Medicare Reimbursement for CPT 17281

CPT 17281 is a procedure code reported to Medicare for physician and outpatient services; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$175.35	$99.53
ALASKA* (AK)	$208.97	$128.22
ALABAMA (AL)	$158.90	$92.56
ARKANSAS (AR)	$156.82	$91.69
ARIZONA (AZ)	$171.07	$97.60
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$223.46	$116.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$227.74	$118.41
OXNARD-THOUSAND OAKS-VENTURA (CA)	$195.20	$105.58
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$196.29	$106.60
NAPA (CA)	$211.78	$111.85
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$223.65	$116.74
VALLEJO (CA)	$211.51	$111.57
BAKERSFIELD (CA)	$184.97	$101.88
CHICO (CA)	$184.44	$101.35
FRESNO (CA)	$184.44	$101.35
HANFORD-CORCORAN (CA)	$184.44	$101.35
MADERA (CA)	$184.44	$101.35
MERCED (CA)	$184.44	$101.35
MODESTO (CA)	$184.44	$101.35
REDDING (CA)	$184.44	$101.35
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$186.30	$103.20
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$193.04	$104.86
SALINAS (CA)	$192.30	$104.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$228.53	$119.20
SANTA CRUZ-WATSONVILLE (CA)	$197.99	$105.87
SANTA ROSA-PETALUMA (CA)	$199.97	$106.86
STOCKTON (CA)	$184.44	$101.35
VISALIA (CA)	$184.44	$101.35
YUBA CITY (CA)	$184.44	$101.35
EL CENTRO (CA)	$184.47	$101.37
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$196.42	$105.74
SAN LUIS OBISPO-PASO ROBLES (CA)	$189.26	$102.90
SANTA MARIA-SANTA BARBARA (CA)	$192.91	$104.51
REST OF CALIFORNIA (CA)	$184.44	$101.35
COLORADO (CO)	$181.97	$101.29
CONNECTICUT (CT)	$186.32	$104.66
DC + MD/VA SUBURBS (DC)	$199.03	$109.72
DELAWARE (DE)	$173.73	$98.82
FORT LAUDERDALE (FL)	$181.40	$104.59
MIAMI (FL)	$188.62	$109.70
REST OF FLORIDA (FL)	$173.29	$100.80
ATLANTA (GA)	$178.46	$101.43
REST OF GEORGIA (GA)	$164.36	$96.73
HAWAII, GUAM (HI)	$188.29	$102.09
IOWA (IA)	$162.42	$93.04
IDAHO (ID)	$163.41	$93.66
EAST ST. LOUIS (IL)	$172.16	$102.41
SUBURBAN CHICAGO (IL)	$183.16	$105.30
CHICAGO (IL)	$183.67	$107.47
REST OF ILLINOIS (IL)	$168.82	$99.59
INDIANA (IN)	$164.27	$93.98
KANSAS (KS)	$161.80	$93.26
KENTUCKY (KY)	$162.45	$95.05
NEW ORLEANS (LA)	$169.53	$98.18
REST OF LOUISIANA (LA)	$162.25	$95.15
METROPOLITAN BOSTON (MA)	$198.81	$108.28
REST OF MASSACHUSETTS (MA)	$181.06	$101.22
BALTIMORE/SURR. CNTYS (MD)	$185.79	$104.44
REST OF MARYLAND (MD)	$176.81	$100.08
SOUTHERN MAINE (ME)	$172.25	$97.11
REST OF MAINE (ME)	$164.26	$94.50
DETROIT (MI)	$175.33	$102.17
REST OF MICHIGAN (MI)	$166.35	$97.13
MINNESOTA (MN)	$174.60	$96.58
METROPOLITAN ST. LOUIS (MO)	$170.00	$97.81
METROPOLITAN KANSAS CITY (MO)	$168.40	$97.20
REST OF MISSOURI (MO)	$159.77	$94.41
MISSISSIPPI (MS)	$158.32	$93.04
MONTANA** (MT)	$175.34	$99.52
NORTH CAROLINA (NC)	$165.81	$95.07
NORTH DAKOTA** (ND)	$171.98	$96.16
NEBRASKA (NE)	$163.21	$93.23
NEW HAMPSHIRE (NH)	$179.23	$100.30
NORTHERN NJ (NJ)	$197.28	$109.33
REST OF NEW JERSEY (NJ)	$188.51	$105.72
NEW MEXICO (NM)	$167.21	$97.68
NEVADA** (NV)	$174.52	$98.62
MANHATTAN (NY)	$200.51	$112.40
NYC SUBURBS/LONG ISLAND (NY)	$205.07	$114.92
POUGHKPSIE/N NYC SUBURBS (NY)	$189.78	$106.75
QUEENS (NY)	$201.93	$112.31
REST OF NEW YORK (NY)	$168.07	$96.04
OHIO (OH)	$165.67	$96.44
OKLAHOMA (OK)	$162.12	$94.41
PORTLAND (OR)	$187.25	$103.01
REST OF OREGON (OR)	$173.22	$97.70
METROPOLITAN PHILADELPHIA (PA)	$182.08	$103.15
REST OF PENNSYLVANIA (PA)	$165.87	$96.26
PUERTO RICO (PR)	$176.50	$99.85
RHODE ISLAND (RI)	$179.53	$101.21
SOUTH CAROLINA (SC)	$166.00	$95.94
SOUTH DAKOTA** (SD)	$171.58	$95.76
TENNESSEE (TN)	$162.54	$93.62
BRAZORIA (TX)	$173.56	$98.42
DALLAS (TX)	$174.62	$99.10
GALVESTON (TX)	$174.06	$98.77
HOUSTON (TX)	$177.17	$101.88
BEAUMONT (TX)	$164.88	$95.88
FORT WORTH (TX)	$173.58	$98.82
AUSTIN (TX)	$181.31	$101.10
REST OF TEXAS (TX)	$169.10	$97.14
UTAH (UT)	$168.06	$96.79
VIRGINIA (VA)	$171.78	$97.25
VIRGIN ISLANDS (VI)	$176.50	$99.85
VERMONT (VT)	$171.43	$96.37
SEATTLE (KING CNTY) (WA)	$202.60	$109.57
REST OF WASHINGTON (WA)	$180.68	$100.84
WISCONSIN (WI)	$166.73	$94.09
WEST VIRGINIA (WV)	$163.14	$97.26
WYOMING** (WY)	$173.88	$98.06

