Medicare Reimbursement for CPT Code 13100

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 13100, a procedure code defined by the American Medical Association (CPT descriptors are not reproduced here). It shows the estimated national payment under the PFS as well as how the amount differs by locality and by site of service — non-facility (e.g., office) versus facility (e.g., hospital).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$338.02	$171.35
ALASKA* (AK)	$396.38	$218.87
ALABAMA (AL)	$304.28	$158.45
ARKANSAS (AR)	$300.02	$156.85
ARIZONA (AZ)	$329.21	$167.71
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$433.93	$198.93
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$442.36	$202.03
OXNARD-THOUSAND OAKS-VENTURA (CA)	$377.74	$180.74
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$379.74	$182.57
NAPA (CA)	$410.81	$191.14
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$434.34	$199.34
VALLEJO (CA)	$410.22	$190.55
BAKERSFIELD (CA)	$357.08	$174.40
CHICO (CA)	$356.00	$173.33
FRESNO (CA)	$356.00	$173.33
HANFORD-CORCORAN (CA)	$356.00	$173.33
MADERA (CA)	$356.00	$173.33
MERCED (CA)	$356.00	$173.33
MODESTO (CA)	$356.00	$173.33
REDDING (CA)	$356.00	$173.33
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$359.91	$177.24
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$373.15	$179.31
SALINAS (CA)	$371.74	$178.57
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$444.04	$203.70
SANTA CRUZ-WATSONVILLE (CA)	$383.54	$181.04
SANTA ROSA-PETALUMA (CA)	$387.39	$182.72
STOCKTON (CA)	$356.00	$173.33
VISALIA (CA)	$356.00	$173.33
YUBA CITY (CA)	$356.00	$173.33
EL CENTRO (CA)	$356.06	$173.39
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$380.16	$180.82
SAN LUIS OBISPO-PASO ROBLES (CA)	$365.81	$175.97
SANTA MARIA-SANTA BARBARA (CA)	$373.05	$178.71
REST OF CALIFORNIA (CA)	$356.00	$173.33
COLORADO (CO)	$351.16	$173.82
CONNECTICUT (CT)	$360.07	$180.56
DC + MD/VA SUBURBS (DC)	$385.27	$188.93
DELAWARE (DE)	$334.55	$169.88
FORT LAUDERDALE (FL)	$350.70	$181.86
MIAMI (FL)	$365.76	$192.25
REST OF FLORIDA (FL)	$334.03	$174.69
ATLANTA (GA)	$344.38	$175.04
REST OF GEORGIA (GA)	$315.69	$167.02
HAWAII, GUAM (HI)	$364.21	$174.70
IOWA (IA)	$311.38	$158.87
IDAHO (ID)	$313.43	$160.09
EAST ST. LOUIS (IL)	$331.96	$178.62
SUBURBAN CHICAGO (IL)	$354.14	$182.97
CHICAGO (IL)	$355.41	$187.91
REST OF ILLINOIS (IL)	$324.94	$172.77
INDIANA (IN)	$315.18	$160.68
KANSAS (KS)	$310.15	$159.48
KENTUCKY (KY)	$311.67	$163.50
NEW ORLEANS (LA)	$326.19	$169.36
REST OF LOUISIANA (LA)	$311.28	$163.77
METROPOLITAN BOSTON (MA)	$384.96	$185.96
REST OF MASSACHUSETTS (MA)	$349.23	$173.73
BALTIMORE/SURR. CNTYS (MD)	$359.09	$180.25
REST OF MARYLAND (MD)	$340.75	$172.08
SOUTHERN MAINE (ME)	$331.53	$166.36
REST OF MAINE (ME)	$315.22	$161.88
DETROIT (MI)	$338.28	$177.44
REST OF MICHIGAN (MI)	$319.72	$167.55
MINNESOTA (MN)	$336.17	$164.66
METROPOLITAN ST. LOUIS (MO)	$327.09	$168.42
METROPOLITAN KANSAS CITY (MO)	$323.82	$167.32
REST OF MISSOURI (MO)	$306.22	$162.55
MISSISSIPPI (MS)	$303.17	$159.67
MONTANA** (MT)	$337.99	$171.32
NORTH CAROLINA (NC)	$318.39	$162.89
NORTH DAKOTA** (ND)	$330.87	$164.20
NEBRASKA (NE)	$312.97	$159.14
NEW HAMPSHIRE (NH)	$345.87	$172.36
NORTHERN NJ (NJ)	$381.50	$188.16
REST OF NEW JERSEY (NJ)	$364.09	$182.08
NEW MEXICO (NM)	$321.50	$168.66
NEVADA** (NV)	$336.24	$169.40
MANHATTAN (NY)	$388.28	$194.61
NYC SUBURBS/LONG ISLAND (NY)	$397.70	$199.53
POUGHKPSIE/N NYC SUBURBS (NY)	$366.62	$184.11
QUEENS (NY)	$391.11	$194.11
REST OF NEW YORK (NY)	$323.04	$164.70
OHIO (OH)	$318.27	$166.10
OKLAHOMA (OK)	$310.93	$162.09
PORTLAND (OR)	$361.83	$176.66
REST OF OREGON (OR)	$333.53	$167.53
METROPOLITAN PHILADELPHIA (PA)	$351.45	$177.95
REST OF PENNSYLVANIA (PA)	$318.65	$165.65
PUERTO RICO (PR)	$340.35	$171.84
RHODE ISLAND (RI)	$346.11	$173.94
SOUTH CAROLINA (SC)	$318.88	$164.87
SOUTH DAKOTA** (SD)	$330.03	$163.36
TENNESSEE (TN)	$311.69	$160.19
BRAZORIA (TX)	$334.10	$168.93
DALLAS (TX)	$336.28	$170.27
GALVESTON (TX)	$335.13	$169.63
HOUSTON (TX)	$341.72	$176.22
BEAUMONT (TX)	$316.63	$164.96
FORT WORTH (TX)	$334.15	$169.82
AUSTIN (TX)	$350.07	$173.74
REST OF TEXAS (TX)	$325.22	$167.05
UTAH (UT)	$323.10	$166.43
VIRGINIA (VA)	$330.60	$166.77
VIRGIN ISLANDS (VI)	$340.35	$171.84
VERMONT (VT)	$329.80	$164.79
SEATTLE (KING CNTY) (WA)	$392.49	$187.99
REST OF WASHINGTON (WA)	$348.51	$173.00
WISCONSIN (WI)	$320.11	$160.44
WEST VIRGINIA (WV)	$313.31	$168.48
WYOMING** (WY)	$334.89	$168.22

