Medicare Reimbursement for CPT 21016

CPT 21016 is a physician procedure code reported to Medicare for payment. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for the code nationally and can be adjusted by locality, with separate non-facility and facility rates where they differ.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$901.49	$901.49
ALASKA* (AK)	$1129.07	$1129.07
ALABAMA (AL)	$822.55	$822.55
ARKANSAS (AR)	$812.86	$812.86
ARIZONA (AZ)	$878.57	$878.57
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1024.07	$1024.07
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1038.96	$1038.96
OXNARD-THOUSAND OAKS-VENTURA (CA)	$937.68	$937.68
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$948.22	$948.22
NAPA (CA)	$987.03	$987.03
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1027.19	$1027.19
VALLEJO (CA)	$982.53	$982.53
BAKERSFIELD (CA)	$905.03	$905.03
CHICO (CA)	$897.33	$897.33
FRESNO (CA)	$897.33	$897.33
HANFORD-CORCORAN (CA)	$897.33	$897.33
MADERA (CA)	$897.33	$897.33
MERCED (CA)	$897.33	$897.33
MODESTO (CA)	$897.33	$897.33
REDDING (CA)	$897.33	$897.33
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$926.95	$926.95
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$927.72	$927.72
SALINAS (CA)	$923.99	$923.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1051.72	$1051.72
SANTA CRUZ-WATSONVILLE (CA)	$936.52	$936.52
SANTA ROSA-PETALUMA (CA)	$945.06	$945.06
STOCKTON (CA)	$897.33	$897.33
VISALIA (CA)	$897.33	$897.33
YUBA CITY (CA)	$897.33	$897.33
EL CENTRO (CA)	$897.79	$897.79
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$935.61	$935.61
SAN LUIS OBISPO-PASO ROBLES (CA)	$910.78	$910.78
SANTA MARIA-SANTA BARBARA (CA)	$924.68	$924.68
REST OF CALIFORNIA (CA)	$897.33	$897.33
COLORADO (CO)	$907.35	$907.35
CONNECTICUT (CT)	$954.79	$954.79
DC + MD/VA SUBURBS (DC)	$994.36	$994.36
DELAWARE (DE)	$890.95	$890.95
FORT LAUDERDALE (FL)	$979.77	$979.77
MIAMI (FL)	$1054.75	$1054.75
REST OF FLORIDA (FL)	$933.94	$933.94
ATLANTA (GA)	$926.45	$926.45
REST OF GEORGIA (GA)	$885.36	$885.36
HAWAII, GUAM (HI)	$905.65	$905.65
IOWA (IA)	$819.53	$819.53
IDAHO (ID)	$828.07	$828.07
EAST ST. LOUIS (IL)	$969.62	$969.62
SUBURBAN CHICAGO (IL)	$984.32	$984.32
CHICAGO (IL)	$1025.48	$1025.48
REST OF ILLINOIS (IL)	$926.00	$926.00
INDIANA (IN)	$831.46	$831.46
KANSAS (KS)	$825.92	$825.92
KENTUCKY (KY)	$858.98	$858.98
NEW ORLEANS (LA)	$895.54	$895.54
REST OF LOUISIANA (LA)	$861.68	$861.68
METROPOLITAN BOSTON (MA)	$972.41	$972.41
REST OF MASSACHUSETTS (MA)	$907.37	$907.37
BALTIMORE/SURR. CNTYS (MD)	$954.03	$954.03
REST OF MARYLAND (MD)	$902.68	$902.68
SOUTHERN MAINE (ME)	$864.78	$864.78
REST OF MAINE (ME)	$841.76	$841.76
DETROIT (MI)	$953.56	$953.56
REST OF MICHIGAN (MI)	$886.14	$886.14
MINNESOTA (MN)	$845.89	$845.89
METROPOLITAN ST. LOUIS (MO)	$886.67	$886.67
METROPOLITAN KANSAS CITY (MO)	$880.31	$880.31
REST OF MISSOURI (MO)	$855.96	$855.96
MISSISSIPPI (MS)	$834.06	$834.06
MONTANA** (MT)	$901.31	$901.31
NORTH CAROLINA (NC)	$847.39	$847.39
NORTH DAKOTA** (ND)	$846.93	$846.93
NEBRASKA (NE)	$820.29	$820.29
NEW HAMPSHIRE (NH)	$902.83	$902.83
NORTHERN NJ (NJ)	$989.07	$989.07
REST OF NEW JERSEY (NJ)	$959.04	$959.04
NEW MEXICO (NM)	$894.00	$894.00
NEVADA** (NV)	$886.46	$886.46
MANHATTAN (NY)	$1037.77	$1037.77
NYC SUBURBS/LONG ISLAND (NY)	$1071.10	$1071.10
POUGHKPSIE/N NYC SUBURBS (NY)	$972.84	$972.84
QUEENS (NY)	$1030.80	$1030.80
REST OF NEW YORK (NY)	$858.58	$858.58
OHIO (OH)	$875.03	$875.03
OKLAHOMA (OK)	$847.56	$847.56
PORTLAND (OR)	$920.63	$920.63
REST OF OREGON (OR)	$872.96	$872.96
METROPOLITAN PHILADELPHIA (PA)	$940.98	$940.98
REST OF PENNSYLVANIA (PA)	$870.80	$870.80
PUERTO RICO (PR)	$903.55	$903.55
RHODE ISLAND (RI)	$911.33	$911.33
SOUTH CAROLINA (SC)	$863.95	$863.95
SOUTH DAKOTA** (SD)	$840.50	$840.50
TENNESSEE (TN)	$830.51	$830.51
BRAZORIA (TX)	$882.45	$882.45
DALLAS (TX)	$891.67	$891.67
GALVESTON (TX)	$887.48	$887.48
HOUSTON (TX)	$937.81	$937.81
BEAUMONT (TX)	$866.83	$866.83
FORT WORTH (TX)	$889.74	$889.74
AUSTIN (TX)	$910.15	$910.15
REST OF TEXAS (TX)	$876.64	$876.64
UTAH (UT)	$873.36	$873.36
VIRGINIA (VA)	$869.17	$869.17
VIRGIN ISLANDS (VI)	$903.55	$903.55
VERMONT (VT)	$852.99	$852.99
SEATTLE (KING CNTY) (WA)	$980.50	$980.50
REST OF WASHINGTON (WA)	$902.57	$902.57
WISCONSIN (WI)	$824.80	$824.80
WEST VIRGINIA (WV)	$900.12	$900.12
WYOMING** (WY)	$877.61	$877.61

