Medicare Reimbursement for CPT 15956
This page covers CPT code 15956, a procedure code defined by the American Medical Association. It shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $1093.21 | $1093.21 |
| ALASKA* (AK) | $1339.45 | $1339.45 |
| ALABAMA (AL) | $987.24 | $987.24 |
| ARKANSAS (AR) | $974.23 | $974.23 |
| ARIZONA (AZ) | $1062.50 | $1062.50 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1249.11 | $1249.11 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1267.48 | $1267.48 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1139.82 | $1139.82 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1152.35 | $1152.35 |
| NAPA (CA) | $1202.68 | $1202.68 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1253.26 | $1253.26 |
| VALLEJO (CA) | $1196.70 | $1196.70 |
| BAKERSFIELD (CA) | $1096.69 | $1096.69 |
| CHICO (CA) | $1086.69 | $1086.69 |
| FRESNO (CA) | $1086.69 | $1086.69 |
| HANFORD-CORCORAN (CA) | $1086.69 | $1086.69 |
| MADERA (CA) | $1086.69 | $1086.69 |
| MERCED (CA) | $1086.69 | $1086.69 |
| MODESTO (CA) | $1086.69 | $1086.69 |
| REDDING (CA) | $1086.69 | $1086.69 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $1125.89 | $1125.89 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1125.53 | $1125.53 |
| SALINAS (CA) | $1121.09 | $1121.09 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1284.43 | $1284.43 |
| SANTA CRUZ-WATSONVILLE (CA) | $1139.40 | $1139.40 |
| SANTA ROSA-PETALUMA (CA) | $1149.84 | $1149.84 |
| STOCKTON (CA) | $1086.69 | $1086.69 |
| VISALIA (CA) | $1086.69 | $1086.69 |
| YUBA CITY (CA) | $1086.69 | $1086.69 |
| EL CENTRO (CA) | $1087.30 | $1087.30 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1136.99 | $1136.99 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $1104.95 | $1104.95 |
| SANTA MARIA-SANTA BARBARA (CA) | $1122.42 | $1122.42 |
| REST OF CALIFORNIA (CA) | $1086.69 | $1086.69 |
| COLORADO (CO) | $1100.24 | $1100.24 |
| CONNECTICUT (CT) | $1162.44 | $1162.44 |
| DC + MD/VA SUBURBS (DC) | $1212.08 | $1212.08 |
| DELAWARE (DE) | $1078.54 | $1078.54 |
| FORT LAUDERDALE (FL) | $1197.24 | $1197.24 |
| MIAMI (FL) | $1297.02 | $1297.02 |
| REST OF FLORIDA (FL) | $1135.85 | $1135.85 |
| ATLANTA (GA) | $1126.15 | $1126.15 |
| REST OF GEORGIA (GA) | $1070.77 | $1070.77 |
| HAWAII, GUAM (HI) | $1100.05 | $1100.05 |
| IOWA (IA) | $983.61 | $983.61 |
| IDAHO (ID) | $995.00 | $995.00 |
| EAST ST. LOUIS (IL) | $1182.87 | $1182.87 |
| SUBURBAN CHICAGO (IL) | $1202.62 | $1202.62 |
| CHICAGO (IL) | $1257.04 | $1257.04 |
| REST OF ILLINOIS (IL) | $1124.91 | $1124.91 |
| INDIANA (IN) | $999.56 | $999.56 |
| KANSAS (KS) | $991.99 | $991.99 |
| KENTUCKY (KY) | $1035.73 | $1035.73 |
| NEW ORLEANS (LA) | $1084.74 | $1084.74 |
| REST OF LOUISIANA (LA) | $1039.27 | $1039.27 |
| METROPOLITAN BOSTON (MA) | $1184.58 | $1184.58 |
| REST OF MASSACHUSETTS (MA) | $1099.71 | $1099.71 |
| BALTIMORE/SURR. CNTYS (MD) | $1161.84 | $1161.84 |
| REST OF MARYLAND (MD) | $1093.78 | $1093.78 |
| SOUTHERN MAINE (ME) | $1044.40 | $1044.40 |
| REST OF MAINE (ME) | $1013.17 | $1013.17 |
| DETROIT (MI) | $1161.99 | $1161.99 |
| REST OF MICHIGAN (MI) | $1072.00 | $1072.00 |
| MINNESOTA (MN) | $1019.70 | $1019.70 |
| METROPOLITAN ST. LOUIS (MO) | $1073.08 | $1073.08 |
| METROPOLITAN KANSAS CITY (MO) | $1064.51 | $1064.51 |
| REST OF MISSOURI (MO) | $1031.46 | $1031.46 |
| MISSISSIPPI (MS) | $1002.38 | $1002.38 |