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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) assigned to the code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, which accounts for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs are typically higher in the non-facility setting (reflecting office overhead) and lower in the facility setting (where the facility, not the billing physician, absorbs most overhead costs), which is why non-facility and facility payment amounts differ.

RVUs — work 2.93, practice expense 6.83 (non-facility) / 1.84 (facility), malpractice 0.36 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual Medicare payment can vary by specific locality, carrier, and claim circumstances.
Medicare typically pays 80% of the allowed amount after the patient's annual deductible is met; the beneficiary or secondary insurance is responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral surgery rules, and other claim-specific adjustments can change the final payment.
Annual updates to RVUs, GPCIs, the conversion factor, and budget-neutrality adjustments mean amounts change year to year.
Sequestration or other federal payment adjustments may further reduce the amount actually disbursed.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

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 the hospital or facility—not the billing physician's practice—bears most of the overhead costs, such as equipment, supplies, and staff time.

Does this amount represent what Medicare actually pays?

No. It represents the Medicare-allowed amount before cost-sharing. Medicare generally reimburses 80% of this figure after the deductible, with the patient or secondary payer responsible for the rest.

Will the amount be the same in every state?

No. The Geographic Practice Cost Indices (GPCIs) adjust the RVUs based on the cost of practicing medicine in each specific locality, so the allowed amount can vary noticeably by region.

Why might my MAC's posted amount differ slightly from this estimate?

Differences can arise from locality-specific GPCI updates, modifier adjustments, claim-specific edits, or timing differences between annual PFS updates and when this page was generated.

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.