Medicare Reimbursement for CPT 22515
This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026. Amounts are presented at the national level and can vary by locality, and are broken out separately for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $2977.69 | $189.05 |
| ALASKA* (AK) | $3214.34 | $244.44 |
| ALABAMA (AL) | $2613.61 | $173.55 |
| ARKANSAS (AR) | $2567.13 | $171.68 |
| ARIZONA (AZ) | $2886.44 | $184.25 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $4131.52 | $199.54 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $4223.01 | $201.79 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $3484.82 | $188.65 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $3490.42 | $191.45 |
| NAPA (CA) | $3870.01 | $194.58 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $4132.42 | $200.43 |
| VALLEJO (CA) | $3868.71 | $193.28 |
| BAKERSFIELD (CA) | $3240.67 | $184.32 |
| CHICO (CA) | $3238.48 | $182.13 |
| FRESNO (CA) | $3238.48 | $182.13 |
| HANFORD-CORCORAN (CA) | $3238.48 | $182.13 |
| MADERA (CA) | $3238.48 | $182.13 |
| MERCED (CA) | $3238.48 | $182.13 |
| MODESTO (CA) | $3238.48 | $182.13 |
| REDDING (CA) | $3238.48 | $182.13 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $3246.98 | $190.63 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $3429.97 | $186.78 |
| SALINAS (CA) | $3418.03 | $186.00 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $4226.68 | $205.45 |
| SANTA CRUZ-WATSONVILLE (CA) | $3574.71 | $186.51 |
| SANTA ROSA-PETALUMA (CA) | $3612.55 | $188.10 |
| STOCKTON (CA) | $3238.48 | $182.13 |
| VISALIA (CA) | $3238.48 | $182.13 |
| YUBA CITY (CA) | $3238.48 | $182.13 |
| EL CENTRO (CA) | $3238.61 | $182.26 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $3522.44 | $187.22 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $3359.79 | $183.52 |
| SANTA MARIA-SANTA BARBARA (CA) | $3437.39 | $185.83 |
| REST OF CALIFORNIA (CA) | $3238.48 | $182.13 |
| COLORADO (CO) | $3154.02 | $186.91 |
| CONNECTICUT (CT) | $3203.06 | $199.69 |
| DC + MD/VA SUBURBS (DC) | $3489.85 | $204.83 |
| DELAWARE (DE) | $2941.82 | $186.65 |
| FORT LAUDERDALE (FL) | $3035.68 | $210.79 |
| MIAMI (FL) | $3133.70 | $230.72 |
| REST OF FLORIDA (FL) | $2866.84 | $200.90 |
| ATLANTA (GA) | $3028.52 | $195.26 |
| REST OF GEORGIA (GA) | $2678.08 | $190.62 |
| HAWAII, GUAM (HI) | $3353.06 | $182.38 |
| IOWA (IA) | $2721.99 | $170.38 |
| IDAHO (ID) | $2738.10 | $172.55 |
| EAST ST. LOUIS (IL) | $2778.76 | $213.21 |
| SUBURBAN CHICAGO (IL) | $3075.14 | $211.21 |
| CHICAGO (IL) | $3026.88 | $224.29 |
| REST OF ILLINOIS (IL) | $2747.12 | $201.09 |
| INDIANA (IN) | $2758.19 | $173.12 |
| KANSAS (KS) | $2693.78 | $172.85 |
| KENTUCKY (KY) | $2662.31 | $183.21 |
| NEW ORLEANS (LA) | $2814.84 | $190.73 |
| REST OF LOUISIANA (LA) | $2652.16 | $184.21 |
| METROPOLITAN BOSTON (MA) | $3527.41 | $197.77 |
| REST OF MASSACHUSETTS (MA) | $3123.93 | $187.49 |
| BALTIMORE/SURR. CNTYS (MD) | $3191.96 | $199.75 |
| REST OF MARYLAND (MD) | $3010.68 | $188.58 |
| SOUTHERN MAINE (ME) | $2942.56 | $179.02 |
| REST OF MAINE (ME) | $2742.03 | $176.48 |
| DETROIT (MI) | $2897.06 | $206.02 |
| REST OF MICHIGAN (MI) | $2735.66 | $189.63 |
| MINNESOTA (MN) | $3040.92 | $171.41 |
| METROPOLITAN ST. LOUIS (MO) | $2842.33 | $187.55 |
| METROPOLITAN KANSAS CITY (MO) | $2805.00 | $186.47 |
| REST OF MISSOURI (MO) | $2587.70 | $183.89 |
| MISSISSIPPI (MS) | $2578.68 | $177.66 |
| MONTANA** (MT) | $2977.64 | $189.00 |
| NORTH CAROLINA (NC) | $2779.15 | $177.35 |
| NORTH DAKOTA** (ND) | $2962.02 | $173.38 |
| NEBRASKA (NE) | $2744.06 | $170.14 |
| NEW HAMPSHIRE (NH) | $3090.05 | $187.08 |
| NORTHERN NJ (NJ) | $3439.06 | $204.23 |
| REST OF NEW JERSEY (NJ) | $3245.00 | $199.80 |
