Medicare Reimbursement for CPT Code 21012
CPT code 21012 is a physician procedure code reported to Medicare for payment under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount nationally and by locality, broken out for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $323.99 | $323.99 |
| ALASKA* (AK) | $392.48 | $392.48 |
| ALABAMA (AL) | $292.22 | $292.22 |
| ARKANSAS (AR) | $288.29 | $288.29 |
| ARIZONA (AZ) | $315.00 | $315.00 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $381.22 | $381.22 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $387.30 | $387.30 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $343.64 | $343.64 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $346.92 | $346.92 |
| NAPA (CA) | $365.43 | $365.43 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $382.26 | $382.26 |
| VALLEJO (CA) | $363.94 | $363.94 |
| BAKERSFIELD (CA) | $329.13 | $329.13 |
| CHICO (CA) | $326.62 | $326.62 |
| FRESNO (CA) | $326.62 | $326.62 |
| HANFORD-CORCORAN (CA) | $326.62 | $326.62 |
| MADERA (CA) | $326.62 | $326.62 |
| MERCED (CA) | $326.62 | $326.62 |
| MODESTO (CA) | $326.62 | $326.62 |
| REDDING (CA) | $326.62 | $326.62 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $336.40 | $336.40 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $339.33 | $339.33 |
| SALINAS (CA) | $338.01 | $338.01 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $391.53 | $391.53 |
| SANTA CRUZ-WATSONVILLE (CA) | $344.89 | $344.89 |
| SANTA ROSA-PETALUMA (CA) | $348.12 | $348.12 |
| STOCKTON (CA) | $326.62 | $326.62 |
| VISALIA (CA) | $326.62 | $326.62 |
| YUBA CITY (CA) | $326.62 | $326.62 |
| EL CENTRO (CA) | $326.77 | $326.77 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $343.55 | $343.55 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $333.01 | $333.01 |
| SANTA MARIA-SANTA BARBARA (CA) | $338.62 | $338.62 |
| REST OF CALIFORNIA (CA) | $326.62 | $326.62 |
| COLORADO (CO) | $328.58 | $328.58 |
| CONNECTICUT (CT) | $344.72 | $344.72 |
| DC + MD/VA SUBURBS (DC) | $361.71 | $361.71 |
| DELAWARE (DE) | $319.86 | $319.86 |
| FORT LAUDERDALE (FL) | $350.48 | $350.48 |
| MIAMI (FL) | $376.56 | $376.56 |
| REST OF FLORIDA (FL) | $332.74 | $332.74 |
| ATLANTA (GA) | $332.91 | $332.91 |
| REST OF GEORGIA (GA) | $313.77 | $313.77 |
| HAWAII, GUAM (HI) | $331.56 | $331.56 |
| IOWA (IA) | $293.03 | $293.03 |
| IDAHO (ID) | $296.08 | $296.08 |
| EAST ST. LOUIS (IL) | $342.92 | $342.92 |
| SUBURBAN CHICAGO (IL) | $352.48 | $352.48 |
| CHICAGO (IL) | $365.11 | $365.11 |
| REST OF ILLINOIS (IL) | $328.17 | $328.17 |
| INDIANA (IN) | $297.52 | $297.52 |
| KANSAS (KS) | $294.64 | $294.64 |
| KENTUCKY (KY) | $304.91 | $304.91 |
| NEW ORLEANS (LA) | $319.35 | $319.35 |
| REST OF LOUISIANA (LA) | $305.62 | $305.62 |
| METROPOLITAN BOSTON (MA) | $355.42 | $355.42 |
| REST OF MASSACHUSETTS (MA) | $328.02 | $328.02 |
| BALTIMORE/SURR. CNTYS (MD) | $344.36 | $344.36 |
| REST OF MARYLAND (MD) | $324.73 | $324.73 |
| SOUTHERN MAINE (ME) | $311.44 | $311.44 |
| REST OF MAINE (ME) | $300.61 | $300.61 |
| DETROIT (MI) | $339.64 | $339.64 |
| REST OF MICHIGAN (MI) | $314.98 | $314.98 |
| MINNESOTA (MN) | $306.90 | $306.90 |
| METROPOLITAN ST. LOUIS (MO) | $316.92 | $316.92 |
| METROPOLITAN KANSAS CITY (MO) | $314.22 | $314.22 |
| REST OF MISSOURI (MO) | $302.69 | $302.69 |
| MISSISSIPPI (MS) | $295.40 | $295.40 |
| MONTANA** (MT) | $323.93 | $323.93 |
| NORTH CAROLINA (NC) | $303.06 | $303.06 |
| NORTH DAKOTA** (ND) | $305.93 | $305.93 |
