Medicare Reimbursement for CPT 15958

CPT 15958 is a physician procedure code reported to Medicare for payment under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out by non-facility and facility settings. Actual payment depends on where the service is performed and the specific Medicare Administrative Contractor (MAC) locality.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1083.86	$1083.86
ALASKA* (AK)	$1336.29	$1336.29
ALABAMA (AL)	$983.32	$983.32
ARKANSAS (AR)	$970.94	$970.94
ARIZONA (AZ)	$1055.01	$1055.01
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1250.49	$1250.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1269.45	$1269.45
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1137.00	$1137.00
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1148.93	$1148.93
NAPA (CA)	$1202.32	$1202.32
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1254.15	$1254.15
VALLEJO (CA)	$1197.05	$1197.05
BAKERSFIELD (CA)	$1093.53	$1093.53
CHICO (CA)	$1084.59	$1084.59
FRESNO (CA)	$1084.59	$1084.59
HANFORD-CORCORAN (CA)	$1084.59	$1084.59
MADERA (CA)	$1084.59	$1084.59
MERCED (CA)	$1084.59	$1084.59
MODESTO (CA)	$1084.59	$1084.59
REDDING (CA)	$1084.59	$1084.59
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1119.23	$1119.23
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1123.82	$1123.82
SALINAS (CA)	$1119.37	$1119.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1284.40	$1284.40
SANTA CRUZ-WATSONVILLE (CA)	$1138.05	$1138.05
SANTA ROSA-PETALUMA (CA)	$1148.56	$1148.56
STOCKTON (CA)	$1084.59	$1084.59
VISALIA (CA)	$1084.59	$1084.59
YUBA CITY (CA)	$1084.59	$1084.59
EL CENTRO (CA)	$1085.13	$1085.13
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1135.41	$1135.41
SAN LUIS OBISPO-PASO ROBLES (CA)	$1103.12	$1103.12
SANTA MARIA-SANTA BARBARA (CA)	$1120.75	$1120.75
REST OF CALIFORNIA (CA)	$1084.59	$1084.59
COLORADO (CO)	$1094.43	$1094.43
CONNECTICUT (CT)	$1150.53	$1150.53
DC + MD/VA SUBURBS (DC)	$1202.16	$1202.16
DELAWARE (DE)	$1070.55	$1070.55
FORT LAUDERDALE (FL)	$1176.36	$1176.36
MIAMI (FL)	$1265.97	$1265.97
REST OF FLORIDA (FL)	$1119.00	$1119.00
ATLANTA (GA)	$1114.01	$1114.01
REST OF GEORGIA (GA)	$1057.97	$1057.97
HAWAII, GUAM (HI)	$1097.61	$1097.61
IOWA (IA)	$982.38	$982.38
IDAHO (ID)	$992.71	$992.71
EAST ST. LOUIS (IL)	$1158.45	$1158.45
SUBURBAN CHICAGO (IL)	$1182.34	$1182.34
CHICAGO (IL)	$1229.11	$1229.11
REST OF ILLINOIS (IL)	$1106.92	$1106.92
INDIANA (IN)	$997.12	$997.12
KANSAS (KS)	$989.15	$989.15
KENTUCKY (KY)	$1026.89	$1026.89
NEW ORLEANS (LA)	$1073.06	$1073.06
REST OF LOUISIANA (LA)	$1029.79	$1029.79
METROPOLITAN BOSTON (MA)	$1177.98	$1177.98
REST OF MASSACHUSETTS (MA)	$1093.59	$1093.59
BALTIMORE/SURR. CNTYS (MD)	$1149.53	$1149.53
REST OF MARYLAND (MD)	$1085.66	$1085.66
SOUTHERN MAINE (ME)	$1040.30	$1040.30
REST OF MAINE (ME)	$1008.74	$1008.74
DETROIT (MI)	$1142.56	$1142.56
REST OF MICHIGAN (MI)	$1060.25	$1060.25
MINNESOTA (MN)	$1020.64	$1020.64
METROPOLITAN ST. LOUIS (MO)	$1063.39	$1063.39
METROPOLITAN KANSAS CITY (MO)	$1055.10	$1055.10
REST OF MISSOURI (MO)	$1021.60	$1021.60
MISSISSIPPI (MS)	$995.90	$995.90
MONTANA** (MT)	$1083.64	$1083.64
NORTH CAROLINA (NC)	$1016.16	$1016.16
NORTH DAKOTA** (ND)	$1019.97	$1019.97
NEBRASKA (NE)	$983.79	$983.79
NEW HAMPSHIRE (NH)	$1088.08	$1088.08
NORTHERN NJ (NJ)	$1194.47	$1194.47
REST OF NEW JERSEY (NJ)	$1155.75	$1155.75
NEW MEXICO (NM)	$1069.71	$1069.71
NEVADA** (NV)	$1066.33	$1066.33
MANHATTAN (NY)	$1251.59	$1251.59
NYC SUBURBS/LONG ISLAND (NY)	$1292.37	$1292.37
POUGHKPSIE/N NYC SUBURBS (NY)	$1171.92	$1171.92
QUEENS (NY)	$1244.72	$1244.72
REST OF NEW YORK (NY)	$1030.37	$1030.37
OHIO (OH)	$1047.23	$1047.23
OKLAHOMA (OK)	$1013.77	$1013.77
PORTLAND (OR)	$1112.88	$1112.88
REST OF OREGON (OR)	$1050.19	$1050.19
METROPOLITAN PHILADELPHIA (PA)	$1132.10	$1132.10
REST OF PENNSYLVANIA (PA)	$1042.61	$1042.61
PUERTO RICO (PR)	$1086.99	$1086.99
RHODE ISLAND (RI)	$1096.83	$1096.83
SOUTH CAROLINA (SC)	$1034.98	$1034.98
SOUTH DAKOTA** (SD)	$1012.45	$1012.45
TENNESSEE (TN)	$994.85	$994.85
BRAZORIA (TX)	$1060.68	$1060.68
DALLAS (TX)	$1071.77	$1071.77
GALVESTON (TX)	$1066.71	$1066.71
HOUSTON (TX)	$1125.65	$1125.65
BEAUMONT (TX)	$1037.44	$1037.44
FORT WORTH (TX)	$1068.86	$1068.86
AUSTIN (TX)	$1097.68	$1097.68
REST OF TEXAS (TX)	$1051.45	$1051.45
UTAH (UT)	$1047.04	$1047.04
VIRGINIA (VA)	$1044.91	$1044.91
VIRGIN ISLANDS (VI)	$1086.99	$1086.99
VERMONT (VT)	$1026.42	$1026.42
SEATTLE (KING CNTY) (WA)	$1189.26	$1189.26
REST OF WASHINGTON (WA)	$1088.08	$1088.08
WISCONSIN (WI)	$991.34	$991.34
WEST VIRGINIA (WV)	$1073.77	$1073.77
WYOMING** (WY)	$1055.90	$1055.90

