Medicare Reimbursement for CPT Code 15946

This page covers CPT code 15946, a procedure code recognized by Medicare's Physician Fee Schedule (PFS). It shows the estimated Medicare allowed amount nationally and adjusted for your locality, broken out by non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1460.62	$1460.62
ALASKA* (AK)	$1813.51	$1813.51
ALABAMA (AL)	$1325.88	$1325.88
ARKANSAS (AR)	$1309.37	$1309.37
ARIZONA (AZ)	$1421.28	$1421.28
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1651.46	$1651.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1675.07	$1675.07
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1514.36	$1514.36
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1531.77	$1531.77
NAPA (CA)	$1592.75	$1592.75
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1657.01	$1657.01
VALLEJO (CA)	$1584.76	$1584.76
BAKERSFIELD (CA)	$1460.97	$1460.97
CHICO (CA)	$1447.50	$1447.50
FRESNO (CA)	$1447.50	$1447.50
HANFORD-CORCORAN (CA)	$1447.50	$1447.50
MADERA (CA)	$1447.50	$1447.50
MERCED (CA)	$1447.50	$1447.50
MODESTO (CA)	$1447.50	$1447.50
REDDING (CA)	$1447.50	$1447.50
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1499.96	$1499.96
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1496.73	$1496.73
SALINAS (CA)	$1490.76	$1490.76
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1697.73	$1697.73
SANTA CRUZ-WATSONVILLE (CA)	$1511.58	$1511.58
SANTA ROSA-PETALUMA (CA)	$1525.30	$1525.30
STOCKTON (CA)	$1447.50	$1447.50
VISALIA (CA)	$1447.50	$1447.50
YUBA CITY (CA)	$1447.50	$1447.50
EL CENTRO (CA)	$1448.32	$1448.32
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1509.90	$1509.90
SAN LUIS OBISPO-PASO ROBLES (CA)	$1469.52	$1469.52
SANTA MARIA-SANTA BARBARA (CA)	$1491.99	$1491.99
REST OF CALIFORNIA (CA)	$1447.50	$1447.50
COLORADO (CO)	$1467.12	$1467.12
CONNECTICUT (CT)	$1549.99	$1549.99
DC + MD/VA SUBURBS (DC)	$1612.60	$1612.60
DELAWARE (DE)	$1441.94	$1441.94
FORT LAUDERDALE (FL)	$1598.98	$1598.98
MIAMI (FL)	$1730.84	$1730.84
REST OF FLORIDA (FL)	$1520.08	$1520.08
ATLANTA (GA)	$1503.93	$1503.93
REST OF GEORGIA (GA)	$1436.62	$1436.62
HAWAII, GUAM (HI)	$1462.15	$1462.15
IOWA (IA)	$1318.81	$1318.81
IDAHO (ID)	$1333.76	$1333.76
EAST ST. LOUIS (IL)	$1584.94	$1584.94
SUBURBAN CHICAGO (IL)	$1605.78	$1605.78
CHICAGO (IL)	$1679.76	$1679.76
REST OF ILLINOIS (IL)	$1507.84	$1507.84
INDIANA (IN)	$1339.46	$1339.46
KANSAS (KS)	$1330.62	$1330.62
KENTUCKY (KY)	$1389.93	$1389.93
NEW ORLEANS (LA)	$1452.58	$1452.58
REST OF LOUISIANA (LA)	$1394.89	$1394.89
METROPOLITAN BOSTON (MA)	$1574.24	$1574.24
REST OF MASSACHUSETTS (MA)	$1467.24	$1467.24
BALTIMORE/SURR. CNTYS (MD)	$1549.20	$1549.20
REST OF MARYLAND (MD)	$1461.26	$1461.26
SOUTHERN MAINE (ME)	$1395.87	$1395.87
REST OF MAINE (ME)	$1358.05	$1358.05
DETROIT (MI)	$1554.52	$1554.52
REST OF MICHIGAN (MI)	$1437.10	$1437.10
MINNESOTA (MN)	$1360.72	$1360.72
METROPOLITAN ST. LOUIS (MO)	$1436.37	$1436.37
METROPOLITAN KANSAS CITY (MO)	$1425.64	$1425.64
REST OF MISSOURI (MO)	$1385.72	$1385.72
MISSISSIPPI (MS)	$1346.91	$1346.91
MONTANA** (MT)	$1460.30	$1460.30
NORTH CAROLINA (NC)	$1367.47	$1367.47
NORTH DAKOTA** (ND)	$1363.80	$1363.80
NEBRASKA (NE)	$1319.81	$1319.81
NEW HAMPSHIRE (NH)	$1461.24	$1461.24
NORTHERN NJ (NJ)	$1603.12	$1603.12
REST OF NEW JERSEY (NJ)	$1554.96	$1554.96
NEW MEXICO (NM)	$1450.88	$1450.88
NEVADA** (NV)	$1433.91	$1433.91
MANHATTAN (NY)	$1689.36	$1689.36
NYC SUBURBS/LONG ISLAND (NY)	$1747.36	$1747.36
POUGHKPSIE/N NYC SUBURBS (NY)	$1578.85	$1578.85
QUEENS (NY)	$1676.13	$1676.13
REST OF NEW YORK (NY)	$1386.61	$1386.61
OHIO (OH)	$1417.38	$1417.38
OKLAHOMA (OK)	$1369.49	$1369.49
PORTLAND (OR)	$1488.30	$1488.30
REST OF OREGON (OR)	$1410.16	$1410.16
METROPOLITAN PHILADELPHIA (PA)	$1527.21	$1527.21
REST OF PENNSYLVANIA (PA)	$1409.67	$1409.67
PUERTO RICO (PR)	$1463.81	$1463.81
RHODE ISLAND (RI)	$1474.84	$1474.84
SOUTH CAROLINA (SC)	$1397.26	$1397.26
SOUTH DAKOTA** (SD)	$1352.39	$1352.39
TENNESSEE (TN)	$1338.56	$1338.56
BRAZORIA (TX)	$1426.44	$1426.44
DALLAS (TX)	$1442.50	$1442.50
GALVESTON (TX)	$1435.29	$1435.29
HOUSTON (TX)	$1524.61	$1524.61
BEAUMONT (TX)	$1402.97	$1402.97
FORT WORTH (TX)	$1439.50	$1439.50
AUSTIN (TX)	$1473.31	$1473.31
REST OF TEXAS (TX)	$1418.70	$1418.70
UTAH (UT)	$1413.27	$1413.27
VIRGINIA (VA)	$1404.00	$1404.00
VIRGIN ISLANDS (VI)	$1463.81	$1463.81
VERMONT (VT)	$1374.98	$1374.98
SEATTLE (KING CNTY) (WA)	$1586.30	$1586.30
REST OF WASHINGTON (WA)	$1459.02	$1459.02
WISCONSIN (WI)	$1326.32	$1326.32
WEST VIRGINIA (WV)	$1463.80	$1463.80
WYOMING** (WY)	$1418.24	$1418.24

