Medicare Reimbursement for CPT 13101

CPT 13101 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount for this code, both nationally and adjusted by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$390.46	$210.09
ALASKA* (AK)	$458.51	$266.43
ALABAMA (AL)	$351.76	$193.94
ARKANSAS (AR)	$346.87	$191.93
ARIZONA (AZ)	$380.37	$205.60
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$501.51	$247.19
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$511.26	$251.18
OXNARD-THOUSAND OAKS-VENTURA (CA)	$436.51	$223.32
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$438.80	$225.43
NAPA (CA)	$474.76	$237.04
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$501.96	$247.65
VALLEJO (CA)	$474.10	$236.38
BAKERSFIELD (CA)	$412.66	$214.98
CHICO (CA)	$411.46	$213.78
FRESNO (CA)	$411.46	$213.78
HANFORD-CORCORAN (CA)	$411.46	$213.78
MADERA (CA)	$411.46	$213.78
MERCED (CA)	$411.46	$213.78
MODESTO (CA)	$411.46	$213.78
REDDING (CA)	$411.46	$213.78
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$415.81	$218.13
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$431.26	$221.49
SALINAS (CA)	$429.64	$220.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$513.12	$253.03
SANTA CRUZ-WATSONVILLE (CA)	$443.24	$224.09
SANTA ROSA-PETALUMA (CA)	$447.68	$226.20
STOCKTON (CA)	$411.46	$213.78
VISALIA (CA)	$411.46	$213.78
YUBA CITY (CA)	$411.46	$213.78
EL CENTRO (CA)	$411.53	$213.85
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$439.34	$223.63
SAN LUIS OBISPO-PASO ROBLES (CA)	$422.78	$217.34
SANTA MARIA-SANTA BARBARA (CA)	$431.14	$220.83
REST OF CALIFORNIA (CA)	$411.46	$213.78
COLORADO (CO)	$405.74	$213.83
CONNECTICUT (CT)	$415.81	$221.55
DC + MD/VA SUBURBS (DC)	$444.97	$232.50
DELAWARE (DE)	$386.52	$208.32
FORT LAUDERDALE (FL)	$404.67	$221.96
MIAMI (FL)	$421.68	$233.92
REST OF FLORIDA (FL)	$385.60	$213.17
ATLANTA (GA)	$397.69	$214.44
REST OF GEORGIA (GA)	$364.60	$203.71
HAWAII, GUAM (HI)	$420.89	$215.82
IOWA (IA)	$360.03	$194.99
IDAHO (ID)	$362.36	$196.42
EAST ST. LOUIS (IL)	$382.95	$217.01
SUBURBAN CHICAGO (IL)	$408.67	$223.44
CHICAGO (IL)	$409.87	$228.60
REST OF ILLINOIS (IL)	$375.08	$210.41
INDIANA (IN)	$364.38	$197.18
KANSAS (KS)	$358.56	$195.51
KENTUCKY (KY)	$360.11	$199.76
NEW ORLEANS (LA)	$376.74	$207.02
REST OF LOUISIANA (LA)	$359.63	$200.00
METROPOLITAN BOSTON (MA)	$444.72	$229.36
REST OF MASSACHUSETTS (MA)	$403.52	$213.59
BALTIMORE/SURR. CNTYS (MD)	$414.66	$221.13
REST OF MARYLAND (MD)	$393.66	$211.13
SOUTHERN MAINE (ME)	$383.16	$204.42
REST OF MAINE (ME)	$364.35	$198.41
DETROIT (MI)	$390.41	$216.36
REST OF MICHIGAN (MI)	$369.28	$204.61
MINNESOTA (MN)	$388.68	$203.09
METROPOLITAN ST. LOUIS (MO)	$377.85	$206.14
METROPOLITAN KANSAS CITY (MO)	$374.09	$204.73
REST OF MISSOURI (MO)	$353.79	$198.31
MISSISSIPPI (MS)	$350.38	$195.09
MONTANA** (MT)	$390.43	$210.06
NORTH CAROLINA (NC)	$368.00	$199.72
NORTH DAKOTA** (ND)	$382.52	$202.16
NEBRASKA (NE)	$361.88	$195.40
NEW HAMPSHIRE (NH)	$399.58	$211.82
NORTHERN NJ (NJ)	$440.65	$231.43
REST OF NEW JERSEY (NJ)	$420.52	$223.56
NEW MEXICO (NM)	$371.30	$205.90
NEVADA** (NV)	$388.49	$207.94
MANHATTAN (NY)	$448.21	$238.63
NYC SUBURBS/LONG ISLAND (NY)	$458.94	$244.49
POUGHKPSIE/N NYC SUBURBS (NY)	$423.39	$225.89
QUEENS (NY)	$451.55	$238.36
REST OF NEW YORK (NY)	$373.33	$201.98
OHIO (OH)	$367.67	$202.99
OKLAHOMA (OK)	$359.31	$198.25
PORTLAND (OR)	$418.07	$217.69
REST OF OREGON (OR)	$385.44	$205.79
METROPOLITAN PHILADELPHIA (PA)	$405.88	$218.12
REST OF PENNSYLVANIA (PA)	$368.14	$202.56
PUERTO RICO (PR)	$393.15	$210.80
RHODE ISLAND (RI)	$399.86	$213.55
SOUTH CAROLINA (SC)	$368.45	$201.79
SOUTH DAKOTA** (SD)	$381.59	$201.22
TENNESSEE (TN)	$360.32	$196.37
BRAZORIA (TX)	$386.06	$207.32
DALLAS (TX)	$388.53	$208.89
GALVESTON (TX)	$387.23	$208.13
HOUSTON (TX)	$394.55	$215.45
BEAUMONT (TX)	$365.82	$201.69
FORT WORTH (TX)	$386.07	$208.23
AUSTIN (TX)	$404.43	$213.60
REST OF TEXAS (TX)	$375.74	$204.57
UTAH (UT)	$373.30	$203.76
VIRGINIA (VA)	$382.05	$204.76
VIRGIN ISLANDS (VI)	$393.15	$210.80
VERMONT (VT)	$381.22	$202.66
SEATTLE (KING CNTY) (WA)	$453.45	$232.14
REST OF WASHINGTON (WA)	$402.69	$212.77
WISCONSIN (WI)	$370.16	$197.37
WEST VIRGINIA (WV)	$361.74	$205.00
WYOMING** (WY)	$386.98	$206.62