| MONTANA** (MT) | $1092.97 | $1092.97 |
| NORTH CAROLINA (NC) | $1020.76 | $1020.76 |
| NORTH DAKOTA** (ND) | $1020.79 | $1020.79 |
| NEBRASKA (NE) | $984.69 | $984.69 |
| NEW HAMPSHIRE (NH) | $1095.38 | $1095.38 |
| NORTHERN NJ (NJ) | $1203.87 | $1203.87 |
| REST OF NEW JERSEY (NJ) | $1165.96 | $1165.96 |
| NEW MEXICO (NM) | $1082.48 | $1082.48 |
| NEVADA** (NV) | $1073.28 | $1073.28 |
| MANHATTAN (NY) | $1268.42 | $1268.42 |
| NYC SUBURBS/LONG ISLAND (NY) | $1312.92 | $1312.92 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1183.75 | $1183.75 |
| QUEENS (NY) | $1259.35 | $1259.35 |
| REST OF NEW YORK (NY) | $1035.78 | $1035.78 |
| OHIO (OH) | $1057.25 | $1057.25 |
| OKLAHOMA (OK) | $1020.60 | $1020.60 |
| PORTLAND (OR) | $1117.87 | $1117.87 |
| REST OF OREGON (OR) | $1055.31 | $1055.31 |
| METROPOLITAN PHILADELPHIA (PA) | $1143.99 | $1143.99 |
| REST OF PENNSYLVANIA (PA) | $1051.70 | $1051.70 |
| PUERTO RICO (PR) | $1096.05 | $1096.05 |
| RHODE ISLAND (RI) | $1104.44 | $1104.44 |
| SOUTH CAROLINA (SC) | $1042.66 | $1042.66 |
| SOUTH DAKOTA** (SD) | $1012.26 | $1012.26 |
| TENNESSEE (TN) | $998.13 | $998.13 |
| BRAZORIA (TX) | $1066.94 | $1066.94 |
| DALLAS (TX) | $1079.12 | $1079.12 |
| GALVESTON (TX) | $1073.64 | $1073.64 |
| HOUSTON (TX) | $1140.45 | $1140.45 |
| BEAUMONT (TX) | $1046.35 | $1046.35 |
| FORT WORTH (TX) | $1076.46 | $1076.46 |
| AUSTIN (TX) | $1105.03 | $1105.03 |
| REST OF TEXAS (TX) | $1059.74 | $1059.74 |
| UTAH (UT) | $1055.30 | $1055.30 |
| VIRGINIA (VA) | $1050.15 | $1050.15 |
| VIRGIN ISLANDS (VI) | $1096.05 | $1096.05 |
| VERMONT (VT) | $1028.74 | $1028.74 |
| SEATTLE (KING CNTY) (WA) | $1194.61 | $1194.61 |
| REST OF WASHINGTON (WA) | $1093.68 | $1093.68 |
| WISCONSIN (WI) | $991.02 | $991.02 |
| WEST VIRGINIA (WV) | $1090.14 | $1090.14 |
| WYOMING** (WY) | $1061.51 | $1061.51 |
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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) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional differences in costs. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two amounts can differ for some codes, though for this code they are currently equal.
RVUs — work 16.37, practice expense 12.71 (non-facility) / 12.71 (facility), malpractice 3.65 — × 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 beneficiary or secondary insurance is responsible for the remainder.
- Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why are the non-facility and facility amounts the same for this code?
When the practice-expense RVUs are identical for both settings, the resulting PFS amounts come out equal, even though they are calculated through the same formula.
Does this figure represent what Medicare will actually pay?
No. This is the Medicare-allowed amount before the standard 80/20 coinsurance split and before any locality-specific or claim-specific adjustments are applied.
Why does the amount change every year?
The conversion factor and RVU values are updated annually by CMS, and these updates, along with periodic budget-neutrality adjustments, change the calculated fee.
Can modifiers affect this amount?
Yes. Certain modifiers (e.g., for bilateral procedures, reduced services, or assistant surgeons) can increase or decrease the final payment relative to the base PFS amount shown here.
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.
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