Medicare Reimbursement for CPT 20615

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 20615, a procedure code whose official descriptor is maintained by the AMA. It shows the national estimate as well as locality-adjusted figures, broken out by non-facility (office) and facility (hospital/ASC) settings, since Medicare pays different rates depending on where the service is performed.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$249.50	$144.29
ALASKA* (AK)	$294.41	$182.36
ALABAMA (AL)	$225.21	$133.15
ARKANSAS (AR)	$222.14	$131.76
ARIZONA (AZ)	$243.18	$141.23
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$319.69	$171.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$325.89	$174.17
OXNARD-THOUSAND OAKS-VENTURA (CA)	$278.57	$154.21
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$280.06	$155.60
NAPA (CA)	$302.75	$164.08
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$319.98	$171.63
VALLEJO (CA)	$302.34	$163.67
BAKERSFIELD (CA)	$263.55	$148.24
CHICO (CA)	$262.79	$147.48
FRESNO (CA)	$262.79	$147.48
HANFORD-CORCORAN (CA)	$262.79	$147.48
MADERA (CA)	$262.79	$147.48
MERCED (CA)	$262.79	$147.48
MODESTO (CA)	$262.79	$147.48
REDDING (CA)	$262.79	$147.48
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$265.51	$150.20
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$275.31	$152.95
SALINAS (CA)	$274.27	$152.33
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$327.05	$175.33
SANTA CRUZ-WATSONVILLE (CA)	$282.77	$154.94
SANTA ROSA-PETALUMA (CA)	$285.60	$156.40
STOCKTON (CA)	$262.79	$147.48
VISALIA (CA)	$262.79	$147.48
YUBA CITY (CA)	$262.79	$147.48
EL CENTRO (CA)	$262.83	$147.52
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$280.36	$154.53
SAN LUIS OBISPO-PASO ROBLES (CA)	$269.90	$150.06
SANTA MARIA-SANTA BARBARA (CA)	$275.20	$152.52
REST OF CALIFORNIA (CA)	$262.79	$147.48
COLORADO (CO)	$259.17	$147.22
CONNECTICUT (CT)	$265.51	$152.19
DC + MD/VA SUBURBS (DC)	$283.97	$160.03
DELAWARE (DE)	$247.06	$143.11
FORT LAUDERDALE (FL)	$258.40	$151.82
MIAMI (FL)	$269.05	$159.52
REST OF FLORIDA (FL)	$246.43	$145.85
ATLANTA (GA)	$254.06	$147.16
REST OF GEORGIA (GA)	$233.25	$139.40
HAWAII, GUAM (HI)	$268.64	$149.01
IOWA (IA)	$230.42	$134.15
IDAHO (ID)	$231.88	$135.08
EAST ST. LOUIS (IL)	$244.75	$147.95
SUBURBAN CHICAGO (IL)	$260.95	$152.89
CHICAGO (IL)	$261.68	$155.94
REST OF ILLINOIS (IL)	$239.82	$143.76
INDIANA (IN)	$233.14	$135.61
KANSAS (KS)	$229.49	$134.38
KENTUCKY (KY)	$230.44	$136.91
NEW ORLEANS (LA)	$240.89	$141.88
REST OF LOUISIANA (LA)	$230.14	$137.03
METROPOLITAN BOSTON (MA)	$283.77	$158.15
REST OF MASSACHUSETTS (MA)	$257.79	$147.00
BALTIMORE/SURR. CNTYS (MD)	$264.77	$151.87
REST OF MARYLAND (MD)	$251.56	$145.09
SOUTHERN MAINE (ME)	$244.94	$140.67
REST OF MAINE (ME)	$233.12	$136.33
DETROIT (MI)	$249.45	$147.92
REST OF MICHIGAN (MI)	$236.20	$140.14
MINNESOTA (MN)	$248.42	$140.16
METROPOLITAN ST. LOUIS (MO)	$241.59	$141.42
METROPOLITAN KANSAS CITY (MO)	$239.23	$140.43
REST OF MISSOURI (MO)	$226.47	$135.78
MISSISSIPPI (MS)	$224.34	$133.76
MONTANA** (MT)	$249.49	$144.28
NORTH CAROLINA (NC)	$235.41	$137.25
NORTH DAKOTA** (ND)	$244.54	$139.33
NEBRASKA (NE)	$231.58	$134.47
NEW HAMPSHIRE (NH)	$255.24	$145.71