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units 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 — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs typically differ between non-facility (e.g., physician office) and facility (e.g., hospital, ASC) settings, which is why the two allowed amounts can differ. The conversion factor and RVU values are updated annually and are subject to budget-neutrality adjustments.

RVUs — work 23.52, practice expense 15.33 (non-facility) / 15.33 (facility), malpractice 4.88 — × 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 payer is responsible for the remainder.
Actual payment can vary based on the exact locality, applicable modifiers, multiple-procedure or bilateral reductions, sequestration, and annual regulatory changes.
Always verify current rates and policy with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the allowed amount differ by locality?

Medicare applies locality-specific Geographic Practice Cost Indices (GPCIs) to the work, practice expense, and malpractice RVUs to reflect regional cost differences before applying the conversion factor.

Why might non-facility and facility amounts differ for this code?

The practice-expense RVU component can vary depending on whether the service is performed in a non-facility setting (like a physician's office, which bears more overhead) versus a facility setting (like a hospital, which absorbs some overhead costs separately).

Is this the amount my practice will actually receive?

Not necessarily. This figure is an estimate based on standard PFS inputs; final payment depends on claim-specific factors such as modifiers, secondary payer coordination, and any applicable adjustments like sequestration.

Where can I find the official rate for my area?

Your Medicare Administrative Contractor (MAC) or the CMS Physician Fee Schedule Look-Up Tool can provide the authoritative, locality-specific rate for a given year.

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.