Medicare Reimbursement for CPT 11921

CPT 11921 is a procedure code used for Medicare Part B billing; the specific descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$233.47	$115.90
ALASKA* (AK)	$269.95	$144.74
ALABAMA (AL)	$208.53	$105.65
ARKANSAS (AR)	$205.39	$104.39
ARIZONA (AZ)	$226.86	$112.93
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$297.90	$132.13
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$303.60	$134.07
OXNARD-THOUSAND OAKS-VENTURA (CA)	$259.76	$120.79
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$261.21	$122.13
NAPA (CA)	$282.23	$127.28
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$298.30	$132.52
VALLEJO (CA)	$281.66	$126.70
BAKERSFIELD (CA)	$245.36	$116.50
CHICO (CA)	$244.38	$115.52
FRESNO (CA)	$244.38	$115.52
HANFORD-CORCORAN (CA)	$244.38	$115.52
MADERA (CA)	$244.38	$115.52
MERCED (CA)	$244.38	$115.52
MODESTO (CA)	$244.38	$115.52
REDDING (CA)	$244.38	$115.52
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$248.15	$119.29
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$256.22	$119.49
SALINAS (CA)	$255.27	$119.01
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$305.23	$135.69
SANTA CRUZ-WATSONVILLE (CA)	$263.55	$120.70
SANTA ROSA-PETALUMA (CA)	$266.18	$121.80
STOCKTON (CA)	$244.38	$115.52
VISALIA (CA)	$244.38	$115.52
YUBA CITY (CA)	$244.38	$115.52
EL CENTRO (CA)	$244.44	$115.58
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$261.16	$120.55
SAN LUIS OBISPO-PASO ROBLES (CA)	$251.21	$117.30
SANTA MARIA-SANTA BARBARA (CA)	$256.20	$119.11
REST OF CALIFORNIA (CA)	$244.38	$115.52
COLORADO (CO)	$241.84	$116.75
CONNECTICUT (CT)	$249.43	$122.80
DC + MD/VA SUBURBS (DC)	$266.48	$127.99
DELAWARE (DE)	$230.70	$114.54
FORT LAUDERDALE (FL)	$244.98	$125.89
MIAMI (FL)	$257.87	$135.47
REST OF FLORIDA (FL)	$232.36	$119.96
ATLANTA (GA)	$238.55	$119.10
REST OF GEORGIA (GA)	$218.55	$113.67
HAWAII, GUAM (HI)	$250.33	$116.65
IOWA (IA)	$212.91	$105.33
IDAHO (ID)	$214.59	$106.43
EAST ST. LOUIS (IL)	$232.61	$124.44
SUBURBAN CHICAGO (IL)	$247.23	$126.48
CHICAGO (IL)	$249.85	$131.69
REST OF ILLINOIS (IL)	$226.22	$118.88
INDIANA (IN)	$215.86	$106.87
KANSAS (KS)	$212.41	$106.13
KENTUCKY (KY)	$214.83	$110.31
NEW ORLEANS (LA)	$225.68	$115.05
REST OF LOUISIANA (LA)	$214.70	$110.65
METROPOLITAN BOSTON (MA)	$265.60	$125.22
REST OF MASSACHUSETTS (MA)	$240.53	$116.73
BALTIMORE/SURR. CNTYS (MD)	$248.85	$122.70
REST OF MARYLAND (MD)	$235.05	$116.07
SOUTHERN MAINE (ME)	$227.73	$111.21
REST OF MAINE (ME)	$216.33	$108.17
DETROIT (MI)	$235.93	$122.47
REST OF MICHIGAN (MI)	$221.15	$113.81
MINNESOTA (MN)	$229.85	$108.87
METROPOLITAN ST. LOUIS (MO)	$225.86	$113.94
METROPOLITAN KANSAS CITY (MO)	$223.51	$113.11
REST OF MISSOURI (MO)	$211.23	$109.88
MISSISSIPPI (MS)	$208.32	$107.09
MONTANA** (MT)	$233.45	$115.88
NORTH CAROLINA (NC)	$218.60	$108.91
NORTH DAKOTA** (ND)	$226.53	$108.96
NEBRASKA (NE)	$213.96	$105.44
NEW HAMPSHIRE (NH)	$238.53	$116.14
NORTHERN NJ (NJ)	$263.66	$127.28
REST OF NEW JERSEY (NJ)	$251.74	$123.36
NEW MEXICO (NM)	$222.63	$114.81
NEVADA** (NV)	$231.68	$113.99
MANHATTAN (NY)	$270.10	$133.48
NYC SUBURBS/LONG ISLAND (NY)	$277.56	$137.77
POUGHKPSIE/N NYC SUBURBS (NY)	$253.86	$125.12
QUEENS (NY)	$271.59	$132.62
REST OF NEW YORK (NY)	$222.05	$110.36
OHIO (OH)	$219.73	$112.39
OKLAHOMA (OK)	$213.85	$108.86
PORTLAND (OR)	$249.13	$118.51
REST OF OREGON (OR)	$229.36	$112.26
METROPOLITAN PHILADELPHIA (PA)	$243.38	$120.99
REST OF PENNSYLVANIA (PA)	$219.79	$111.86
PUERTO RICO (PR)	$235.05	$116.18
RHODE ISLAND (RI)	$238.65	$117.20
SOUTH CAROLINA (SC)	$219.64	$111.00
SOUTH DAKOTA** (SD)	$225.71	$108.14
TENNESSEE (TN)	$213.59	$106.72
BRAZORIA (TX)	$229.97	$113.46
DALLAS (TX)	$231.74	$114.64
GALVESTON (TX)	$230.85	$114.10
HOUSTON (TX)	$237.26	$120.51
BEAUMONT (TX)	$218.33	$111.34
FORT WORTH (TX)	$230.30	$114.38
AUSTIN (TX)	$241.49	$117.10
REST OF TEXAS (TX)	$224.23	$112.65
UTAH (UT)	$222.74	$112.22
VIRGINIA (VA)	$227.33	$111.76
VIRGIN ISLANDS (VI)	$235.05	$116.18
VERMONT (VT)	$226.11	$109.71
SEATTLE (KING CNTY) (WA)	$270.56	$126.30
REST OF WASHINGTON (WA)	$239.92	$116.12
WISCONSIN (WI)	$218.71	$106.07
WEST VIRGINIA (WV)	$217.68	$115.51
WYOMING** (WY)	$230.43	$112.86

