Medicare Reimbursement for CPT 21025

CPT 21025 is a surgical procedure code; the specific clinical descriptor is not shown here because CPT text is licensed by the AMA. This page displays the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code at the national level and adjusted for locality, shown separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$840.03	$613.57
ALASKA* (AK)	$1014.24	$773.06
ALABAMA (AL)	$762.34	$564.19
ARKANSAS (AR)	$752.60	$558.07
ARIZONA (AZ)	$819.17	$599.74
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1038.45	$719.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1057.15	$730.60
OXNARD-THOUSAND OAKS-VENTURA (CA)	$918.15	$650.48
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$924.66	$656.76
NAPA (CA)	$988.42	$689.95
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1039.94	$720.63
VALLEJO (CA)	$986.28	$687.81
BAKERSFIELD (CA)	$874.21	$626.02
CHICO (CA)	$870.37	$622.17
FRESNO (CA)	$870.37	$622.17
HANFORD-CORCORAN (CA)	$870.37	$622.17
MADERA (CA)	$870.37	$622.17
MERCED (CA)	$870.37	$622.17
MODESTO (CA)	$870.37	$622.17
REDDING (CA)	$870.37	$622.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$884.56	$636.37
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$908.04	$644.67
SALINAS (CA)	$904.53	$642.06
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1063.23	$736.68
SANTA CRUZ-WATSONVILLE (CA)	$927.56	$652.41
SANTA ROSA-PETALUMA (CA)	$936.60	$658.51
STOCKTON (CA)	$870.37	$622.17
VISALIA (CA)	$870.37	$622.17
YUBA CITY (CA)	$870.37	$622.17
EL CENTRO (CA)	$870.59	$622.39
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$921.84	$650.99
SAN LUIS OBISPO-PASO ROBLES (CA)	$890.56	$632.62
SANTA MARIA-SANTA BARBARA (CA)	$906.83	$642.78
REST OF CALIFORNIA (CA)	$870.37	$622.17
COLORADO (CO)	$864.43	$623.47
CONNECTICUT (CT)	$891.91	$648.02
DC + MD/VA SUBURBS (DC)	$946.21	$679.44
DELAWARE (DE)	$831.61	$607.87
FORT LAUDERDALE (FL)	$881.49	$652.09
MIAMI (FL)	$926.19	$690.45
REST OF FLORIDA (FL)	$841.38	$624.88
ATLANTA (GA)	$857.32	$627.24
REST OF GEORGIA (GA)	$797.72	$595.71
HAWAII, GUAM (HI)	$885.95	$628.47
IOWA (IA)	$773.73	$566.52
IDAHO (ID)	$779.40	$571.06
EAST ST. LOUIS (IL)	$846.83	$638.49
SUBURBAN CHICAGO (IL)	$888.78	$656.21
CHICAGO (IL)	$901.33	$673.74
REST OF ILLINOIS (IL)	$823.81	$617.05
INDIANA (IN)	$783.26	$573.33
KANSAS (KS)	$773.25	$568.53
KENTUCKY (KY)	$784.19	$582.86
NEW ORLEANS (LA)	$818.28	$605.18
REST OF LOUISIANA (LA)	$784.19	$583.77
METROPOLITAN BOSTON (MA)	$939.72	$669.33
REST OF MASSACHUSETTS (MA)	$861.27	$622.81
BALTIMORE/SURR. CNTYS (MD)	$889.91	$646.92
REST OF MARYLAND (MD)	$845.35	$616.17
SOUTHERN MAINE (ME)	$819.66	$595.24
REST OF MAINE (ME)	$785.92	$577.58
DETROIT (MI)	$853.61	$635.08
REST OF MICHIGAN (MI)	$804.82	$598.06
MINNESOTA (MN)	$822.85	$589.82
METROPOLITAN ST. LOUIS (MO)	$817.58	$601.99
METROPOLITAN KANSAS CITY (MO)	$810.38	$597.74
REST OF MISSOURI (MO)	$774.09	$578.88
MISSISSIPPI (MS)	$763.34	$568.36
MONTANA** (MT)	$839.95	$613.49
NORTH CAROLINA (NC)	$792.77	$581.49
NORTH DAKOTA** (ND)	$814.04	$587.58
NEBRASKA (NE)	$776.66	$567.64
NEW HAMPSHIRE (NH)	$853.82	$618.07
NORTHERN NJ (NJ)	$938.73	$676.03
