Medicare Reimbursement for CPT 16036

CPT 16036 is a procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code at the national level and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$73.48	$73.48
ALASKA* (AK)	$93.29	$93.29
ALABAMA (AL)	$66.68	$66.68
ARKANSAS (AR)	$65.86	$65.86
ARIZONA (AZ)	$71.36	$71.36
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$76.40	$76.40
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$77.21	$77.21
OXNARD-THOUSAND OAKS-VENTURA (CA)	$72.62	$72.62
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$73.76	$73.76
NAPA (CA)	$74.67	$74.67
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$76.81	$76.81
VALLEJO (CA)	$74.09	$74.09
BAKERSFIELD (CA)	$70.93	$70.93
CHICO (CA)	$69.95	$69.95
FRESNO (CA)	$69.95	$69.95
HANFORD-CORCORAN (CA)	$69.95	$69.95
MADERA (CA)	$69.95	$69.95
MERCED (CA)	$69.95	$69.95
MODESTO (CA)	$69.95	$69.95
REDDING (CA)	$69.95	$69.95
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$73.81	$73.81
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$71.73	$71.73
SALINAS (CA)	$71.43	$71.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$78.88	$78.88
SANTA CRUZ-WATSONVILLE (CA)	$71.66	$71.66
SANTA ROSA-PETALUMA (CA)	$72.26	$72.26
STOCKTON (CA)	$69.95	$69.95
VISALIA (CA)	$69.95	$69.95
YUBA CITY (CA)	$69.95	$69.95
EL CENTRO (CA)	$70.01	$70.01
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$71.93	$71.93
SAN LUIS OBISPO-PASO ROBLES (CA)	$70.50	$70.50
SANTA MARIA-SANTA BARBARA (CA)	$71.38	$71.38
REST OF CALIFORNIA (CA)	$69.95	$69.95
COLORADO (CO)	$72.25	$72.25
CONNECTICUT (CT)	$77.96	$77.96
DC + MD/VA SUBURBS (DC)	$79.73	$79.73
DELAWARE (DE)	$72.36	$72.36
FORT LAUDERDALE (FL)	$83.36	$83.36
MIAMI (FL)	$92.39	$92.39
REST OF FLORIDA (FL)	$78.97	$78.97
ATLANTA (GA)	$76.25	$76.25
REST OF GEORGIA (GA)	$74.42	$74.42
HAWAII, GUAM (HI)	$70.16	$70.16
IOWA (IA)	$65.15	$65.15
IDAHO (ID)	$66.13	$66.13
EAST ST. LOUIS (IL)	$84.66	$84.66
SUBURBAN CHICAGO (IL)	$83.45	$83.45
CHICAGO (IL)	$89.46	$89.46
REST OF ILLINOIS (IL)	$79.15	$79.15
INDIANA (IN)	$66.37	$66.37
KANSAS (KS)	$66.30	$66.30
KENTUCKY (KY)	$71.05	$71.05
NEW ORLEANS (LA)	$74.37	$74.37
REST OF LOUISIANA (LA)	$71.52	$71.52
METROPOLITAN BOSTON (MA)	$76.62	$76.62
REST OF MASSACHUSETTS (MA)	$72.49	$72.49
BALTIMORE/SURR. CNTYS (MD)	$78.04	$78.04
REST OF MARYLAND (MD)	$73.14	$73.14
SOUTHERN MAINE (ME)	$68.93	$68.93
REST OF MAINE (ME)	$67.92	$67.92
DETROIT (MI)	$81.29	$81.29
REST OF MICHIGAN (MI)	$73.93	$73.93
MINNESOTA (MN)	$65.38	$65.38
METROPOLITAN ST. LOUIS (MO)	$72.90	$72.90
METROPOLITAN KANSAS CITY (MO)	$72.43	$72.43
REST OF MISSOURI (MO)	$71.42	$71.42
MISSISSIPPI (MS)	$68.58	$68.58
MONTANA** (MT)	$73.46	$73.46
NORTH CAROLINA (NC)	$68.29	$68.29
NORTH DAKOTA** (ND)	$66.34	$66.34
NEBRASKA (NE)	$65.03	$65.03
NEW HAMPSHIRE (NH)	$72.50	$72.50
NORTHERN NJ (NJ)	$79.40	$79.40
REST OF NEW JERSEY (NJ)	$77.77	$77.77
NEW MEXICO (NM)	$74.85	$74.85
NEVADA** (NV)	$71.49	$71.49
MANHATTAN (NY)	$85.71	$85.71
NYC SUBURBS/LONG ISLAND (NY)	$89.31	$89.31
POUGHKPSIE/N NYC SUBURBS (NY)	$79.41	$79.41
QUEENS (NY)	$84.23	$84.23
REST OF NEW YORK (NY)	$69.28	$69.28
OHIO (OH)	$72.47	$72.47
OKLAHOMA (OK)	$69.44	$69.44
PORTLAND (OR)	$72.59	$72.59
REST OF OREGON (OR)	$69.86	$69.86
METROPOLITAN PHILADELPHIA (PA)	$77.20	$77.20
REST OF PENNSYLVANIA (PA)	$71.78	$71.78
PUERTO RICO (PR)	$73.44	$73.44
RHODE ISLAND (RI)	$73.53	$73.53
SOUTH CAROLINA (SC)	$70.71	$70.71
SOUTH DAKOTA** (SD)	$65.50	$65.50
TENNESSEE (TN)	$66.76	$66.76
BRAZORIA (TX)	$71.11	$71.11
DALLAS (TX)	$72.16	$72.16
GALVESTON (TX)	$71.72	$71.72
HOUSTON (TX)	$78.30	$78.30
BEAUMONT (TX)	$71.49	$71.49
FORT WORTH (TX)	$72.19	$72.19
AUSTIN (TX)	$72.94	$72.94
REST OF TEXAS (TX)	$71.67	$71.67
UTAH (UT)	$71.49	$71.49
VIRGINIA (VA)	$69.73	$69.73
VIRGIN ISLANDS (VI)	$73.44	$73.44
VERMONT (VT)	$67.42	$67.42
SEATTLE (KING CNTY) (WA)	$76.60	$76.60
REST OF WASHINGTON (WA)	$71.91	$71.91
WISCONSIN (WI)	$64.63	$64.63
WEST VIRGINIA (WV)	$77.00	$77.00
WYOMING** (WY)	$70.36	$70.36

