Medicare Reimbursement for CPT 13121
CPT 13121 is a physician procedure code; the specific clinical descriptor is not shown here due to AMA licensing restrictions. This page displays the Medicare Physician Fee Schedule (PFS) allowed amount for this code, shown nationally and adjustable by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $417.85 | $215.44 |
| ALASKA* (AK) | $494.12 | $278.55 |
| ALABAMA (AL) | $377.36 | $200.25 |
| ARKANSAS (AR) | $372.24 | $198.37 |
| ARIZONA (AZ) | $407.27 | $211.13 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $533.65 | $248.26 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $543.93 | $252.05 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $465.62 | $226.37 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $468.19 | $228.74 |
| NAPA (CA) | $505.60 | $238.82 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $534.15 | $248.76 |
| VALLEJO (CA) | $504.88 | $238.10 |
| BAKERSFIELD (CA) | $440.77 | $218.93 |
| CHICO (CA) | $439.44 | $217.60 |
| FRESNO (CA) | $439.44 | $217.60 |
| HANFORD-CORCORAN (CA) | $439.44 | $217.60 |
| MADERA (CA) | $439.44 | $217.60 |
| MERCED (CA) | $439.44 | $217.60 |
| MODESTO (CA) | $439.44 | $217.60 |
| REDDING (CA) | $439.44 | $217.60 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $444.23 | $222.39 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $460.20 | $224.79 |
| SALINAS (CA) | $458.45 | $223.86 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $545.97 | $254.10 |
| SANTA CRUZ-WATSONVILLE (CA) | $472.43 | $226.50 |
| SANTA ROSA-PETALUMA (CA) | $477.15 | $228.59 |
| STOCKTON (CA) | $439.44 | $217.60 |
| VISALIA (CA) | $439.44 | $217.60 |
| YUBA CITY (CA) | $439.44 | $217.60 |
| EL CENTRO (CA) | $439.51 | $217.67 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $468.51 | $226.43 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $451.17 | $220.63 |
| SANTA MARIA-SANTA BARBARA (CA) | $459.97 | $223.96 |
| REST OF CALIFORNIA (CA) | $439.44 | $217.60 |
| COLORADO (CO) | $433.65 | $218.29 |
| CONNECTICUT (CT) | $444.55 | $226.55 |
| DC + MD/VA SUBURBS (DC) | $475.11 | $236.68 |
| DELAWARE (DE) | $413.74 | $213.76 |
| FORT LAUDERDALE (FL) | $433.27 | $228.23 |
| MIAMI (FL) | $451.50 | $240.80 |
| REST OF FLORIDA (FL) | $413.23 | $219.73 |
| ATLANTA (GA) | $425.56 | $219.91 |
| REST OF GEORGIA (GA) | $391.20 | $210.65 |
| HAWAII, GUAM (HI) | $449.04 | $218.90 |
| IOWA (IA) | $385.79 | $200.58 |
| IDAHO (ID) | $388.27 | $202.05 |
| EAST ST. LOUIS (IL) | $410.92 | $224.70 |
| SUBURBAN CHICAGO (IL) | $437.47 | $229.60 |
| CHICAGO (IL) | $439.15 | $235.73 |
| REST OF ILLINOIS (IL) | $402.38 | $217.58 |
| INDIANA (IN) | $390.37 | $202.74 |
| KANSAS (KS) | $384.36 | $201.38 |
| KENTUCKY (KY) | $386.31 | $206.36 |
| NEW ORLEANS (LA) | $403.74 | $213.28 |
| REST OF LOUISIANA (LA) | $385.85 | $206.71 |
| METROPOLITAN BOSTON (MA) | $474.51 | $232.83 |
| REST OF MASSACHUSETTS (MA) | $431.41 | $218.27 |
| BALTIMORE/SURR. CNTYS (MD) | $443.33 | $226.15 |
| REST OF MARYLAND (MD) | $421.22 | $216.38 |
| SOUTHERN MAINE (ME) | $409.97 | $209.38 |
| REST OF MAINE (ME) | $390.46 | $204.24 |
| DETROIT (MI) | $418.38 | $223.05 |
| REST OF MICHIGAN (MI) | $396.00 | $211.20 |
| MINNESOTA (MN) | $415.41 | $207.13 |
| METROPOLITAN ST. LOUIS (MO) | $404.78 | $212.08 |
| METROPOLITAN KANSAS CITY (MO) | $400.86 | $210.80 |
| REST OF MISSOURI (MO) | $379.80 | $205.33 |
| MISSISSIPPI (MS) | $376.08 | $201.80 |
| MONTANA** (MT) | $417.82 | $215.41 |
| NORTH CAROLINA (NC) | $394.26 | $205.41 |