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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 PFS payment is built from three Relative Value Units (RVUs) — physician work, practice expense (PE), and malpractice (MP) — assigned to this procedure code. 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. Non-facility and facility rates differ because the PE RVU is typically lower in facility settings, where the facility (not the physician) bears certain overhead costs. The resulting national and locality-adjusted figures represent the full Medicare-allowed amount before cost-sharing.

RVUs — work 16.33, practice expense 12.9 (non-facility) / 12.9 (facility), malpractice 3.22 — × 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 patient meets the annual Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers (e.g., bilateral, multiple procedure, assistant-at-surgery) can increase or decrease the final payment.
Amounts may be reduced by sequestration or adjusted annually for budget-neutrality changes to the conversion factor.
Always verify current, locality-specific rates with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The facility rate generally uses a lower practice-expense RVU because overhead costs (equipment, supplies, staff) are borne by the facility rather than the physician's office, while the non-facility rate assumes the physician practice covers those costs.

Why might my locality's payment differ from the national amount?

Medicare applies Geographic Practice Cost Indices (GPCIs) to each RVU component to account for regional differences in wages, rent, and malpractice costs, so the same code can pay differently across localities.

Does this amount include what the patient owes?

No. The figures shown represent the total Medicare-allowed amount; after the deductible is met, Medicare typically pays 80% and the patient or secondary insurer is responsible for the remaining 20%.

Will this exact amount be paid for every claim with this code?

Not necessarily. Modifiers, multiple-procedure reductions, sequestration, and annual fee schedule updates can all change the final paid amount.

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.