Medicare Reimbursement for CPT 16030

CPT 16030 is a procedure code reported to Medicare for physician and outpatient billing; the specific clinical descriptor is not shown here due to AMA licensing restrictions. This page displays the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and adjusted for a specific 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)	$213.77	$122.92
ALASKA* (AK)	$249.77	$153.02
ALABAMA (AL)	$191.08	$111.59
ARKANSAS (AR)	$188.24	$110.20
ARIZONA (AZ)	$207.62	$119.58
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$265.90	$137.81
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$270.73	$139.72
OXNARD-THOUSAND OAKS-VENTURA (CA)	$234.20	$126.82
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$235.80	$128.33
NAPA (CA)	$252.82	$133.08
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$266.39	$138.29
VALLEJO (CA)	$252.12	$132.38
BAKERSFIELD (CA)	$222.07	$122.50
CHICO (CA)	$220.89	$121.32
FRESNO (CA)	$220.89	$121.32
HANFORD-CORCORAN (CA)	$220.89	$121.32
MADERA (CA)	$220.89	$121.32
MERCED (CA)	$220.89	$121.32
MODESTO (CA)	$220.89	$121.32
REDDING (CA)	$220.89	$121.32
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$225.51	$125.94
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$230.99	$125.33
SALINAS (CA)	$230.13	$124.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$272.73	$141.72
SANTA CRUZ-WATSONVILLE (CA)	$236.82	$126.44
SANTA ROSA-PETALUMA (CA)	$239.14	$127.58
STOCKTON (CA)	$220.89	$121.32
VISALIA (CA)	$220.89	$121.32
YUBA CITY (CA)	$220.89	$121.32
EL CENTRO (CA)	$220.96	$121.39
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$235.02	$126.36
SAN LUIS OBISPO-PASO ROBLES (CA)	$226.55	$123.07
SANTA MARIA-SANTA BARBARA (CA)	$230.85	$124.91
REST OF CALIFORNIA (CA)	$220.89	$121.32
COLORADO (CO)	$219.86	$123.19
CONNECTICUT (CT)	$228.27	$130.43
DC + MD/VA SUBURBS (DC)	$242.47	$135.45
DELAWARE (DE)	$211.07	$121.31
FORT LAUDERDALE (FL)	$227.08	$135.05
MIAMI (FL)	$241.12	$146.55
REST OF FLORIDA (FL)	$215.20	$128.35
ATLANTA (GA)	$218.96	$126.66
REST OF GEORGIA (GA)	$202.31	$121.27
HAWAII, GUAM (HI)	$225.75	$122.45
IOWA (IA)	$193.92	$110.79
IDAHO (ID)	$195.67	$112.09
EAST ST. LOUIS (IL)	$217.80	$134.22
SUBURBAN CHICAGO (IL)	$228.88	$135.58
CHICAGO (IL)	$233.50	$142.19
REST OF ILLINOIS (IL)	$210.40	$127.46
INDIANA (IN)	$196.78	$112.56
KANSAS (KS)	$194.01	$111.88
KENTUCKY (KY)	$197.94	$117.17
NEW ORLEANS (LA)	$207.95	$122.46
REST OF LOUISIANA (LA)	$198.03	$117.63
METROPOLITAN BOSTON (MA)	$240.50	$132.02
REST OF MASSACHUSETTS (MA)	$218.91	$123.24
BALTIMORE/SURR. CNTYS (MD)	$227.86	$130.38
REST OF MARYLAND (MD)	$214.85	$122.90
SOUTHERN MAINE (ME)	$207.28	$117.25
REST OF MAINE (ME)	$197.81	$114.23
DETROIT (MI)	$219.01	$131.34
REST OF MICHIGAN (MI)	$204.17	$121.22
MINNESOTA (MN)	$207.47	$113.99
METROPOLITAN ST. LOUIS (MO)	$207.48	$120.99
METROPOLITAN KANSAS CITY (MO)	$205.41	$120.10
REST OF MISSOURI (MO)	$195.23	$116.92
MISSISSIPPI (MS)	$191.72	$113.50
MONTANA** (MT)	$213.74	$122.89
NORTH CAROLINA (NC)	$199.76	$115.00
NORTH DAKOTA** (ND)	$205.23	$114.38
NEBRASKA (NE)	$194.70	$110.84
NEW HAMPSHIRE (NH)	$217.37	$122.79
NORTHERN NJ (NJ)	$240.07	$134.68
REST OF NEW JERSEY (NJ)	$229.98	$130.77
NEW MEXICO (NM)	$205.73	$122.42
NEVADA** (NV)	$211.50	$120.56
MANHATTAN (NY)	$247.84	$142.27
NYC SUBURBS/LONG ISLAND (NY)	$255.29	$147.26
POUGHKPSIE/N NYC SUBURBS (NY)	$232.33	$132.85
QUEENS (NY)	$248.40	$141.02
REST OF NEW YORK (NY)	$202.92	$116.61
OHIO (OH)	$202.43	$119.49
OKLAHOMA (OK)	$196.48	$115.35
PORTLAND (OR)	$225.78	$124.85
REST OF OREGON (OR)	$208.97	$118.49
METROPOLITAN PHILADELPHIA (PA)	$223.15	$128.58
REST OF PENNSYLVANIA (PA)	$202.18	$118.78
PUERTO RICO (PR)	$215.00	$123.15
RHODE ISLAND (RI)	$217.85	$124.00
SOUTH CAROLINA (SC)	$201.61	$117.66
SOUTH DAKOTA** (SD)	$204.23	$113.38
TENNESSEE (TN)	$195.14	$112.56
BRAZORIA (TX)	$209.96	$119.93
DALLAS (TX)	$211.81	$121.32
GALVESTON (TX)	$210.92	$120.70
HOUSTON (TX)	$218.79	$128.57
BEAUMONT (TX)	$200.90	$118.23
FORT WORTH (TX)	$210.68	$121.10
AUSTIN (TX)	$219.90	$123.78
REST OF TEXAS (TX)	$205.66	$119.44
UTAH (UT)	$204.40	$119.01
VIRGINIA (VA)	$207.31	$118.00
VIRGIN ISLANDS (VI)	$215.00	$123.15
VERMONT (VT)	$205.35	$115.41
SEATTLE (KING CNTY) (WA)	$244.40	$132.93
REST OF WASHINGTON (WA)	$218.19	$122.52
WISCONSIN (WI)	$198.30	$111.27
WEST VIRGINIA (WV)	$202.72	$123.77
WYOMING** (WY)	$210.03	$119.18

