Non-Facility
Private Office Rate
$875.77
Effective Q3 2026
Physician Service
15200 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Fth/gft fr trnk 20 sq cm/<.
CPT Code 15200
National Average Payment
Facility
Hospital / Outpatient Facility Rate
$605.22
Effective Q3 2026
National Medicare payment
The amounts shown are the published national payments. Local payment can vary based on your specific Zip Code, GPCI adjustments, and site of service.
Rates vary by location
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q3 | $875.77 | $605.22 | +6.89% | -8.19% |
| 2026 Q2 | $875.77 | $605.22 | +6.89% | -8.19% |
| 2026 Q1 | $875.77 | $605.22 | +6.89% | -8.19% |
| 2025 Q4 | $819.34 | $659.22 | — | — |
| 2025 Q3 | $819.34 | $659.22 | — | — |
| 2025 Q2 | $819.34 | $659.22 | — | — |
| 2025 Q1 | $819.34 | $659.22 | — | — |
Code Description
Fth/gft fr trnk 20 sq cm/<
Reimbursement Summary
CPT code 15200 (Fth/gft fr trnk 20 sq cm/<) had a 2026 Medicare non-facility reimbursement rate of $875.77. This reflects a 6.89% change from the prior year. The code carries 26.22 total RVUs across work, practice expense, and malpractice components.
For 2026, the estimated National Average Medicare payment for 15200 is $875.77 in a non-facility (office) setting and $605.22 in a facility (hospital/outpatient) setting. Your actual reimbursement depends on locality adjustments.
This code’s RVU components (Work, Practice Expense, and Malpractice) combine to approximately 26.22 total RVUs in the office setting and 18.12 total RVUs in the facility setting.
Description: Fth/gft fr trnk 20 sq cm/<. For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Note: amounts shown are estimates based on CMS national averages for Q3 2026.
Q3 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 8.92 | 8.92 |
| Practice Expense (PE) | 15.8 | 7.7 |
| Malpractice (MP) | 1.5 | 1.5 |
| Total RVUs | 26.22 | 18.12 |
Are you being paid correctly for this code?
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Facility vs. Non-Facility (Office) Payment
Medicare often publishes two payment rates for the same code: a **non-facility** rate (typically used when the service is performed in a private office where the clinician bears more overhead) and a **facility** rate (typically used when performed in a hospital or facility where the facility bills separately for its costs).
Because the practice expense portion of RVUs differs by setting, the non-facility and facility payment amounts can be different. For locality-adjusted estimates in 2026, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for 15200?
The 2026 National Average Medicare reimbursement rate for 15200 (Physician Service) is $875.77. This rate is effective as of January 1, 2026.
What is the description for code 15200?
Fth/gft fr trnk 20 sq cm/<
Why do facility and non-facility payments differ for 15200?
For many physician services, Medicare publishes different practice-expense RVUs by setting. In general, non-facility rates apply when services are performed in a private office, while facility rates apply when performed in a hospital or facility where the facility bills separately.
How can I find my local Medicare rate for 15200?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is 15200 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
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