NORTHERN NJ (NJ)	$281.30	$159.26
REST OF NEW JERSEY (NJ)	$268.56	$153.67
NEW MEXICO (NM)	$237.46	$140.98
NEVADA** (NV)	$248.28	$142.96
MANHATTAN (NY)	$286.03	$163.78
NYC SUBURBS/LONG ISLAND (NY)	$292.76	$167.66
POUGHKPSIE/N NYC SUBURBS (NY)	$270.38	$155.17
QUEENS (NY)	$288.14	$163.78
REST OF NEW YORK (NY)	$238.76	$138.81
OHIO (OH)	$235.19	$139.13
OKLAHOMA (OK)	$229.95	$136.00
PORTLAND (OR)	$266.93	$150.04
REST OF OREGON (OR)	$246.36	$141.57
METROPOLITAN PHILADELPHIA (PA)	$259.26	$149.73
REST OF PENNSYLVANIA (PA)	$235.49	$138.90
PUERTO RICO (PR)	$251.20	$144.83
RHODE ISLAND (RI)	$255.50	$146.81
SOUTH CAROLINA (SC)	$235.69	$138.47
SOUTH DAKOTA** (SD)	$243.96	$138.75
TENNESSEE (TN)	$230.59	$134.95
BRAZORIA (TX)	$246.79	$142.52
DALLAS (TX)	$248.34	$143.55
GALVESTON (TX)	$247.52	$143.04
HOUSTON (TX)	$252.09	$147.62
BEAUMONT (TX)	$234.03	$138.29
FORT WORTH (TX)	$246.80	$143.06
AUSTIN (TX)	$258.29	$146.98
REST OF TEXAS (TX)	$240.26	$140.42
UTAH (UT)	$238.73	$139.83
VIRGINIA (VA)	$244.24	$140.81
VIRGIN ISLANDS (VI)	$251.20	$144.83
VERMONT (VT)	$243.73	$139.57
SEATTLE (KING CNTY) (WA)	$289.30	$160.20
REST OF WASHINGTON (WA)	$257.26	$146.47
WISCONSIN (WI)	$236.78	$135.99
WEST VIRGINIA (WV)	$231.44	$140.01
WYOMING** (WY)	$247.33	$142.12

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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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, accounting for 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 (staff, supplies, equipment) are treated differently when the service is performed in a physician office versus a hospital or ambulatory surgical center.

RVUs — work 2.27, practice expense 4.95 (non-facility) / 1.8 (facility), malpractice 0.25 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their annual deductible; the patient or secondary payer is generally responsible for the remainder.
Actual payment can vary based on the specific locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always confirm the exact allowed amount and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why do non-facility and facility amounts differ for the same code?

The practice expense RVU component changes based on site of service because overhead costs (equipment, supplies, staff time) are allocated differently when a service is performed in an office versus a facility like a hospital or ASC.

Why does the Medicare amount change by locality?

Each Medicare locality has its own Geographic Practice Cost Indices (GPCIs) applied to work, practice expense, and malpractice RVUs, reflecting regional differences in labor and operating costs.

Does this reflect what the patient will actually owe?

No. This reflects the Medicare-allowed amount before cost-sharing. Patients typically owe 20% coinsurance after their deductible, and secondary insurance or supplemental plans may cover some or all of that balance.

Will this amount change during the year?

It can. The conversion factor, RVUs, and GPCIs are typically updated annually, and mid-year adjustments such as sequestration or budget-neutrality corrections can also affect the final paid amount.

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.