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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's PFS 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 the Geographic Practice Cost Index (GPCI) for the specific Medicare locality where the service is performed, reflecting local cost differences. The locality-adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar figure set by CMS) to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can use different practice-expense RVUs, which is why the two rates may differ for some codes, though for this code they are currently aligned.

RVUs — work 14.88, practice expense 9.36 (non-facility) / 9.36 (facility), malpractice 2.75 — × 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, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Rates shown are national; actual payment depends on the specific locality's GPCI values and your Medicare Administrative Contractor (MAC).
Always confirm current-year rates and local adjustments with your MAC before billing or appealing a denial.

Frequently asked

Why might the allowed amount differ from what I see in my MAC's fee schedule?

Locality-specific GPCI adjustments, provider-specific modifiers, claim-level edits, and annual updates to the conversion factor can all cause local payment to differ from a national estimate.

Why are the non-facility and facility amounts the same for this code?

When the practice-expense RVUs assigned to a code are identical for non-facility and facility settings, the resulting PFS amounts will match; this isn't the case for every code.

Does this amount reflect what the patient will owe?

No. The PFS amount is the total allowed charge. Medicare generally pays 80% after the deductible is met, with the patient or secondary insurance covering the rest, subject to plan-specific rules.

How often do these rates change?

CMS updates RVUs, GPCIs, and the conversion factor annually (and occasionally mid-year), so amounts should be re-verified each year or when billing disputes arise.

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.