Medicare Reimbursement for CPT 16025

CPT 16025 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both at the national level and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$165.67	$101.87
ALASKA* (AK)	$196.50	$128.56
ALABAMA (AL)	$149.27	$93.45
ARKANSAS (AR)	$147.21	$92.41
ARIZONA (AZ)	$161.27	$99.46
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$206.82	$116.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$210.62	$118.62
OXNARD-THOUSAND OAKS-VENTURA (CA)	$182.03	$106.63
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$183.24	$107.77
NAPA (CA)	$196.57	$112.48
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$207.13	$117.18
VALLEJO (CA)	$196.13	$112.04
BAKERSFIELD (CA)	$172.81	$102.89
CHICO (CA)	$172.04	$102.12
FRESNO (CA)	$172.04	$102.12
HANFORD-CORCORAN (CA)	$172.04	$102.12
MADERA (CA)	$172.04	$102.12
MERCED (CA)	$172.04	$102.12
MODESTO (CA)	$172.04	$102.12
REDDING (CA)	$172.04	$102.12
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$174.95	$105.03
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$179.81	$105.61
SALINAS (CA)	$179.12	$105.18
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$211.87	$119.88
SANTA CRUZ-WATSONVILLE (CA)	$184.15	$106.64
SANTA ROSA-PETALUMA (CA)	$185.96	$107.62
STOCKTON (CA)	$172.04	$102.12
VISALIA (CA)	$172.04	$102.12
YUBA CITY (CA)	$172.04	$102.12
EL CENTRO (CA)	$172.08	$102.16
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$182.82	$106.52
SAN LUIS OBISPO-PASO ROBLES (CA)	$176.33	$103.67
SANTA MARIA-SANTA BARBARA (CA)	$179.65	$105.27
REST OF CALIFORNIA (CA)	$172.04	$102.12
COLORADO (CO)	$170.77	$102.89
CONNECTICUT (CT)	$176.39	$107.68
DC + MD/VA SUBURBS (DC)	$187.53	$112.38
DELAWARE (DE)	$163.84	$100.81
FORT LAUDERDALE (FL)	$174.25	$109.63
MIAMI (FL)	$183.55	$117.14
REST OF FLORIDA (FL)	$165.81	$104.82
ATLANTA (GA)	$169.25	$104.43
REST OF GEORGIA (GA)	$156.61	$99.71
HAWAII, GUAM (HI)	$175.55	$103.02
IOWA (IA)	$151.74	$93.37
IDAHO (ID)	$152.93	$94.23
EAST ST. LOUIS (IL)	$166.82	$108.13
SUBURBAN CHICAGO (IL)	$175.72	$110.21
CHICAGO (IL)	$178.24	$114.13
REST OF ILLINOIS (IL)	$162.06	$103.81
INDIANA (IN)	$153.74	$94.60
KANSAS (KS)	$151.61	$93.94
KENTUCKY (KY)	$153.82	$97.10
NEW ORLEANS (LA)	$161.00	$100.97
REST OF LOUISIANA (LA)	$153.80	$97.35
METROPOLITAN BOSTON (MA)	$186.38	$110.21
REST OF MASSACHUSETTS (MA)	$170.04	$102.86
BALTIMORE/SURR. CNTYS (MD)	$176.00	$107.55
REST OF MARYLAND (MD)	$166.70	$102.13
SOUTHERN MAINE (ME)	$161.44	$98.22
REST OF MAINE (ME)	$154.27	$95.58
DETROIT (MI)	$168.36	$106.80
REST OF MICHIGAN (MI)	$158.14	$99.90
MINNESOTA (MN)	$162.22	$96.57
METROPOLITAN ST. LOUIS (MO)	$160.89	$100.16
METROPOLITAN KANSAS CITY (MO)	$159.37	$99.46
REST OF MISSOURI (MO)	$151.65	$96.66
MISSISSIPPI (MS)	$149.43	$94.50
MONTANA** (MT)	$165.65	$101.85
NORTH CAROLINA (NC)	$155.72	$96.20
NORTH DAKOTA** (ND)	$160.31	$96.52
NEBRASKA (NE)	$152.37	$93.49
NEW HAMPSHIRE (NH)	$168.64	$102.22
NORTHERN NJ (NJ)	$185.84	$111.83
REST OF NEW JERSEY (NJ)	$178.00	$108.34
NEW MEXICO (NM)	$159.19	$100.69
NEVADA** (NV)	$164.26	$100.40
MANHATTAN (NY)	$190.77	$116.64
NYC SUBURBS/LONG ISLAND (NY)	$195.91	$120.05
POUGHKPSIE/N NYC SUBURBS (NY)	$179.60	$109.75
QUEENS (NY)	$191.46	$116.06
REST OF NEW YORK (NY)	$158.00	$97.39
OHIO (OH)	$157.05	$98.81
OKLAHOMA (OK)	$152.97	$96.00
PORTLAND (OR)	$175.35	$104.48
REST OF OREGON (OR)	$162.59	$99.05
METROPOLITAN PHILADELPHIA (PA)	$172.53	$106.11
REST OF PENNSYLVANIA (PA)	$156.98	$98.42
PUERTO RICO (PR)	$166.63	$102.13
RHODE ISLAND (RI)	$169.07	$103.17
SOUTH CAROLINA (SC)	$156.73	$97.78
SOUTH DAKOTA** (SD)	$159.68	$95.88
TENNESSEE (TN)	$152.40	$94.41
BRAZORIA (TX)	$163.24	$100.02
DALLAS (TX)	$164.50	$100.96
GALVESTON (TX)	$163.87	$100.52
HOUSTON (TX)	$168.81	$105.47
BEAUMONT (TX)	$156.04	$97.99
FORT WORTH (TX)	$163.62	$100.72
AUSTIN (TX)	$170.55	$103.05
REST OF TEXAS (TX)	$159.70	$99.16
UTAH (UT)	$158.76	$98.79
VIRGINIA (VA)	$161.32	$98.61
VIRGIN ISLANDS (VI)	$166.63	$102.13
VERMONT (VT)	$160.21	$97.06
SEATTLE (KING CNTY) (WA)	$189.53	$111.25
REST OF WASHINGTON (WA)	$169.54	$102.37
WISCONSIN (WI)	$155.23	$94.12
WEST VIRGINIA (WV)	$156.47	$101.03
WYOMING** (WY)	$163.32	$99.53

Look up another code or locality →

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 pricing for this code is based on three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted using Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting local cost-of-living and practice-cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility rates (e.g., a physician's own office) typically include higher practice-expense RVUs than facility rates (e.g., hospital outpatient), since the facility itself absorbs some of those overhead costs.

RVUs — work 1.7, practice expense 2.99 (non-facility) / 1.08 (facility), malpractice 0.27 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual Medicare payment may differ based on locality, modifiers, and claim-specific factors.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Sequestration, budget-neutrality adjustments, and annual rule changes can alter the final payment amount.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility rate lower than the non-facility rate for this code?

Facility rates include lower practice-expense RVUs because the facility (e.g., hospital) — not the billing physician — covers certain overhead costs like equipment and supplies.

Does this amount represent what Medicare will actually pay?

No. It's an estimated allowed amount. Medicare generally reimburses 80% of this figure after the patient meets their deductible, and the final amount can vary by locality and modifiers.

Why don't you show the CPT code description?

CPT code descriptors are copyrighted by the American Medical Association, so we cannot reproduce them directly on this page.

Will this amount change next year?

Yes. The conversion factor, RVUs, and GPCIs are updated annually by CMS, so the estimated payment for this code can change from year to 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.