REST OF NEW JERSEY (NJ)	$900.55	$653.26
NEW MEXICO (NM)	$809.85	$602.19
NEVADA** (NV)	$833.20	$606.51
MANHATTAN (NY)	$962.66	$699.51
NYC SUBURBS/LONG ISLAND (NY)	$987.19	$717.94
POUGHKPSIE/N NYC SUBURBS (NY)	$908.53	$660.56
QUEENS (NY)	$965.75	$698.08
REST OF NEW YORK (NY)	$803.56	$588.42
OHIO (OH)	$799.53	$592.77
OKLAHOMA (OK)	$780.03	$577.80
PORTLAND (OR)	$886.19	$634.59
REST OF OREGON (OR)	$825.16	$599.61
METROPOLITAN PHILADELPHIA (PA)	$873.61	$637.87
REST OF PENNSYLVANIA (PA)	$799.12	$591.23
PUERTO RICO (PR)	$844.54	$615.59
RHODE ISLAND (RI)	$857.01	$623.08
SOUTH CAROLINA (SC)	$797.78	$588.53
SOUTH DAKOTA** (SD)	$810.98	$584.52
TENNESSEE (TN)	$777.04	$571.19
BRAZORIA (TX)	$828.79	$604.37
DALLAS (TX)	$834.88	$609.33
GALVESTON (TX)	$831.83	$606.96
HOUSTON (TX)	$855.81	$630.94
BEAUMONT (TX)	$794.66	$588.58
FORT WORTH (TX)	$830.75	$607.47
AUSTIN (TX)	$862.94	$623.34
REST OF TEXAS (TX)	$811.84	$596.93
UTAH (UT)	$807.39	$594.52
VIRGINIA (VA)	$819.19	$596.58
VIRGIN ISLANDS (VI)	$844.54	$615.59
VERMONT (VT)	$813.72	$589.53
SEATTLE (KING CNTY) (WA)	$954.96	$677.10
REST OF WASHINGTON (WA)	$858.71	$620.25
WISCONSIN (WI)	$790.03	$573.08
WEST VIRGINIA (WV)	$797.37	$600.58
WYOMING** (WY)	$828.66	$602.20

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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 — each adjusted by the Geographic Practice Cost Indices (GPCIs) for a given locality. These locality-adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the two amounts differ — non-facility rates typically reflect the practice bearing more overhead costs. The conversion factor and RVU values are updated annually by CMS and can shift the final figure even if the code itself doesn't change.

RVUs — work 9.78, practice expense 14.06 (non-facility) / 7.28 (facility), malpractice 1.31 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national or locality-adjusted PFS inputs — actual payment may differ.
Medicare typically pays 80% of the approved 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 all change the final paid amount.
Always confirm final allowed amounts and coverage policy with your local Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount?

Facility rates use a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) — not the billing physician's practice — is absorbing a larger share of overhead and equipment costs.

Does this amount reflect what Medicare will actually pay?

No. It's an estimate derived from standard PFS formulas. Actual payment depends on your specific locality, any applicable modifiers, patient deductible status, and other adjustments like sequestration.

Why do these amounts change every year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, so the same code can have a different allowed amount from one year to the next.

Can I bill the patient the difference between my charge and the Medicare amount?

This depends on whether you participate with Medicare, assignment rules, and any applicable limiting charge — consult your MAC or billing compliance resource for specifics.

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.