Medicare Reimbursement for CPT Code 21026

CPT code 21026 is a physician procedure code; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$576.17	$413.50
ALASKA* (AK)	$681.52	$508.29
ALABAMA (AL)	$519.62	$377.29
ARKANSAS (AR)	$512.49	$372.77
ARIZONA (AZ)	$561.23	$403.61
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$729.22	$499.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$743.00	$508.44
OXNARD-THOUSAND OAKS-VENTURA (CA)	$638.43	$446.16
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$642.23	$449.80
NAPA (CA)	$691.74	$477.35
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$730.07	$500.72
VALLEJO (CA)	$690.51	$476.12
BAKERSFIELD (CA)	$604.98	$426.70
CHICO (CA)	$602.78	$424.50
FRESNO (CA)	$602.78	$424.50
HANFORD-CORCORAN (CA)	$602.78	$424.50
MADERA (CA)	$602.78	$424.50
MERCED (CA)	$602.78	$424.50
MODESTO (CA)	$602.78	$424.50
REDDING (CA)	$602.78	$424.50
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$610.90	$432.63
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$630.79	$441.61
SALINAS (CA)	$628.40	$439.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$746.48	$511.92
SANTA CRUZ-WATSONVILLE (CA)	$647.00	$449.37
SANTA ROSA-PETALUMA (CA)	$653.43	$453.68
STOCKTON (CA)	$602.78	$424.50
VISALIA (CA)	$602.78	$424.50
YUBA CITY (CA)	$602.78	$424.50
EL CENTRO (CA)	$602.90	$424.63
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$641.88	$447.34
SAN LUIS OBISPO-PASO ROBLES (CA)	$618.49	$433.22
SANTA MARIA-SANTA BARBARA (CA)	$630.40	$440.73
REST OF CALIFORNIA (CA)	$602.78	$424.50
COLORADO (CO)	$596.29	$423.22
CONNECTICUT (CT)	$613.28	$438.09
DC + MD/VA SUBURBS (DC)	$654.07	$462.45
DELAWARE (DE)	$570.18	$409.47
FORT LAUDERDALE (FL)	$601.16	$436.38
MIAMI (FL)	$629.45	$460.12
REST OF FLORIDA (FL)	$572.69	$417.18
ATLANTA (GA)	$587.60	$422.34
REST OF GEORGIA (GA)	$541.51	$396.42
HAWAII, GUAM (HI)	$615.68	$430.73
IOWA (IA)	$530.00	$381.16
IDAHO (ID)	$533.73	$384.08
EAST ST. LOUIS (IL)	$572.33	$422.69
SUBURBAN CHICAGO (IL)	$606.67	$439.62
CHICAGO (IL)	$611.73	$448.26
REST OF ILLINOIS (IL)	$558.48	$409.97
INDIANA (IN)	$536.61	$385.83
KANSAS (KS)	$528.66	$381.61
KENTUCKY (KY)	$533.48	$388.87
NEW ORLEANS (LA)	$558.01	$404.95
REST OF LOUISIANA (LA)	$533.09	$389.14
METROPOLITAN BOSTON (MA)	$651.91	$457.69
REST OF MASSACHUSETTS (MA)	$593.42	$422.13
BALTIMORE/SURR. CNTYS (MD)	$611.75	$437.21
REST OF MARYLAND (MD)	$580.35	$415.74
SOUTHERN MAINE (ME)	$563.63	$402.43
REST OF MAINE (ME)	$537.46	$387.81
DETROIT (MI)	$580.56	$423.59
REST OF MICHIGAN (MI)	$547.61	$399.10
MINNESOTA (MN)	$569.13	$401.75
METROPOLITAN ST. LOUIS (MO)	$558.68	$403.82
METROPOLITAN KANSAS CITY (MO)	$553.30	$400.56
REST OF MISSOURI (MO)	$525.09	$384.87
MISSISSIPPI (MS)	$518.84	$378.78
MONTANA** (MT)	$576.12	$413.45
NORTH CAROLINA (NC)	$542.64	$390.88
NORTH DAKOTA** (ND)	$561.29	$398.62
NEBRASKA (NE)	$532.45	$382.31
NEW HAMPSHIRE (NH)	$588.02	$418.68
NORTHERN NJ (NJ)	$648.03	$459.35
REST OF NEW JERSEY (NJ)	$619.64	$442.01
NEW MEXICO (NM)	$550.87	$401.71
NEVADA** (NV)	$572.35	$409.52
MANHATTAN (NY)	$661.93	$472.91
NYC SUBURBS/LONG ISLAND (NY)	$678.58	$485.18
POUGHKPSIE/N NYC SUBURBS (NY)	$624.50	$446.38
QUEENS (NY)	$665.63	$473.36
REST OF NEW YORK (NY)	$550.46	$395.93
OHIO (OH)	$544.58	$396.06
OKLAHOMA (OK)	$531.48	$386.22
PORTLAND (OR)	$613.28	$432.57
REST OF OREGON (OR)	$567.26	$405.25
METROPOLITAN PHILADELPHIA (PA)	$599.32	$429.99
REST OF PENNSYLVANIA (PA)	$544.82	$395.50
PUERTO RICO (PR)	$579.81	$415.36
RHODE ISLAND (RI)	$589.05	$421.02
SOUTH CAROLINA (SC)	$544.64	$394.34
SOUTH DAKOTA** (SD)	$559.53	$396.87
TENNESSEE (TN)	$531.32	$383.46
BRAZORIA (TX)	$568.85	$407.65
DALLAS (TX)	$572.82	$410.81
GALVESTON (TX)	$570.78	$409.26
HOUSTON (TX)	$584.51	$422.99
BEAUMONT (TX)	$541.50	$393.48
FORT WORTH (TX)	$569.49	$409.10
AUSTIN (TX)	$594.87	$422.78
REST OF TEXAS (TX)	$555.10	$400.73
UTAH (UT)	$551.69	$398.78
VIRGINIA (VA)	$562.59	$402.69
VIRGIN ISLANDS (VI)	$579.81	$415.36
VERMONT (VT)	$560.14	$399.10
SEATTLE (KING CNTY) (WA)	$663.81	$464.23
REST OF WASHINGTON (WA)	$591.96	$420.68
WISCONSIN (WI)	$543.48	$387.65
WEST VIRGINIA (WV)	$539.09	$397.74
WYOMING** (WY)	$569.65	$406.99