Look up another code or locality →

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 pricing starts with 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 furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (equipment, supplies, staff time) are treated differently depending on where the service is performed.

RVUs — work 3.41, practice expense 7.88 (non-facility) / 2.48 (facility), malpractice 0.4 — × 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 Part B deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary based on modifiers, place-of-service codes, sequestration reductions, and annual budget-neutrality adjustments.
Always verify final allowed amounts and coverage with your local Medicare Administrative Contractor (MAC).

Frequently asked

Why is the non-facility amount higher than the facility amount for this code?

In non-facility settings, the practice absorbs overhead costs like equipment, supplies, and staff time, so the practice-expense RVU is higher. In facility settings, the facility itself bills separately for overhead, so the physician's practice-expense RVU is lower, reducing the allowed amount.

Does this amount reflect what the patient will owe?

No. The figures shown are Medicare's allowed amount. Patient responsibility depends on deductible status, any applicable coinsurance (typically 20%), and secondary coverage.

Will this amount change during the year?

The conversion factor and RVUs are typically set annually, but mid-year changes, sequestration, or correction notices from CMS can affect the final paid amount.

Why might my MAC pay a different amount than shown here?

Locality GPCIs, applied modifiers, contractual adjustments, and local coverage determinations can all cause the actual paid amount to differ from this estimate.

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.