Medicare Reimbursement for CPT 23515
CPT 23515 is a procedure code reported to Medicare for physician and outpatient services; the exact clinical description is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for your locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $679.04 | $679.04 |
| ALASKA* (AK) | $827.17 | $827.17 |
| ALABAMA (AL) | $613.59 | $613.59 |
| ARKANSAS (AR) | $605.51 | $605.51 |
| ARIZONA (AZ) | $660.45 | $660.45 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $794.19 | $794.19 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $806.67 | $806.67 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $717.80 | $717.80 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $724.85 | $724.85 |
| NAPA (CA) | $762.00 | $762.00 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $796.40 | $796.40 |
| VALLEJO (CA) | $758.83 | $758.83 |
| BAKERSFIELD (CA) | $688.37 | $688.37 |
| CHICO (CA) | $683.01 | $683.01 |
| FRESNO (CA) | $683.01 | $683.01 |
| HANFORD-CORCORAN (CA) | $683.01 | $683.01 |
| MADERA (CA) | $683.01 | $683.01 |
| MERCED (CA) | $683.01 | $683.01 |
| MODESTO (CA) | $683.01 | $683.01 |
| REDDING (CA) | $683.01 | $683.01 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $703.86 | $703.86 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $709.01 | $709.01 |
| SALINAS (CA) | $706.24 | $706.24 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $815.68 | $815.68 |
| SANTA CRUZ-WATSONVILLE (CA) | $719.80 | $719.80 |
| SANTA ROSA-PETALUMA (CA) | $726.53 | $726.53 |
| STOCKTON (CA) | $683.01 | $683.01 |
| VISALIA (CA) | $683.01 | $683.01 |
| YUBA CITY (CA) | $683.01 | $683.01 |
| EL CENTRO (CA) | $683.33 | $683.33 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $717.36 | $717.36 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $695.85 | $695.85 |
| SANTA MARIA-SANTA BARBARA (CA) | $707.38 | $707.38 |
| REST OF CALIFORNIA (CA) | $683.01 | $683.01 |
| COLORADO (CO) | $687.75 | $687.75 |
| CONNECTICUT (CT) | $721.95 | $721.95 |
| DC + MD/VA SUBURBS (DC) | $756.56 | $756.56 |
| DELAWARE (DE) | $670.49 | $670.49 |
| FORT LAUDERDALE (FL) | $735.28 | $735.28 |
| MIAMI (FL) | $790.36 | $790.36 |
| REST OF FLORIDA (FL) | $698.49 | $698.49 |
| ATLANTA (GA) | $697.79 | $697.79 |
| REST OF GEORGIA (GA) | $659.23 | $659.23 |
| HAWAII, GUAM (HI) | $692.67 | $692.67 |
| IOWA (IA) | $614.59 | $614.59 |
| IDAHO (ID) | $621.00 | $621.00 |
| EAST ST. LOUIS (IL) | $720.86 | $720.86 |
| SUBURBAN CHICAGO (IL) | $739.34 | $739.34 |
| CHICAGO (IL) | $766.66 | $766.66 |
| REST OF ILLINOIS (IL) | $689.54 | $689.54 |
| INDIANA (IN) | $623.94 | $623.94 |
| KANSAS (KS) | $618.23 | $618.23 |
| KENTUCKY (KY) | $640.39 | $640.39 |
| NEW ORLEANS (LA) | $670.24 | $670.24 |
| REST OF LOUISIANA (LA) | $641.98 | $641.98 |
| METROPOLITAN BOSTON (MA) | $742.78 | $742.78 |
| REST OF MASSACHUSETTS (MA) | $686.76 | $686.76 |
| BALTIMORE/SURR. CNTYS (MD) | $721.25 | $721.25 |
| REST OF MARYLAND (MD) | $680.47 | $680.47 |
| SOUTHERN MAINE (ME) | $652.44 | $652.44 |
| REST OF MAINE (ME) | $630.66 | $630.66 |
| DETROIT (MI) | $713.04 | $713.04 |
| REST OF MICHIGAN (MI) | $661.42 | $661.42 |
| MINNESOTA (MN) | $642.08 | $642.08 |
| METROPOLITAN ST. LOUIS (MO) | $664.84 | $664.84 |
| METROPOLITAN KANSAS CITY (MO) | $659.34 | $659.34 |
| REST OF MISSOURI (MO) | $636.15 | $636.15 |
| MISSISSIPPI (MS) | $620.62 | $620.62 |
| MONTANA** (MT) | $678.91 | $678.91 |
| NORTH CAROLINA (NC) | $635.64 | $635.64 |