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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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to a locality. The adjusted RVUs are summed and multiplied by the annual national Conversion Factor to produce a dollar amount. Practice-expense RVUs differ depending on whether the service is reported in a non-facility (e.g., office) or facility (e.g., hospital) setting, which is why two different totals appear. Work and malpractice RVUs generally stay the same across settings, but GPCIs and the conversion factor can shift year to year and by location.

RVUs — work 5.56, practice expense 10.94 (non-facility) / 6.07 (facility), malpractice 0.75 — × 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 annual Part B deductible is met; 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.
Locality-specific GPICs can meaningfully raise or lower the amount compared to the national figure.
Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the amount differ between non-facility and facility settings?

The practice-expense RVU component is lower in facility settings because the facility (e.g., hospital) absorbs overhead costs like staff and supplies, whereas in non-facility settings the physician's practice bears those costs directly.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare Physician Fee Schedule allowed amount before the standard 20% coinsurance, deductible, sequestration, or any applicable modifiers are applied.

Why would the amount be different in my locality than the national figure?

Geographic Practice Cost Indices (GPCIs) adjust the RVUs based on local costs for labor, rent, and malpractice insurance, so the same code can have different allowed amounts across regions.

Why isn't the CPT code description shown here?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so this page references the code generically rather than reproducing the official descriptor.

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.