Medicare Reimbursement for CPT 16035

This page covers CPT 16035, a physician procedure code reimbursed under the Medicare Physician Fee Schedule (PFS). It shows the national average allowed amount as well as locality-adjusted figures, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings. These are estimates intended to help billers and practice managers anticipate expected Medicare payment.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$178.69	$178.69
ALASKA* (AK)	$232.18	$232.18
ALABAMA (AL)	$164.89	$164.89
ARKANSAS (AR)	$163.22	$163.22
ARIZONA (AZ)	$174.48	$174.48
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$192.17	$192.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$194.52	$194.52
OXNARD-THOUSAND OAKS-VENTURA (CA)	$180.31	$180.31
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$182.82	$182.82
NAPA (CA)	$186.85	$186.85
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$192.91	$192.91
VALLEJO (CA)	$185.78	$185.78
BAKERSFIELD (CA)	$175.89	$175.89
CHICO (CA)	$174.06	$174.06
FRESNO (CA)	$174.06	$174.06
HANFORD-CORCORAN (CA)	$174.06	$174.06
MADERA (CA)	$174.06	$174.06
MERCED (CA)	$174.06	$174.06
MODESTO (CA)	$174.06	$174.06
REDDING (CA)	$174.06	$174.06
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$181.06	$181.06
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$178.73	$178.73
SALINAS (CA)	$177.98	$177.98
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$197.53	$197.53
SANTA CRUZ-WATSONVILLE (CA)	$178.72	$178.72
SANTA ROSA-PETALUMA (CA)	$180.27	$180.27
STOCKTON (CA)	$174.06	$174.06
VISALIA (CA)	$174.06	$174.06
YUBA CITY (CA)	$174.06	$174.06
EL CENTRO (CA)	$174.17	$174.17
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$179.28	$179.28
SAN LUIS OBISPO-PASO ROBLES (CA)	$175.57	$175.57
SANTA MARIA-SANTA BARBARA (CA)	$177.86	$177.86
REST OF CALIFORNIA (CA)	$174.06	$174.06
COLORADO (CO)	$177.65	$177.65
CONNECTICUT (CT)	$188.39	$188.39
DC + MD/VA SUBURBS (DC)	$193.97	$193.97
DELAWARE (DE)	$176.69	$176.69
FORT LAUDERDALE (FL)	$196.69	$196.69
MIAMI (FL)	$213.33	$213.33
REST OF FLORIDA (FL)	$188.07	$188.07
ATLANTA (GA)	$183.99	$183.99
REST OF GEORGIA (GA)	$179.08	$179.08
HAWAII, GUAM (HI)	$174.36	$174.36
IOWA (IA)	$162.62	$162.62
IDAHO (ID)	$164.45	$164.45
EAST ST. LOUIS (IL)	$197.90	$197.90
SUBURBAN CHICAGO (IL)	$197.26	$197.26
CHICAGO (IL)	$207.84	$207.84
REST OF ILLINOIS (IL)	$187.87	$187.87
INDIANA (IN)	$164.98	$164.98
KANSAS (KS)	$164.56	$164.56
KENTUCKY (KY)	$172.96	$172.96
NEW ORLEANS (LA)	$179.58	$179.58
REST OF LOUISIANA (LA)	$173.75	$173.75
METROPOLITAN BOSTON (MA)	$188.11	$188.11
REST OF MASSACHUSETTS (MA)	$178.10	$178.10
BALTIMORE/SURR. CNTYS (MD)	$188.35	$188.35
REST OF MARYLAND (MD)	$178.55	$178.55
SOUTHERN MAINE (ME)	$170.37	$170.37
REST OF MAINE (ME)	$167.68	$167.68
DETROIT (MI)	$192.36	$192.36
REST OF MICHIGAN (MI)	$178.44	$178.44
MINNESOTA (MN)	$164.43	$164.43
METROPOLITAN ST. LOUIS (MO)	$177.05	$177.05
METROPOLITAN KANSAS CITY (MO)	$176.06	$176.06
REST OF MISSOURI (MO)	$173.29	$173.29
MISSISSIPPI (MS)	$168.15	$168.15
MONTANA** (MT)	$178.65	$178.65
NORTH CAROLINA (NC)	$168.51	$168.51
NORTH DAKOTA** (ND)	$165.80	$165.80
NEBRASKA (NE)	$162.49	$162.49
NEW HAMPSHIRE (NH)	$177.42	$177.42
NORTHERN NJ (NJ)	$193.46	$193.46
REST OF NEW JERSEY (NJ)	$188.90	$188.90
NEW MEXICO (NM)	$180.15	$180.15
NEVADA** (NV)	$175.10	$175.10
MANHATTAN (NY)	$204.90	$204.90
NYC SUBURBS/LONG ISLAND (NY)	$211.73	$211.73
POUGHKPSIE/N NYC SUBURBS (NY)	$192.07	$192.07
QUEENS (NY)	$202.48	$202.48
REST OF NEW YORK (NY)	$170.49	$170.49
OHIO (OH)	$175.82	$175.82
OKLAHOMA (OK)	$170.10	$170.10
PORTLAND (OR)	$178.98	$178.98
REST OF OREGON (OR)	$172.11	$172.11
METROPOLITAN PHILADELPHIA (PA)	$186.52	$186.52
REST OF PENNSYLVANIA (PA)	$174.62	$174.62
PUERTO RICO (PR)	$178.75	$178.75
RHODE ISLAND (RI)	$179.82	$179.82
SOUTH CAROLINA (SC)	$172.77	$172.77
SOUTH DAKOTA** (SD)	$164.28	$164.28
TENNESSEE (TN)	$165.45	$165.45
BRAZORIA (TX)	$174.58	$174.58
DALLAS (TX)	$176.57	$176.57
GALVESTON (TX)	$175.69	$175.69
HOUSTON (TX)	$187.59	$187.59
BEAUMONT (TX)	$174.00	$174.00
FORT WORTH (TX)	$176.50	$176.50
AUSTIN (TX)	$178.50	$178.50
REST OF TEXAS (TX)	$174.80	$174.80
UTAH (UT)	$174.38	$174.38
VIRGINIA (VA)	$171.72	$171.72
VIRGIN ISLANDS (VI)	$178.75	$178.75
VERMONT (VT)	$167.62	$167.62
SEATTLE (KING CNTY) (WA)	$188.78	$188.78
REST OF WASHINGTON (WA)	$176.95	$176.95
WISCONSIN (WI)	$162.20	$162.20
WEST VIRGINIA (WV)	$183.46	$183.46
WYOMING** (WY)	$173.05	$173.05

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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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted using Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs because overhead costs (equipment, supplies, staff time) differ when a procedure is performed in a physician's office versus a hospital or ambulatory surgical center.

RVUs — work 3.65, practice expense 1.05 (non-facility) / 1.05 (facility), malpractice 0.65 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Always verify the final allowed amount and payment policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why do non-facility and facility amounts differ for this code?

The two settings use different practice-expense RVUs because overhead costs, such as supplies and staff time, are accounted for differently depending on where the service is performed.

Does the national amount apply to every state?

No. The national figure reflects an average; actual payment is adjusted by the GPCIs of the specific locality where the service is rendered.

Will Medicare always pay the full allowed amount shown here?

No. Medicare generally pays 80% of the allowed amount after the annual deductible is satisfied, and modifiers or other claim-specific factors can change the final payment.

Why might the amount on my remittance advice differ from this estimate?

Differences can result from locality-specific GPCIs, applied modifiers, multiple-procedure payment reductions, sequestration, or mid-year/annual fee schedule updates.

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.