Medicare Reimbursement for CPT 21013

This page explains the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 21013, a procedure code defined by the American Medical Association. It shows the national PFS estimate as well as locality-adjusted amounts, broken out by non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$565.48	$371.75
ALASKA* (AK)	$662.12	$455.81
ALABAMA (AL)	$506.72	$337.21
ARKANSAS (AR)	$499.35	$332.94
ARIZONA (AZ)	$549.72	$362.00
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$709.53	$436.38
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$722.66	$443.31
OXNARD-THOUSAND OAKS-VENTURA (CA)	$622.94	$393.95
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$626.93	$397.75
NAPA (CA)	$673.81	$418.48
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$710.64	$437.49
VALLEJO (CA)	$672.21	$416.88
BAKERSFIELD (CA)	$590.24	$377.92
CHICO (CA)	$587.50	$375.18
FRESNO (CA)	$587.50	$375.18
HANFORD-CORCORAN (CA)	$587.50	$375.18
MADERA (CA)	$587.50	$375.18
MERCED (CA)	$587.50	$375.18
MODESTO (CA)	$587.50	$375.18
REDDING (CA)	$587.50	$375.18
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$598.05	$385.73
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$614.73	$389.43
SALINAS (CA)	$612.42	$387.89
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$727.21	$447.86
SANTA CRUZ-WATSONVILLE (CA)	$630.62	$395.24
SANTA ROSA-PETALUMA (CA)	$636.84	$398.94
STOCKTON (CA)	$587.50	$375.18
VISALIA (CA)	$587.50	$375.18
YUBA CITY (CA)	$587.50	$375.18
EL CENTRO (CA)	$587.66	$375.34
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$625.63	$393.93
SAN LUIS OBISPO-PASO ROBLES (CA)	$602.83	$382.17
SANTA MARIA-SANTA BARBARA (CA)	$614.39	$388.50
REST OF CALIFORNIA (CA)	$587.50	$375.18
COLORADO (CO)	$583.23	$377.11
CONNECTICUT (CT)	$603.32	$394.68
DC + MD/VA SUBURBS (DC)	$642.14	$413.93
DELAWARE (DE)	$558.78	$367.38
FORT LAUDERDALE (FL)	$596.56	$400.31
MIAMI (FL)	$630.14	$428.47
REST OF FLORIDA (FL)	$566.26	$381.06
ATLANTA (GA)	$578.29	$381.46
REST OF GEORGIA (GA)	$533.27	$360.47
HAWAII, GUAM (HI)	$600.52	$380.26
IOWA (IA)	$515.45	$338.19
IDAHO (ID)	$519.72	$341.49
EAST ST. LOUIS (IL)	$570.16	$391.93
SUBURBAN CHICAGO (IL)	$601.60	$402.65
CHICAGO (IL)	$610.88	$416.19
REST OF ILLINOIS (IL)	$552.90	$376.03
INDIANA (IN)	$522.64	$343.05
KANSAS (KS)	$515.03	$339.90
KENTUCKY (KY)	$523.14	$350.91
NEW ORLEANS (LA)	$548.90	$366.61
REST OF LOUISIANA (LA)	$523.12	$351.67
METROPOLITAN BOSTON (MA)	$638.25	$406.94
REST OF MASSACHUSETTS (MA)	$580.54	$376.55
BALTIMORE/SURR. CNTYS (MD)	$602.07	$394.21
REST OF MARYLAND (MD)	$568.83	$372.78
SOUTHERN MAINE (ME)	$550.19	$358.21
REST OF MAINE (ME)	$524.59	$346.37
DETROIT (MI)	$575.46	$388.51
REST OF MICHIGAN (MI)	$538.69	$361.82
MINNESOTA (MN)	$552.77	$353.43
METROPOLITAN ST. LOUIS (MO)	$548.44	$364.01
METROPOLITAN KANSAS CITY (MO)	$542.98	$361.08
REST OF MISSOURI (MO)	$515.44	$348.45
MISSISSIPPI (MS)	$507.40	$340.60
MONTANA** (MT)	$565.41	$371.69
NORTH CAROLINA (NC)	$529.78	$349.04
NORTH DAKOTA** (ND)	$546.03	$352.31
NEBRASKA (NE)	$517.68	$338.87
NEW HAMPSHIRE (NH)	$576.00	$374.33
NORTHERN NJ (NJ)	$635.84	$411.11
REST OF NEW JERSEY (NJ)	$608.49	$396.95
NEW MEXICO (NM)	$542.48	$364.83
NEVADA** (NV)	$560.37	$366.45
MANHATTAN (NY)	$653.68	$428.57
NYC SUBURBS/LONG ISLAND (NY)	$672.17	$441.83
POUGHKPSIE/N NYC SUBURBS (NY)	$614.14	$402.01
QUEENS (NY)	$656.09	$427.11
REST OF NEW YORK (NY)	$537.94	$353.90
OHIO (OH)	$534.73	$357.86
OKLAHOMA (OK)	$520.04	$347.05
PORTLAND (OR)	$599.48	$384.25
REST OF OREGON (OR)	$554.33	$361.38
METROPOLITAN PHILADELPHIA (PA)	$589.58	$387.91
REST OF PENNSYLVANIA (PA)	$534.45	$356.61
PUERTO RICO (PR)	$568.91	$373.05
RHODE ISLAND (RI)	$577.05	$376.94
SOUTH CAROLINA (SC)	$533.48	$354.48
SOUTH DAKOTA** (SD)	$543.74	$350.02
TENNESSEE (TN)	$517.89	$341.79
BRAZORIA (TX)	$556.48	$364.50
DALLAS (TX)	$560.99	$368.04
GALVESTON (TX)	$558.76	$366.39
HOUSTON (TX)	$576.70	$384.33
BEAUMONT (TX)	$531.08	$354.79
FORT WORTH (TX)	$557.85	$366.84
AUSTIN (TX)	$582.77	$377.81
REST OF TEXAS (TX)	$544.13	$360.28
UTAH (UT)	$540.76	$358.65
VIRGINIA (VA)	$549.80	$359.36
VIRGIN ISLANDS (VI)	$568.91	$373.05
VERMONT (VT)	$545.74	$353.96
SEATTLE (KING CNTY) (WA)	$649.20	$411.50
REST OF WASHINGTON (WA)	$578.84	$374.84
WISCONSIN (WI)	$527.86	$342.27
WEST VIRGINIA (WV)	$532.90	$364.55
WYOMING** (WY)	$556.97	$363.24

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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 PFS payments are built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted using the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital, ASC) settings, which is why the same code can have two different national and locality-specific amounts.

RVUs — work 5.28, practice expense 10.67 (non-facility) / 4.87 (facility), malpractice 0.98 — × 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 deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts change year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does CPT 21013 show two different national amounts?

The non-facility amount applies when the service is performed in a setting like a physician's office, while the facility amount applies in hospitals or ambulatory surgical centers. The practice expense RVU component differs between these settings, producing two separate PFS amounts.

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

The national amount uses a GPCI value of 1.0 for comparison purposes, but actual payments are adjusted by the specific GPCI values for the locality where the service was rendered, which can raise or lower the payment relative to the national figure.

Does this amount reflect what the patient will owe?

No. This figure represents the full Medicare-allowed amount. Medicare generally pays 80% of this amount after the deductible is met, with the patient or supplemental insurance responsible for the remaining portion.

Will this amount stay the same next year?

No. The Medicare conversion factor and RVUs are updated annually, and budget-neutrality adjustments can shift payment amounts for individual codes from year to year.

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.