	$988.37	$988.37
NEBRASKA (NE)	$952.16	$952.16
NEW HAMPSHIRE (NH)	$1051.03	$1051.03
NORTHERN NJ (NJ)	$1153.68	$1153.68
REST OF NEW JERSEY (NJ)	$1115.01	$1115.01
NEW MEXICO (NM)	$1028.16	$1028.16
NEVADA** (NV)	$1029.60	$1029.60
MANHATTAN (NY)	$1204.55	$1204.55
NYC SUBURBS/LONG ISLAND (NY)	$1242.20	$1242.20
POUGHKPSIE/N NYC SUBURBS (NY)	$1129.68	$1129.68
QUEENS (NY)	$1199.51	$1199.51
REST OF NEW YORK (NY)	$994.97	$994.97
OHIO (OH)	$1007.99	$1007.99
OKLAHOMA (OK)	$977.21	$977.21
PORTLAND (OR)	$1077.23	$1077.23
REST OF OREGON (OR)	$1015.00	$1015.00
METROPOLITAN PHILADELPHIA (PA)	$1090.66	$1090.66
REST OF PENNSYLVANIA (PA)	$1004.15	$1004.15
PUERTO RICO (PR)	$1048.47	$1048.47
RHODE ISLAND (RI)	$1058.94	$1058.94
SOUTH CAROLINA (SC)	$997.68	$997.68
SOUTH DAKOTA** (SD)	$981.68	$981.68
TENNESSEE (TN)	$961.25	$961.25
BRAZORIA (TX)	$1024.29	$1024.29
DALLAS (TX)	$1034.43	$1034.43
GALVESTON (TX)	$1029.75	$1029.75
HOUSTON (TX)	$1082.10	$1082.10
BEAUMONT (TX)	$999.13	$999.13
FORT WORTH (TX)	$1031.32	$1031.32
AUSTIN (TX)	$1060.51	$1060.51
REST OF TEXAS (TX)	$1013.64	$1013.64
UTAH (UT)	$1009.24	$1009.24
VIRGINIA (VA)	$1009.63	$1009.63
VIRGIN ISLANDS (VI)	$1048.47	$1048.47
VERMONT (VT)	$993.57	$993.57
SEATTLE (KING CNTY) (WA)	$1152.20	$1152.20
REST OF WASHINGTON (WA)	$1052.05	$1052.05
WISCONSIN (WI)	$960.72	$960.72
WEST VIRGINIA (WV)	$1029.23	$1029.23
WYOMING** (WY)	$1020.28	$1020.28

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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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by a locality-specific Geographic Practice Cost Index (GPCI) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs typically differ between non-facility (e.g., physician office) and facility (e.g., hospital, ASC) settings, which is why the same code can have two different allowed amounts depending on place of service. The national figures shown here use national GPCI values rather than a specific locality, so actual local payments will vary.

RVUs — work 15.39, practice expense 13.04 (non-facility) / 13.04 (facility), malpractice 2.86 — × 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 approved amount after the patient's deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Actual payment varies by locality GPCI, applicable modifiers, sequestration, and annual budget-neutrality adjustments.
Facility vs. non-facility amounts depend on the actual place of service reported on the claim.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the allowed amount differ by locality?

Medicare adjusts the work, practice expense, and malpractice RVUs using locality-specific GPCIs to account for regional differences in costs like wages and rent, so the same code can pay differently across states or regions.

Why are non-facility and facility amounts sometimes different?

The practice expense RVU component often differs between settings because overhead costs (equipment, supplies, staff time) are handled differently when a procedure is performed in a facility versus a physician office.

Does this figure represent what Medicare will actually pay?

No. It represents the Medicare-approved amount before patient responsibility. Medicare generally pays 80% of this amount after the deductible, and modifiers, sequestration, or other adjustments can change the final payment.

Where can I find the official rate for my specific locality?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules, which should be used to confirm exact reimbursement for billing purposes.

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.