| NEW MEXICO (NM) | $2748.85 | $191.66 |
| NEVADA** (NV) | $2976.10 | $184.67 |
| MANHATTAN (NY) | $3458.50 | $218.10 |
| NYC SUBURBS/LONG ISLAND (NY) | $3541.82 | $226.12 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $3257.09 | $203.53 |
| QUEENS (NY) | $3511.12 | $214.95 |
| REST OF NEW YORK (NY) | $2828.80 | $179.59 |
| OHIO (OH) | $2732.47 | $186.44 |
| OKLAHOMA (OK) | $2669.95 | $179.70 |
| PORTLAND (OR) | $3286.15 | $187.97 |
| REST OF OREGON (OR) | $2958.57 | $181.08 |
| METROPOLITAN PHILADELPHIA (PA) | $3100.79 | $197.81 |
| REST OF PENNSYLVANIA (PA) | $2744.91 | $184.94 |
| PUERTO RICO (PR) | $3008.33 | $189.01 |
| RHODE ISLAND (RI) | $3070.41 | $189.74 |
| SOUTH CAROLINA (SC) | $2759.33 | $182.63 |
| SOUTH DAKOTA** (SD) | $2960.17 | $171.53 |
| TENNESSEE (TN) | $2708.76 | $173.88 |
| BRAZORIA (TX) | $2947.54 | $183.99 |
| DALLAS (TX) | $2963.83 | $186.34 |
| GALVESTON (TX) | $2954.45 | $185.33 |
| HOUSTON (TX) | $2968.91 | $199.79 |
| BEAUMONT (TX) | $2721.92 | $184.26 |
| FORT WORTH (TX) | $2935.96 | $186.36 |
| AUSTIN (TX) | $3138.56 | $188.18 |
| REST OF TEXAS (TX) | $2831.26 | $184.84 |
| UTAH (UT) | $2805.74 | $184.41 |
| VIRGINIA (VA) | $2921.97 | $180.74 |
| VIRGIN ISLANDS (VI) | $3008.33 | $189.01 |
| VERMONT (VT) | $2936.44 | $175.69 |
| SEATTLE (KING CNTY) (WA) | $3619.75 | $198.09 |
| REST OF WASHINGTON (WA) | $3122.59 | $186.15 |
| WISCONSIN (WI) | $2840.95 | $169.43 |
| WEST VIRGINIA (WV) | $2619.51 | $196.18 |
| WYOMING** (WY) | $2970.83 | $182.19 |
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Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 4 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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to this code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost differences. The 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 use different practice-expense RVUs because the resources required differ depending on where the service is furnished, which is why this code typically shows two different allowed amounts.
RVUs — work 3.9, practice expense 84.46 (non-facility) / 0.97 (facility), malpractice 0.79 — × 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 approved amount after the annual Part B deductible is met; the beneficiary or secondary payer is generally responsible for the remainder.
- Actual payment can vary by locality, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
- Always verify the current allowed amount and any applicable edits with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why does this code show two different amounts?
Medicare uses separate practice-expense RVUs for non-facility (e.g., physician office) and facility (e.g., hospital outpatient or ASC) settings, since overhead costs differ by place of service, resulting in two distinct allowed amounts.
Why might the amount I see differ from what my MAC pays?
The amount shown is calculated using national RVUs, a locality's GPCIs, and the annual conversion factor, but local coverage policies, modifiers, claim adjustments, and timing of updates can cause the actual paid amount to differ.
Does this amount reflect what the patient owes?
No. This figure is the Medicare-approved amount before cost-sharing. The patient's out-of-pocket responsibility depends on deductible status, coinsurance (typically 20%), and any secondary insurance.
Can this amount change during the year?
Yes. CMS can apply mid-year adjustments, correction notices, or budget-neutrality changes, and the conversion factor and RVUs are typically updated annually, so amounts can shift from year to year or after corrections.
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.
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