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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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The GPCI-adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar allowed amount. Practice expense RVUs differ between non-facility settings (e.g., a physician's office, where overhead is billed by the provider) and facility settings (e.g., hospital outpatient, where the facility bears more of the overhead cost), which is why the two amounts differ. These calculations are updated annually and can shift due to national policy changes even if the code's RVUs stay constant.

RVUs — work 1.88, practice expense 4.76 (non-facility) / 1.24 (facility), malpractice 0.35 — × 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 vary.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Locality-adjusted amounts differ from the national rate shown here — verify the specific locality figure that applies to your practice.
Always confirm 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 for this code?

The practice expense RVU component is lower in facility settings because the facility (e.g., hospital) absorbs part of the overhead cost, whereas in non-facility settings the billing provider covers those costs directly.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare Physician Fee Schedule allowed amount before the 80/20 cost-sharing split, deductible status, and any applicable adjustments like sequestration or modifiers.

Why might my locality's rate be different from the national figure?

Medicare adjusts RVUs using Geographic Practice Cost Indices (GPCIs) that reflect regional differences in cost of living and practice costs, so the same code can price differently across localities.

Where can I find the exact CPT code description?

CPT descriptors are copyrighted by the American Medical Association (AMA); consult your CPT codebook or licensed coding software 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.