Medicare Reimbursement for CPT 12021

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and shows its estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026. Amounts are presented at the national level and can vary by locality, and are broken out by non-facility (e.g., office) versus facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$185.71	$134.61
ALASKA* (AK)	$218.85	$164.42
ALABAMA (AL)	$166.77	$122.06
ARKANSAS (AR)	$164.40	$120.50
ARIZONA (AZ)	$180.61	$131.09
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$231.63	$159.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$235.87	$162.18
OXNARD-THOUSAND OAKS-VENTURA (CA)	$203.88	$143.48
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$205.25	$144.79
NAPA (CA)	$220.16	$152.81
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$232.01	$159.95
VALLEJO (CA)	$219.62	$152.27
BAKERSFIELD (CA)	$193.44	$137.43
CHICO (CA)	$192.51	$136.50
FRESNO (CA)	$192.51	$136.50
HANFORD-CORCORAN (CA)	$192.51	$136.50
MADERA (CA)	$192.51	$136.50
MERCED (CA)	$192.51	$136.50
MODESTO (CA)	$192.51	$136.50
REDDING (CA)	$192.51	$136.50
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$196.06	$140.06
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$201.26	$141.83
SALINAS (CA)	$200.50	$141.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$237.40	$163.71
SANTA CRUZ-WATSONVILLE (CA)	$206.23	$144.14
SANTA ROSA-PETALUMA (CA)	$208.25	$145.50
STOCKTON (CA)	$192.51	$136.50
VISALIA (CA)	$192.51	$136.50
YUBA CITY (CA)	$192.51	$136.50
EL CENTRO (CA)	$192.56	$136.56
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$204.70	$143.58
SAN LUIS OBISPO-PASO ROBLES (CA)	$197.38	$139.17
SANTA MARIA-SANTA BARBARA (CA)	$201.11	$141.52
REST OF CALIFORNIA (CA)	$192.51	$136.50
COLORADO (CO)	$191.28	$136.91
CONNECTICUT (CT)	$197.97	$142.93
DC + MD/VA SUBURBS (DC)	$210.43	$150.23
DELAWARE (DE)	$183.54	$133.05
FORT LAUDERDALE (FL)	$196.09	$144.32
MIAMI (FL)	$207.20	$154.01
REST OF FLORIDA (FL)	$186.27	$137.42
ATLANTA (GA)	$189.92	$138.00
REST OF GEORGIA (GA)	$175.60	$130.01
HAWAII, GUAM (HI)	$196.58	$138.48
IOWA (IA)	$169.44	$122.68
IDAHO (ID)	$170.84	$123.83
EAST ST. LOUIS (IL)	$187.83	$140.81
SUBURBAN CHICAGO (IL)	$197.71	$145.22
CHICAGO (IL)	$200.98	$149.62
REST OF ILLINOIS (IL)	$182.06	$135.41
INDIANA (IN)	$171.78	$124.40
KANSAS (KS)	$169.37	$123.17
KENTUCKY (KY)	$172.20	$126.77
NEW ORLEANS (LA)	$180.53	$132.44
REST OF LOUISIANA (LA)	$172.22	$127.00
METROPOLITAN BOSTON (MA)	$208.98	$147.97
REST OF MASSACHUSETTS (MA)	$190.46	$136.64
BALTIMORE/SURR. CNTYS (MD)	$197.57	$142.74
REST OF MARYLAND (MD)	$186.78	$135.06
SOUTHERN MAINE (ME)	$180.62	$129.98
REST OF MAINE (ME)	$172.48	$125.47
DETROIT (MI)	$189.31	$139.99
REST OF MICHIGAN (MI)	$177.28	$130.62
MINNESOTA (MN)	$181.23	$128.65
METROPOLITAN ST. LOUIS (MO)	$180.30	$131.65
METROPOLITAN KANSAS CITY (MO)	$178.55	$130.56
REST OF MISSOURI (MO)	$169.80	$125.75
MISSISSIPPI (MS)	$167.09	$123.09
MONTANA** (MT)	$185.69	$134.58
NORTH CAROLINA (NC)	$174.14	$126.46
NORTH DAKOTA** (ND)	$179.16	$128.06
NEBRASKA (NE)	$170.13	$122.97
NEW HAMPSHIRE (NH)	$188.97	$135.77
NORTHERN NJ (NJ)	$208.45	$149.17
REST OF NEW JERSEY (NJ)	$199.65	$143.85
NEW MEXICO (NM)	$178.53	$131.66
NEVADA** (NV)	$183.98	$132.83
MANHATTAN (NY)	$214.44	$155.06
NYC SUBURBS/LONG ISLAND (NY)	$220.49	$159.73
POUGHKPSIE/N NYC SUBURBS (NY)	$201.55	$145.59
QUEENS (NY)	$215.12	$154.72
REST OF NEW YORK (NY)	$176.77	$128.23
OHIO (OH)	$175.95	$129.29
OKLAHOMA (OK)	$171.14	$125.50
PORTLAND (OR)	$196.44	$139.66
REST OF OREGON (OR)	$181.98	$131.08
METROPOLITAN PHILADELPHIA (PA)	$193.58	$140.39
REST OF PENNSYLVANIA (PA)	$175.82	$128.91
PUERTO RICO (PR)	$186.79	$135.12
RHODE ISLAND (RI)	$189.42	$136.63
SOUTH CAROLINA (SC)	$175.45	$128.23
SOUTH DAKOTA** (SD)	$178.39	$127.29
TENNESSEE (TN)	$170.30	$123.85
BRAZORIA (TX)	$182.76	$132.11
DALLAS (TX)	$184.24	$133.35
GALVESTON (TX)	$183.51	$132.77
HOUSTON (TX)	$189.55	$138.81
BEAUMONT (TX)	$174.74	$128.23
FORT WORTH (TX)	$183.26	$132.87
AUSTIN (TX)	$191.14	$137.08
REST OF TEXAS (TX)	$178.87	$130.37
UTAH (UT)	$177.79	$129.75
VIRGINIA (VA)	$180.54	$130.31
VIRGIN ISLANDS (VI)	$186.79	$135.12
VERMONT (VT)	$179.13	$128.54
SEATTLE (KING CNTY) (WA)	$212.47	$149.76
REST OF WASHINGTON (WA)	$189.87	$136.06
WISCONSIN (WI)	$173.33	$124.37
WEST VIRGINIA (WV)	$175.63	$131.22
WYOMING** (WY)	$182.84	$131.74

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 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) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility amounts differ primarily because the practice-expense RVU is higher in non-facility settings, where the billing provider bears more overhead costs directly.

RVUs — work 1.84, practice expense 3.39 (non-facility) / 1.86 (facility), malpractice 0.33 — × 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 patient meets their deductible; the patient or secondary insurance may be responsible for the remainder.
Actual payment can vary by locality GPCIs, applied modifiers, claim-specific circumstances, and sequestration or other federal payment adjustments.
Annual budget-neutrality adjustments and conversion factor updates can change amounts from year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the facility amount differ from the non-facility amount for this code?

The practice-expense RVU is lower in the facility setting because overhead costs (like equipment and supplies) are assumed to be borne by the facility rather than the billing physician or practice.

Does this amount reflect what Medicare will actually pay?

No. It reflects the PFS allowed amount before the patient deductible and coinsurance are applied, and before any claim-specific adjustments such as modifiers or sequestration.

Why isn't the CPT code description shown on this page?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so they cannot be reproduced here. Refer to your CPT codebook or practice management system for the official descriptor.

Will this amount be the same in every state?

No. The GPCI adjustments mean the same code can have different allowed amounts depending on the locality where the service is furnished.

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.