Medicare Reimbursement for CPT 21029

CPT 21029 is a physician procedure code billed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed payment amount for this code at the national level and adjusted by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$813.65	$571.16
ALASKA* (AK)	$962.21	$703.95
ALABAMA (AL)	$732.16	$519.98
ARKANSAS (AR)	$721.93	$513.64
ARIZONA (AZ)	$791.80	$556.82
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1016.76	$674.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1035.45	$685.78
OXNARD-THOUSAND OAKS-VENTURA (CA)	$894.45	$607.82
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$900.34	$613.48
NAPA (CA)	$966.19	$646.59
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1018.29	$676.38
VALLEJO (CA)	$963.98	$644.38
BAKERSFIELD (CA)	$848.76	$582.99
CHICO (CA)	$844.92	$579.15
FRESNO (CA)	$844.92	$579.15
HANFORD-CORCORAN (CA)	$844.92	$579.15
MADERA (CA)	$844.92	$579.15
MERCED (CA)	$844.92	$579.15
MODESTO (CA)	$844.92	$579.15
REDDING (CA)	$844.92	$579.15
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$859.49	$593.72
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$883.30	$601.28
SALINAS (CA)	$879.95	$598.91
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1041.72	$692.04
SANTA CRUZ-WATSONVILLE (CA)	$904.96	$610.33
SANTA ROSA-PETALUMA (CA)	$913.86	$616.08
STOCKTON (CA)	$844.92	$579.15
VISALIA (CA)	$844.92	$579.15
YUBA CITY (CA)	$844.92	$579.15
EL CENTRO (CA)	$845.15	$579.38
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$898.28	$608.26
SAN LUIS OBISPO-PASO ROBLES (CA)	$866.22	$590.02
SANTA MARIA-SANTA BARBARA (CA)	$882.60	$599.86
REST OF CALIFORNIA (CA)	$844.92	$579.15
COLORADO (CO)	$838.75	$580.74
CONNECTICUT (CT)	$866.72	$605.56
DC + MD/VA SUBURBS (DC)	$921.66	$636.01
DELAWARE (DE)	$804.51	$564.93
FORT LAUDERDALE (FL)	$856.52	$610.88
MIAMI (FL)	$902.90	$650.47
REST OF FLORIDA (FL)	$814.53	$582.71
ATLANTA (GA)	$831.45	$585.08
REST OF GEORGIA (GA)	$768.81	$552.51
HAWAII, GUAM (HI)	$862.52	$586.81
IOWA (IA)	$744.35	$522.47
IDAHO (ID)	$750.26	$527.16
EAST ST. LOUIS (IL)	$819.74	$596.65
SUBURBAN CHICAGO (IL)	$863.74	$614.71
CHICAGO (IL)	$876.43	$632.73
REST OF ILLINOIS (IL)	$795.94	$574.54
INDIANA (IN)	$754.31	$529.52
KANSAS (KS)	$743.73	$524.52
KENTUCKY (KY)	$754.83	$539.26
NEW ORLEANS (LA)	$790.55	$562.37
REST OF LOUISIANA (LA)	$754.79	$540.18
METROPOLITAN BOSTON (MA)	$915.98	$626.45
REST OF MASSACHUSETTS (MA)	$835.12	$579.77
BALTIMORE/SURR. CNTYS (MD)	$864.86	$604.67
REST OF MARYLAND (MD)	$818.62	$573.22
SOUTHERN MAINE (ME)	$792.55	$552.24
REST OF MAINE (ME)	$756.97	$533.88
DETROIT (MI)	$827.24	$593.24
REST OF MICHIGAN (MI)	$776.37	$554.97
MINNESOTA (MN)	$796.27	$546.74
METROPOLITAN ST. LOUIS (MO)	$789.96	$559.11
METROPOLITAN KANSAS CITY (MO)	$782.39	$554.69
REST OF MISSOURI (MO)	$744.12	$535.09
MISSISSIPPI (MS)	$733.03	$524.24
MONTANA** (MT)	$813.56	$571.07
NORTH CAROLINA (NC)	$764.18	$537.94
NORTH DAKOTA** (ND)	$786.86	$544.37
NEBRASKA (NE)	$747.46	$523.64
NEW HAMPSHIRE (NH)	$828.32	$575.89
NORTHERN NJ (NJ)	$913.18	$631.89
REST OF NEW JERSEY (NJ)	$874.52	$609.72
NEW MEXICO (NM)	$781.60	$559.23
NEVADA** (NV)	$806.61	$563.88
MANHATTAN (NY)	$937.80	$656.03
NYC SUBURBS/LONG ISLAND (NY)	$963.39	$675.07
POUGHKPSIE/N NYC SUBURBS (NY)	$882.47	$616.94
QUEENS (NY)	$941.21	$654.59
REST OF NEW YORK (NY)	$775.49	$545.12
OHIO (OH)	$770.91	$549.52
OKLAHOMA (OK)	$750.59	$534.05
PORTLAND (OR)	$861.46	$592.05
REST OF OREGON (OR)	$798.27	$556.75
METROPOLITAN PHILADELPHIA (PA)	$847.58	$595.14
REST OF PENNSYLVANIA (PA)	$770.55	$547.94
PUERTO RICO (PR)	$818.42	$573.26
RHODE ISLAND (RI)	$830.31	$579.82
SOUTH CAROLINA (SC)	$769.24	$545.18
SOUTH DAKOTA** (SD)	$783.71	$541.21
TENNESSEE (TN)	$747.69	$527.27
BRAZORIA (TX)	$801.45	$561.15
DALLAS (TX)	$807.72	$566.20
GALVESTON (TX)	$804.61	$563.82
HOUSTON (TX)	$829.32	$588.53
BEAUMONT (TX)	$765.86	$545.20
FORT WORTH (TX)	$803.35	$564.26
AUSTIN (TX)	$837.78	$581.23
REST OF TEXAS (TX)	$784.01	$553.89
UTAH (UT)	$779.33	$551.39
VIRGINIA (VA)	$791.97	$553.60
VIRGIN ISLANDS (VI)	$818.42	$573.26
VERMONT (VT)	$786.42	$546.35
SEATTLE (KING CNTY) (WA)	$931.50	$633.96
REST OF WASHINGTON (WA)	$832.67	$577.33
WISCONSIN (WI)	$761.64	$529.33
WEST VIRGINIA (WV)	$768.19	$557.47
WYOMING** (WY)	$801.92	$559.43