| NORTH DAKOTA** (ND) | $640.55 | $640.55 |
| NEBRASKA (NE) | $615.74 | $615.74 |
| NEW HAMPSHIRE (NH) | $683.18 | $683.18 |
| NORTHERN NJ (NJ) | $751.11 | $751.11 |
| REST OF NEW JERSEY (NJ) | $725.42 | $725.42 |
| NEW MEXICO (NM) | $667.28 | $667.28 |
| NEVADA** (NV) | $668.52 | $668.52 |
| MANHATTAN (NY) | $785.59 | $785.59 |
| NYC SUBURBS/LONG ISLAND (NY) | $811.21 | $811.21 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $735.22 | $735.22 |
| QUEENS (NY) | $782.23 | $782.23 |
| REST OF NEW YORK (NY) | $644.87 | $644.87 |
| OHIO (OH) | $653.58 | $653.58 |
| OKLAHOMA (OK) | $632.64 | $632.64 |
| PORTLAND (OR) | $700.65 | $700.65 |
| REST OF OREGON (OR) | $658.60 | $658.60 |
| METROPOLITAN PHILADELPHIA (PA) | $709.47 | $709.47 |
| REST OF PENNSYLVANIA (PA) | $650.99 | $650.99 |
| PUERTO RICO (PR) | $681.35 | $681.35 |
| RHODE ISLAND (RI) | $687.89 | $687.89 |
| SOUTH CAROLINA (SC) | $646.63 | $646.63 |
| SOUTH DAKOTA** (SD) | $636.01 | $636.01 |
| TENNESSEE (TN) | $621.87 | $621.87 |
| BRAZORIA (TX) | $664.62 | $664.62 |
| DALLAS (TX) | $671.49 | $671.49 |
| GALVESTON (TX) | $668.33 | $668.33 |
| HOUSTON (TX) | $703.84 | $703.84 |
| BEAUMONT (TX) | $647.57 | $647.57 |
| FORT WORTH (TX) | $669.34 | $669.34 |
| AUSTIN (TX) | $689.60 | $689.60 |
| REST OF TEXAS (TX) | $657.53 | $657.53 |
| UTAH (UT) | $654.51 | $654.51 |
| VIRGINIA (VA) | $654.91 | $654.91 |
| VIRGIN ISLANDS (VI) | $681.35 | $681.35 |
| VERMONT (VT) | $644.04 | $644.04 |
| SEATTLE (KING CNTY) (WA) | $750.75 | $750.75 |
| REST OF WASHINGTON (WA) | $683.48 | $683.48 |
| WISCONSIN (WI) | $621.66 | $621.66 |
| WEST VIRGINIA (WV) | $667.85 | $667.85 |
| WYOMING** (WY) | $662.19 | $662.19 |
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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's fee schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to reflect 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 often differ because the practice-expense RVU is lower in facility settings, where the facility itself bears more of the overhead cost.
RVUs — work 9.45, practice expense 8.94 (non-facility) / 8.94 (facility), malpractice 1.94 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only, not a guarantee of payment — actual reimbursement can differ.
- Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary payer is responsible for the remainder.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
- Locality-specific GPCI adjustments mean the actual rate in your area may differ from the national figure shown.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The practice-expense RVU component is usually lower in the facility setting because the facility, not the physician's office, absorbs costs like equipment and staff for the procedure.
Does this amount reflect what Medicare will actually pay?
No. It's an estimate based on standard PFS formulas. Actual payment depends on your specific locality, any applicable modifiers, sequestration, and other adjustments.
Why can't you show the CPT code description?
CPT code descriptors are copyrighted and licensed by the American Medical Association, so we reference the code generically rather than reproducing the official language.
How often do these fee schedule amounts change?
Medicare updates the conversion factor and may revise RVUs annually, and budget-neutrality adjustments can also shift amounts from year to year.
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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