| NEBRASKA (NE) | $293.64 | $293.64 |
| NEW HAMPSHIRE (NH) | $326.28 | $326.28 |
| NORTHERN NJ (NJ) | $358.97 | $358.97 |
| REST OF NEW JERSEY (NJ) | $346.41 | $346.41 |
| NEW MEXICO (NM) | $317.76 | $317.76 |
| NEVADA** (NV) | $319.06 | $319.06 |
| MANHATTAN (NY) | $375.16 | $375.16 |
| NYC SUBURBS/LONG ISLAND (NY) | $387.41 | $387.41 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $351.02 | $351.02 |
| QUEENS (NY) | $373.75 | $373.75 |
| REST OF NEW YORK (NY) | $307.53 | $307.53 |
| OHIO (OH) | $311.30 | $311.30 |
| OKLAHOMA (OK) | $301.31 | $301.31 |
| PORTLAND (OR) | $335.03 | $335.03 |
| REST OF OREGON (OR) | $314.37 | $314.37 |
| METROPOLITAN PHILADELPHIA (PA) | $338.56 | $338.56 |
| REST OF PENNSYLVANIA (PA) | $310.13 | $310.13 |
| PUERTO RICO (PR) | $325.17 | $325.17 |
| RHODE ISLAND (RI) | $328.37 | $328.37 |
| SOUTH CAROLINA (SC) | $308.13 | $308.13 |
| SOUTH DAKOTA** (SD) | $303.81 | $303.81 |
| TENNESSEE (TN) | $296.39 | $296.39 |
| BRAZORIA (TX) | $317.12 | $317.12 |
| DALLAS (TX) | $320.38 | $320.38 |
| GALVESTON (TX) | $318.88 | $318.88 |
| HOUSTON (TX) | $335.54 | $335.54 |
| BEAUMONT (TX) | $308.45 | $308.45 |
| FORT WORTH (TX) | $319.29 | $319.29 |
| AUSTIN (TX) | $329.43 | $329.43 |
| REST OF TEXAS (TX) | $313.46 | $313.46 |
| UTAH (UT) | $311.97 | $311.97 |
| VIRGINIA (VA) | $312.53 | $312.53 |
| VIRGIN ISLANDS (VI) | $325.17 | $325.17 |
| VERMONT (VT) | $307.49 | $307.49 |
| SEATTLE (KING CNTY) (WA) | $359.41 | $359.41 |
| REST OF WASHINGTON (WA) | $326.49 | $326.49 |
| WISCONSIN (WI) | $296.71 | $296.71 |
| WEST VIRGINIA (WV) | $317.62 | $317.62 |
| WYOMING** (WY) | $316.09 | $316.09 |
Look up another code or locality →
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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is furnished. The GPCI-adjusted RVUs are summed and then multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which can cause the allowed amount to vary by place of service. These amounts are recalculated each year as RVUs, GPCIs, and the conversion factor are updated.
RVUs — work 4.34, practice expense 4.45 (non-facility) / 4.45 (facility), malpractice 0.91 — × 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 the annual Part B deductible; the patient or secondary payer is responsible for the remainder.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
- Always verify current rates and local policies with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the allowed amount differ by locality?
Medicare adjusts each RVU component using locality-specific GPCIs to reflect differences in local labor, rent, and malpractice costs, which changes the final allowed amount.
Why might the non-facility and facility amounts be the same or different?
The practice-expense RVU can differ between non-facility and facility settings depending on where the procedure's overhead costs are incurred; when the PE RVUs are equal, the allowed amounts will also be equal.
Does this amount reflect what the provider will actually be paid?
No — it reflects the Medicare-allowed amount before the 80/20 split, deductible, secondary payer adjustments, and any applicable modifiers or sequestration reductions.
Will this amount change next year?
Yes, CMS updates RVUs, GPCIs, and the conversion factor annually, and amounts are often further adjusted for budget neutrality.
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.
Bill accurately, get paid faster
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free