Medicare Reimbursement for CPT 21015

This page covers a CPT procedure code billed under the Medicare Physician Fee Schedule (PFS). Because CPT descriptors are licensed by the AMA, this page refers to it generically as 'this procedure code.' Below you'll find the estimated PFS allowed amount nationally and by locality, shown separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$639.63	$639.63
ALASKA* (AK)	$792.25	$792.25
ALABAMA (AL)	$582.48	$582.48
ARKANSAS (AR)	$575.42	$575.42
ARIZONA (AZ)	$623.40	$623.40
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$744.85	$744.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$756.46	$756.46
OXNARD-THOUSAND OAKS-VENTURA (CA)	$674.90	$674.90
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$681.66	$681.66
NAPA (CA)	$715.20	$715.20
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$746.77	$746.77
VALLEJO (CA)	$712.43	$712.43
BAKERSFIELD (CA)	$648.75	$648.75
CHICO (CA)	$643.98	$643.98
FRESNO (CA)	$643.98	$643.98
HANFORD-CORCORAN (CA)	$643.98	$643.98
MADERA (CA)	$643.98	$643.98
MERCED (CA)	$643.98	$643.98
MODESTO (CA)	$643.98	$643.98
REDDING (CA)	$643.98	$643.98
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$662.20	$662.20
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$667.60	$667.60
SALINAS (CA)	$664.95	$664.95
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$764.30	$764.30
SANTA CRUZ-WATSONVILLE (CA)	$676.35	$676.35
SANTA ROSA-PETALUMA (CA)	$682.65	$682.65
STOCKTON (CA)	$643.98	$643.98
VISALIA (CA)	$643.98	$643.98
YUBA CITY (CA)	$643.98	$643.98
EL CENTRO (CA)	$644.27	$644.27
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$674.63	$674.63
SAN LUIS OBISPO-PASO ROBLES (CA)	$655.22	$655.22
SANTA MARIA-SANTA BARBARA (CA)	$665.81	$665.81
REST OF CALIFORNIA (CA)	$643.98	$643.98
COLORADO (CO)	$647.85	$647.85
CONNECTICUT (CT)	$678.03	$678.03
DC + MD/VA SUBURBS (DC)	$709.89	$709.89
DELAWARE (DE)	$632.40	$632.40
FORT LAUDERDALE (FL)	$688.63	$688.63
MIAMI (FL)	$736.64	$736.64
REST OF FLORIDA (FL)	$656.53	$656.53
ATLANTA (GA)	$656.12	$656.12
REST OF GEORGIA (GA)	$622.26	$622.26
HAWAII, GUAM (HI)	$651.65	$651.65
IOWA (IA)	$583.39	$583.39
IDAHO (ID)	$588.98	$588.98
EAST ST. LOUIS (IL)	$675.97	$675.97
SUBURBAN CHICAGO (IL)	$692.51	$692.51
CHICAGO (IL)	$716.29	$716.29
REST OF ILLINOIS (IL)	$648.68	$648.68
INDIANA (IN)	$591.55	$591.55
KANSAS (KS)	$586.55	$586.55
KENTUCKY (KY)	$605.84	$605.84
NEW ORLEANS (LA)	$631.89	$631.89
REST OF LOUISIANA (LA)	$607.22	$607.22
METROPOLITAN BOSTON (MA)	$697.29	$697.29
REST OF MASSACHUSETTS (MA)	$647.16	$647.16
BALTIMORE/SURR. CNTYS (MD)	$677.22	$677.22
REST OF MARYLAND (MD)	$641.35	$641.35
SOUTHERN MAINE (ME)	$616.45	$616.45
REST OF MAINE (ME)	$597.39	$597.39
DETROIT (MI)	$669.21	$669.21
REST OF MICHIGAN (MI)	$624.18	$624.18
MINNESOTA (MN)	$607.46	$607.46
METROPOLITAN ST. LOUIS (MO)	$627.20	$627.20
METROPOLITAN KANSAS CITY (MO)	$622.40	$622.40
REST OF MISSOURI (MO)	$602.11	$602.11
MISSISSIPPI (MS)	$588.59	$588.59
MONTANA** (MT)	$639.51	$639.51
NORTH CAROLINA (NC)	$601.75	$601.75
NORTH DAKOTA** (ND)	$606.10	$606.10
NEBRASKA (NE)	$584.40	$584.40
NEW HAMPSHIRE (NH)	$643.28	$643.28
NORTHERN NJ (NJ)	$705.54	$705.54
REST OF NEW JERSEY (NJ)	$682.01	$682.01
NEW MEXICO (NM)	$629.29	$629.29
NEVADA** (NV)	$630.46	$630.46
MANHATTAN (NY)	$735.63	$735.63
NYC SUBURBS/LONG ISLAND (NY)	$757.98	$757.98
POUGHKPSIE/N NYC SUBURBS (NY)	$690.78	$690.78
QUEENS (NY)	$732.72	$732.72
REST OF NEW YORK (NY)	$609.80	$609.80
OHIO (OH)	$617.35	$617.35
OKLAHOMA (OK)	$599.09	$599.09
PORTLAND (OR)	$659.32	$659.32
REST OF OREGON (OR)	$621.82	$621.82
METROPOLITAN PHILADELPHIA (PA)	$667.03	$667.03
REST OF PENNSYLVANIA (PA)	$615.10	$615.10
PUERTO RICO (PR)	$641.65	$641.65
RHODE ISLAND (RI)	$648.27	$648.27
SOUTH CAROLINA (SC)	$611.31	$611.31
SOUTH DAKOTA** (SD)	$602.15	$602.15
TENNESSEE (TN)	$589.72	$589.72
BRAZORIA (TX)	$627.43	$627.43
DALLAS (TX)	$633.46	$633.46
GALVESTON (TX)	$630.67	$630.67
HOUSTON (TX)	$661.60	$661.60
BEAUMONT (TX)	$612.11	$612.11
FORT WORTH (TX)	$631.59	$631.59
AUSTIN (TX)	$648.99	$648.99
REST OF TEXAS (TX)	$620.83	$620.83
UTAH (UT)	$618.20	$618.20
VIRGINIA (VA)	$618.59	$618.59
VIRGIN ISLANDS (VI)	$641.65	$641.65
VERMONT (VT)	$609.13	$609.13
SEATTLE (KING CNTY) (WA)	$704.69	$704.69
REST OF WASHINGTON (WA)	$644.17	$644.17
WISCONSIN (WI)	$589.60	$589.60
WEST VIRGINIA (WV)	$629.74	$629.74
WYOMING** (WY)	$624.95	$624.95