| NORTH DAKOTA** (ND) | $409.12 | $206.71 |
| NEBRASKA (NE) | $387.69 | $200.87 |
| NEW HAMPSHIRE (NH) | $427.20 | $216.49 |
| NORTHERN NJ (NJ) | $470.71 | $235.92 |
| REST OF NEW JERSEY (NJ) | $449.59 | $228.56 |
| NEW MEXICO (NM) | $398.15 | $212.54 |
| NEVADA** (NV) | $415.66 | $213.05 |
| MANHATTAN (NY) | $479.00 | $243.80 |
| NYC SUBURBS/LONG ISLAND (NY) | $490.35 | $249.69 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $452.72 | $231.08 |
| QUEENS (NY) | $482.34 | $243.10 |
| REST OF NEW YORK (NY) | $399.84 | $207.55 |
| OHIO (OH) | $394.22 | $209.42 |
| OKLAHOMA (OK) | $385.37 | $204.62 |
| PORTLAND (OR) | $446.46 | $221.58 |
| REST OF OREGON (OR) | $412.39 | $210.79 |
| METROPOLITAN PHILADELPHIA (PA) | $434.21 | $223.51 |
| REST OF PENNSYLVANIA (PA) | $394.66 | $208.85 |
| PUERTO RICO (PR) | $420.63 | $215.99 |
| RHODE ISLAND (RI) | $427.74 | $218.65 |
| SOUTH CAROLINA (SC) | $394.90 | $207.88 |
| SOUTH DAKOTA** (SD) | $408.09 | $205.68 |
| TENNESSEE (TN) | $386.21 | $202.22 |
| BRAZORIA (TX) | $413.20 | $212.61 |
| DALLAS (TX) | $415.84 | $214.24 |
| GALVESTON (TX) | $414.45 | $213.46 |
| HOUSTON (TX) | $422.50 | $221.51 |
| BEAUMONT (TX) | $392.24 | $208.05 |
| FORT WORTH (TX) | $413.30 | $213.73 |
| AUSTIN (TX) | $432.26 | $218.11 |
| REST OF TEXAS (TX) | $402.50 | $210.42 |
| UTAH (UT) | $399.97 | $209.71 |
| VIRGINIA (VA) | $408.89 | $209.92 |
| VIRGIN ISLANDS (VI) | $420.63 | $215.99 |
| VERMONT (VT) | $407.86 | $207.47 |
| SEATTLE (KING CNTY) (WA) | $483.61 | $235.26 |
| REST OF WASHINGTON (WA) | $430.49 | $217.35 |
| WISCONSIN (WI) | $396.21 | $202.31 |
| WEST VIRGINIA (WV) | $388.43 | $212.54 |
| WYOMING** (WY) | $414.02 | $211.61 |
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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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why the two amounts shown differ.
RVUs — work 3.9, practice expense 8.17 (non-facility) / 2.11 (facility), malpractice 0.44 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only — actual payment depends on the specific locality, claim details, and payer processing.
- Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the patient or secondary insurer is responsible for the remainder.
- Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can change the final paid amount.
- Annual budget-neutrality adjustments and conversion factor updates can shift amounts year to year.
- Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The facility rate uses lower practice-expense RVUs because Medicare assumes the facility (e.g., hospital) is absorbing overhead costs like equipment and staff, whereas the non-facility rate assumes the physician's office bears those costs.
Does this amount reflect what Medicare will actually pay?
No. It reflects the Medicare-allowed amount before the standard 80/20 split, deductible application, and any locality-specific or claim-specific adjustments.
Why can't you show the CPT code description?
CPT code descriptors are copyrighted by the American Medical Association (AMA) and cannot be reproduced without a license, so this page refers to the code generically.
Why might my locality's amount differ from the national figure?
Geographic Practice Cost Indices (GPCIs) adjust the RVUs based on local wage, rent, and malpractice cost differences, so the same code can price differently across Medicare localities.
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.
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