Medicare Reimbursement for CPT 16000

CPT 16000 is a procedure code defined by the American Medical Association (AMA); its official descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$90.18	$42.09
ALASKA* (AK)	$106.11	$54.89
ALABAMA (AL)	$80.99	$38.91
ARKANSAS (AR)	$79.84	$38.52
ARIZONA (AZ)	$87.72	$41.12
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$113.07	$45.25
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$115.16	$45.80
OXNARD-THOUSAND OAKS-VENTURA (CA)	$99.32	$42.47
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$99.96	$43.06
NAPA (CA)	$107.39	$44.00
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$113.24	$45.42
VALLEJO (CA)	$107.15	$43.75
BAKERSFIELD (CA)	$94.16	$41.45
CHICO (CA)	$93.74	$41.02
FRESNO (CA)	$93.74	$41.02
HANFORD-CORCORAN (CA)	$93.74	$41.02
MADERA (CA)	$93.74	$41.02
MERCED (CA)	$93.74	$41.02
MODESTO (CA)	$93.74	$41.02
REDDING (CA)	$93.74	$41.02
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$95.36	$42.64
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$98.05	$42.11
SALINAS (CA)	$97.68	$41.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$115.86	$46.50
SANTA CRUZ-WATSONVILLE (CA)	$100.53	$42.09
SANTA ROSA-PETALUMA (CA)	$101.52	$42.46
STOCKTON (CA)	$93.74	$41.02
VISALIA (CA)	$93.74	$41.02
YUBA CITY (CA)	$93.74	$41.02
EL CENTRO (CA)	$93.76	$41.05
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$99.76	$42.23
SAN LUIS OBISPO-PASO ROBLES (CA)	$96.15	$41.37
SANTA MARIA-SANTA BARBARA (CA)	$97.99	$41.90
REST OF CALIFORNIA (CA)	$93.74	$41.02
COLORADO (CO)	$93.03	$41.85
CONNECTICUT (CT)	$96.14	$44.34
DC + MD/VA SUBURBS (DC)	$102.31	$45.65
DELAWARE (DE)	$89.15	$41.63
FORT LAUDERDALE (FL)	$94.96	$46.24
MIAMI (FL)	$100.14	$50.07
REST OF FLORIDA (FL)	$90.23	$44.25
ATLANTA (GA)	$92.17	$43.31
REST OF GEORGIA (GA)	$85.08	$42.18
HAWAII, GUAM (HI)	$95.76	$41.07
IOWA (IA)	$82.39	$38.38
IDAHO (ID)	$83.05	$38.80
EAST ST. LOUIS (IL)	$90.77	$46.52
SUBURBAN CHICAGO (IL)	$95.77	$46.37
CHICAGO (IL)	$97.15	$48.82
REST OF ILLINOIS (IL)	$88.12	$44.21
INDIANA (IN)	$83.51	$38.92
KANSAS (KS)	$82.31	$38.83
KENTUCKY (KY)	$83.53	$40.77
NEW ORLEANS (LA)	$87.55	$42.29
REST OF LOUISIANA (LA)	$83.52	$40.95
METROPOLITAN BOSTON (MA)	$101.71	$44.28
REST OF MASSACHUSETTS (MA)	$92.60	$41.96
BALTIMORE/SURR. CNTYS (MD)	$95.93	$44.32
REST OF MARYLAND (MD)	$90.74	$42.06
SOUTHERN MAINE (ME)	$87.83	$40.16
REST OF MAINE (ME)	$83.80	$39.55
DETROIT (MI)	$91.66	$45.24
REST OF MICHIGAN (MI)	$85.95	$42.03
MINNESOTA (MN)	$88.28	$38.79
METROPOLITAN ST. LOUIS (MO)	$87.50	$41.71
METROPOLITAN KANSAS CITY (MO)	$86.64	$41.48
REST OF MISSOURI (MO)	$82.31	$40.85
MISSISSIPPI (MS)	$81.08	$39.66
MONTANA** (MT)	$90.17	$42.08
NORTH CAROLINA (NC)	$84.61	$39.74
NORTH DAKOTA** (ND)	$87.21	$39.11
NEBRASKA (NE)	$82.75	$38.35
NEW HAMPSHIRE (NH)	$91.86	$41.79
NORTHERN NJ (NJ)	$101.33	$45.54
REST OF NEW JERSEY (NJ)	$96.99	$44.47
NEW MEXICO (NM)	$86.53	$42.43
NEVADA** (NV)	$89.40	$41.26
MANHATTAN (NY)	$104.07	$48.18
NYC SUBURBS/LONG ISLAND (NY)	$106.94	$49.75
POUGHKPSIE/N NYC SUBURBS (NY)	$97.87	$45.21
QUEENS (NY)	$104.47	$47.62
REST OF NEW YORK (NY)	$85.89	$40.20
OHIO (OH)	$85.34	$41.43
OKLAHOMA (OK)	$83.06	$40.11
PORTLAND (OR)	$95.59	$42.16
REST OF OREGON (OR)	$88.47	$40.57
METROPOLITAN PHILADELPHIA (PA)	$93.97	$43.90
REST OF PENNSYLVANIA (PA)	$85.31	$41.15
PUERTO RICO (PR)	$90.72	$42.10
RHODE ISLAND (RI)	$92.05	$42.36
SOUTH CAROLINA (SC)	$85.17	$40.72
SOUTH DAKOTA** (SD)	$86.86	$38.76
TENNESSEE (TN)	$82.76	$39.04
BRAZORIA (TX)	$88.81	$41.14
DALLAS (TX)	$89.51	$41.60
GALVESTON (TX)	$89.16	$41.40
HOUSTON (TX)	$91.91	$44.15
BEAUMONT (TX)	$84.78	$41.01
FORT WORTH (TX)	$89.01	$41.59
AUSTIN (TX)	$92.92	$42.04
REST OF TEXAS (TX)	$86.83	$41.19
UTAH (UT)	$86.30	$41.09
VIRGINIA (VA)	$87.76	$40.48
VIRGIN ISLANDS (VI)	$90.72	$42.10
VERMONT (VT)	$87.15	$39.53
SEATTLE (KING CNTY) (WA)	$103.46	$44.44
REST OF WASHINGTON (WA)	$92.34	$41.69
WISCONSIN (WI)	$84.36	$38.28
WEST VIRGINIA (WV)	$84.99	$43.19
WYOMING** (WY)	$88.88	$40.78

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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: Policy. 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 risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice expense RVUs differ between non-facility and facility settings because overhead costs (equipment, supplies, staff time) are treated differently depending on where the service is furnished.

RVUs — work 0.87, practice expense 1.68 (non-facility) / 0.24 (facility), malpractice 0.15 — × 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 their Part B deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary due to modifiers, place-of-service codes, 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 is the non-facility amount different from the facility amount?

Non-facility rates include higher practice expense RVUs because the billing provider is assumed to absorb overhead costs like supplies and staff, whereas in a facility setting those costs are typically borne by the facility itself.

Does this amount reflect what Medicare actually pays?

It reflects the Medicare-allowed amount before the 80/20 cost-sharing split and before any applicable deductible, modifiers, or sequestration adjustments are applied.

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

Geographic Practice Cost Indices (GPCIs) adjust the RVUs to reflect local differences in labor, rent, and malpractice insurance costs, so the same code can be priced differently across localities.

Will this amount change next year?

Yes. The conversion factor, RVUs, and GPCIs are updated annually (and sometimes during the year), so the allowed amount for this code can change from year to year.

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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.