Medicare Reimbursement for CPT 21030

CPT 21030 is a procedure code used in medical billing; because CPT descriptors are proprietary to the AMA, this page refers to it generically rather than reproducing the official description. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for the code nationally and 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)	$475.96	$336.68
ALASKA* (AK)	$566.37	$418.03
ALABAMA (AL)	$430.38	$308.51
ARKANSAS (AR)	$424.63	$304.99
ARIZONA (AZ)	$463.94	$328.98
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$601.30	$404.91
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$612.63	$411.78
OXNARD-THOUSAND OAKS-VENTURA (CA)	$526.93	$362.30
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$530.12	$365.35
NAPA (CA)	$570.56	$386.99
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$601.97	$405.58
VALLEJO (CA)	$569.59	$386.02
BAKERSFIELD (CA)	$499.74	$347.09
CHICO (CA)	$497.98	$345.33
FRESNO (CA)	$497.98	$345.33
HANFORD-CORCORAN (CA)	$497.98	$345.33
MADERA (CA)	$497.98	$345.33
MERCED (CA)	$497.98	$345.33
MODESTO (CA)	$497.98	$345.33
REDDING (CA)	$497.98	$345.33
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$504.39	$351.73
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$520.87	$358.89
SALINAS (CA)	$518.88	$357.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$615.37	$414.52
SANTA CRUZ-WATSONVILLE (CA)	$533.88	$364.65
SANTA ROSA-PETALUMA (CA)	$539.17	$368.13
STOCKTON (CA)	$497.98	$345.33
VISALIA (CA)	$497.98	$345.33
YUBA CITY (CA)	$497.98	$345.33
EL CENTRO (CA)	$498.08	$345.43
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$529.81	$363.22
SAN LUIS OBISPO-PASO ROBLES (CA)	$510.72	$352.08
SANTA MARIA-SANTA BARBARA (CA)	$520.48	$358.08
REST OF CALIFORNIA (CA)	$497.98	$345.33
COLORADO (CO)	$492.53	$344.33
CONNECTICUT (CT)	$506.11	$356.11
DC + MD/VA SUBURBS (DC)	$539.56	$375.49
DELAWARE (DE)	$471.22	$333.61
FORT LAUDERDALE (FL)	$495.74	$354.64
MIAMI (FL)	$518.24	$373.25
REST OF FLORIDA (FL)	$472.84	$339.69
ATLANTA (GA)	$485.14	$343.63
REST OF GEORGIA (GA)	$447.75	$323.51
HAWAII, GUAM (HI)	$508.25	$349.89
IOWA (IA)	$438.90	$311.45
IDAHO (ID)	$441.88	$313.74
EAST ST. LOUIS (IL)	$472.24	$344.10
SUBURBAN CHICAGO (IL)	$500.30	$357.25
CHICAGO (IL)	$504.08	$364.11
REST OF ILLINOIS (IL)	$461.28	$334.12
INDIANA (IN)	$444.21	$315.09
KANSAS (KS)	$437.75	$311.84
KENTUCKY (KY)	$441.40	$317.58
NEW ORLEANS (LA)	$461.16	$330.10
REST OF LOUISIANA (LA)	$441.06	$317.80
METROPOLITAN BOSTON (MA)	$537.83	$371.53
REST OF MASSACHUSETTS (MA)	$490.22	$343.56
BALTIMORE/SURR. CNTYS (MD)	$504.82	$355.37
REST OF MARYLAND (MD)	$479.50	$338.55
SOUTHERN MAINE (ME)	$466.02	$328.00
REST OF MAINE (ME)	$444.81	$316.67
DETROIT (MI)	$479.11	$344.71
REST OF MICHIGAN (MI)	$452.73	$325.57
MINNESOTA (MN)	$470.68	$327.36
METROPOLITAN ST. LOUIS (MO)	$461.78	$329.19
METROPOLITAN KANSAS CITY (MO)	$457.44	$326.65
REST OF MISSOURI (MO)	$434.57	$314.50
MISSISSIPPI (MS)	$429.64	$309.72
MONTANA** (MT)	$475.92	$336.64
NORTH CAROLINA (NC)	$449.00	$319.05
NORTH DAKOTA** (ND)	$464.26	$324.98
NEBRASKA (NE)	$440.89	$312.34
NEW HAMPSHIRE (NH)	$485.65	$340.65
NORTHERN NJ (NJ)	$534.78	$373.22
REST OF NEW JERSEY (NJ)	$511.53	$359.43