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 5 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) — work, practice expense (PE), and malpractice (MP) — that reflect physician effort, overhead costs, and liability insurance costs respectively. Each RVU component is adjusted by locality-specific Geographic Practice Cost Indices (GPCIs) to account for regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility (e.g., physician office) and facility (e.g., hospital outpatient) settings use different PE RVUs because overhead costs shift when a facility absorbs some expenses, which is why the same code can have two different allowed amounts. These figures represent the full Medicare-allowed rate before any patient cost-sharing is applied.

RVUs — work 1.73, practice expense 3.35 (non-facility) / 1.08 (facility), malpractice 0.17 — × 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 differ.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service coding, multiple-procedure reductions, and claim-specific circumstances can increase or decrease the final payment.
Sequestration and annual budget-neutrality adjustments can change the effective amount paid compared to the published fee schedule.
Rates vary by locality due to GPCI adjustments — the national figure is a reference point, not what every claim will pay.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does CPT 17281 have two different allowed amounts?

The non-facility and facility amounts differ because the practice expense RVU changes depending on whether the service is performed in a physician office (non-facility) or a facility setting like a hospital outpatient department, where the facility bears more of the overhead cost.

Why might my locality's payment differ from the national amount shown?

Local Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs to reflect regional cost-of-living and cost-of-practice differences, so the same code can pay more or less depending on where the service is rendered.

Does this amount include patient cost-sharing?

No. The figures shown are the Medicare-allowed amount before cost-sharing; Medicare generally pays 80% after the deductible is met, with the remaining portion owed by the patient or a secondary payer.

Will modifiers or multiple-procedure billing change the amount?

Yes. Modifiers, bilateral or multiple-procedure payment reductions, and other claim-specific factors can adjust the final payment above or below the base fee schedule amount shown here.

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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.