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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: 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 Physician Fee Schedule 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 the Geographic Practice Cost Index (GPCI) for the specific Medicare locality where the service is furnished, reflecting local cost-of-living and practice-cost differences. The geographically adjusted RVUs are summed and multiplied by the annual national Conversion Factor to produce a dollar allowed amount. Non-facility and facility amounts differ because the practice-expense RVU is higher in non-facility settings (where the billing provider bears more overhead) and lower in facility settings (where the facility bills separately for overhead costs).

RVUs — work 2.03, practice expense 3.94 (non-facility) / 1.22 (facility), malpractice 0.43 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, place of service, 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 facility amount lower than the non-facility amount for this code?

In facility settings, the facility (e.g., hospital) bills separately for overhead and resources, so the practice-expense RVU used in the facility calculation is lower than the practice-expense RVU used when the billing provider absorbs those costs in a non-facility setting like an office.

Does this amount reflect what my specific locality will be paid?

The national amount is a baseline; actual payment depends on the Geographic Practice Cost Indices (GPCIs) for the specific Medicare locality where the service was furnished, which can raise or lower the final allowed amount shown for that locality.

Will modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or assistant-at-surgery can increase or decrease the allowed amount relative to the base rate shown here.

Why might the amount change next year?

The Conversion Factor and RVUs are updated annually through CMS rulemaking, and budget-neutrality adjustments across the fee schedule can shift allowed amounts for individual codes from one year to the next.

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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.