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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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. These locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often use different practice-expense RVUs, since overhead costs differ between those settings. For this code, the practice-expense RVU is the same in both settings, so the resulting national amounts shown here are identical; this can differ in other localities or for other codes. The conversion factor is updated annually and is applied uniformly, while GPCIs vary by geographic area.

RVUs — work 9.64, practice expense 7.82 (non-facility) / 7.82 (facility), malpractice 1.69 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, 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 insurer is generally responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts change year to year.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why do non-facility and facility amounts sometimes differ?

Practice-expense RVUs account for overhead costs like staff and supplies, which are typically lower when a service is performed in a facility (since the facility bears some of those costs). For some codes, including this one, the practice-expense RVU is the same in both settings, so the amounts match.

Why does the amount vary by locality?

Each Medicare locality has its own GPCIs reflecting local costs for physician work, practice expense, and malpractice insurance. These indices adjust the RVUs before applying the conversion factor, so the same code can price differently across the country.

Is this the amount my practice will actually receive?

Not necessarily. The figure shown is the Medicare-allowed amount before cost-sharing, modifiers, or adjustments like sequestration are applied. Your actual payment may be lower depending on these factors.

Where can I find the official CPT code description?

CPT code descriptors are copyrighted by the American Medical Association. Check your CPT codebook or a licensed coding reference for the official language.

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.