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit 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) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the 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 and facility settings because overhead costs (equipment, supplies, staff) are treated differently depending on where the service is rendered.

RVUs — work 8.18, practice expense 14.83 (non-facility) / 7.57 (facility), malpractice 1.35 — × 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 annual deductible; the patient or secondary payer is generally responsible for the remainder.
Actual payment can vary based on the specific locality, applicable modifiers, claims sequestration, and annual budget-neutrality adjustments.
Always confirm the exact allowed amount and any applicable edits with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 21029?

The practice expense RVU component is lower in the facility setting because the facility (not the billing physician) incurs the overhead costs such as equipment and supplies, whereas the non-facility rate reflects those costs being borne by the physician's own practice.

Why might the amount I'm paid differ from the national rate shown here?

The national rate reflects an unadjusted conversion factor applied to RVUs; actual payments are adjusted by locality-specific GPCIs, so amounts can be higher or lower depending on where the service is performed.

Does this amount represent what the patient will owe?

No. The figures shown represent the total Medicare-allowed amount. Medicare generally pays 80% of this after the deductible is met, with the remaining portion owed by the patient or a secondary payer.

Can modifiers change the reimbursement for this code?

Yes. Modifiers (such as those indicating bilateral procedures, reduced services, or multiple procedures) can increase or decrease the final allowed amount relative to the base rate shown here.

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.