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 8 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's allowed amount for this procedure code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates can differ because the practice-expense RVU often changes depending on where the service is furnished (e.g., physician office vs. hospital or ASC), reflecting different overhead costs. The resulting national and locality-specific figures represent Medicare's full allowed amount before patient cost-sharing is applied.

RVUs — work 1.46, practice expense 0.38 (non-facility) / 0.38 (facility), malpractice 0.36 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on published PFS RVUs, GPCIs, and conversion factor — not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Rates vary by locality under the GPCI; always confirm the exact amount with your Medicare Administrative Contractor (MAC) or official CMS fee schedule lookup tool.

Frequently asked

Why do the facility and non-facility amounts show the same figure for this code?

When the practice-expense RVU is identical for both settings, the calculated allowed amount is the same whether the service is billed in a non-facility (e.g., office) or facility (e.g., hospital, ASC) setting.

Why does the allowed amount change by locality?

Each Medicare locality has its own Geographic Practice Cost Index (GPCI) values for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost differences before the conversion factor is applied.

Does this amount reflect what the patient will owe?

No. The figure shown is Medicare's total allowed amount. After the deductible is met, Medicare generally pays 80% of this amount, and the patient or secondary insurer is responsible for the remaining 20%.

Can this amount change during the year?

Yes. CMS can apply mid-year adjustments such as sequestration, and the conversion factor and RVUs are updated annually, so amounts can differ from one year to the next.

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.