NEW MEXICO (NM)	$455.33	$327.61
NEVADA** (NV)	$472.97	$333.55
MANHATTAN (NY)	$545.75	$383.90
NYC SUBURBS/LONG ISLAND (NY)	$559.08	$393.48
POUGHKPSIE/N NYC SUBURBS (NY)	$515.45	$362.93
QUEENS (NY)	$548.83	$384.20
REST OF NEW YORK (NY)	$455.30	$322.98
OHIO (OH)	$450.35	$323.18
OKLAHOMA (OK)	$439.87	$315.49
PORTLAND (OR)	$506.36	$351.62
REST OF OREGON (OR)	$468.92	$330.20
METROPOLITAN PHILADELPHIA (PA)	$494.79	$349.80
REST OF PENNSYLVANIA (PA)	$450.59	$322.72
PUERTO RICO (PR)	$478.93	$338.11
RHODE ISLAND (RI)	$486.65	$342.77
SOUTH CAROLINA (SC)	$450.49	$321.79
SOUTH DAKOTA** (SD)	$462.88	$323.60
TENNESSEE (TN)	$439.88	$313.27
BRAZORIA (TX)	$470.24	$332.21
DALLAS (TX)	$473.42	$334.69
GALVESTON (TX)	$471.78	$333.47
HOUSTON (TX)	$482.58	$344.27
BEAUMONT (TX)	$447.90	$321.15
FORT WORTH (TX)	$470.71	$333.38
AUSTIN (TX)	$491.22	$343.86
REST OF TEXAS (TX)	$458.94	$326.76
UTAH (UT)	$456.18	$325.25
VIRGINIA (VA)	$465.13	$328.22
VIRGIN ISLANDS (VI)	$478.93	$338.11
VERMONT (VT)	$463.27	$325.38
SEATTLE (KING CNTY) (WA)	$547.61	$376.71
REST OF WASHINGTON (WA)	$489.03	$342.37
WISCONSIN (WI)	$449.88	$316.45
WEST VIRGINIA (WV)	$445.65	$324.61
WYOMING** (WY)	$470.84	$331.56

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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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) assigned to a 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 allowed amount. Non-facility and facility settings use different practice-expense RVUs because facilities (like hospitals) absorb certain overhead costs, which typically results in a lower facility-rate amount compared to non-facility.

RVUs — work 4.79, practice expense 8.87 (non-facility) / 4.7 (facility), malpractice 0.59 — × 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 insurer is responsible for the remainder.
Actual payment can vary due to modifiers, place-of-service rules, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Rates differ by locality based on GPCI values, which are updated periodically.
Always verify current rates and coverage policy 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 this code?

The practice-expense RVU component is lower in the facility setting because the facility (such as a hospital) bears more of the overhead costs, whereas in a non-facility setting the billing provider covers those costs directly.

Does this amount reflect what my practice will actually be paid?

No. It is a national or locality-adjusted estimate based on standard PFS inputs. Actual reimbursement depends on your specific locality, any applicable modifiers, secondary payer coordination, and current sequestration or budget-neutrality adjustments.

Why can't you show the official CPT code description?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA). This page refers to the code generically and does not reproduce the official descriptor.

How often do these Medicare Physician Fee Schedule amounts change?

The conversion factor, RVUs, and GPCIs are typically updated annually by CMS, and mid-year adjustments can occur due to legislative or regulatory changes.

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.