Medicare Reimbursement for CPT 21031

CPT 21031 is a procedure code defined by the AMA; the descriptor itself is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and, where available, by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$389.45	$253.18
ALASKA* (AK)	$454.17	$309.04
ALABAMA (AL)	$349.78	$230.54
ARKANSAS (AR)	$344.77	$227.70
ARIZONA (AZ)	$379.09	$247.04
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$501.11	$308.96
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$510.88	$314.37
OXNARD-THOUSAND OAKS-VENTURA (CA)	$435.74	$274.67
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$438.00	$276.78
NAPA (CA)	$474.24	$294.63
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$501.59	$309.44
VALLEJO (CA)	$473.54	$293.93
BAKERSFIELD (CA)	$411.57	$262.21
CHICO (CA)	$410.30	$260.94
FRESNO (CA)	$410.30	$260.94
HANFORD-CORCORAN (CA)	$410.30	$260.94
MADERA (CA)	$410.30	$260.94
MERCED (CA)	$410.30	$260.94
MODESTO (CA)	$410.30	$260.94
REDDING (CA)	$410.30	$260.94
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$414.96	$265.60
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$430.27	$271.78
SALINAS (CA)	$428.66	$270.72
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$512.87	$316.36
SANTA CRUZ-WATSONVILLE (CA)	$442.57	$277.00
SANTA ROSA-PETALUMA (CA)	$447.02	$279.67
STOCKTON (CA)	$410.30	$260.94
VISALIA (CA)	$410.30	$260.94
YUBA CITY (CA)	$410.30	$260.94
EL CENTRO (CA)	$410.37	$261.02
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$438.54	$275.56
SAN LUIS OBISPO-PASO ROBLES (CA)	$421.81	$266.59
SANTA MARIA-SANTA BARBARA (CA)	$430.21	$271.32
REST OF CALIFORNIA (CA)	$410.30	$260.94
COLORADO (CO)	$404.72	$259.73
CONNECTICUT (CT)	$415.22	$268.45
DC + MD/VA SUBURBS (DC)	$444.51	$283.97
DELAWARE (DE)	$385.33	$250.69
FORT LAUDERDALE (FL)	$404.54	$266.49
MIAMI (FL)	$422.38	$280.52
REST OF FLORIDA (FL)	$384.91	$254.63
ATLANTA (GA)	$396.94	$258.49
REST OF GEORGIA (GA)	$363.32	$241.76
HAWAII, GUAM (HI)	$420.06	$265.12
IOWA (IA)	$358.05	$233.36
IDAHO (ID)	$360.48	$235.11
EAST ST. LOUIS (IL)	$382.61	$257.24
SUBURBAN CHICAGO (IL)	$408.52	$268.56
CHICAGO (IL)	$410.14	$273.19
REST OF ILLINOIS (IL)	$374.26	$249.84
INDIANA (IN)	$362.54	$236.21
KANSAS (KS)	$356.65	$233.45
KENTUCKY (KY)	$358.54	$237.39
NEW ORLEANS (LA)	$375.62	$247.39
REST OF LOUISIANA (LA)	$358.08	$237.48
METROPOLITAN BOSTON (MA)	$444.19	$281.47
REST OF MASSACHUSETTS (MA)	$402.44	$258.94
BALTIMORE/SURR. CNTYS (MD)	$414.11	$267.89
REST OF MARYLAND (MD)	$392.56	$254.65
SOUTHERN MAINE (ME)	$381.75	$246.70
REST OF MAINE (ME)	$362.62	$237.25
DETROIT (MI)	$389.94	$258.44
REST OF MICHIGAN (MI)	$368.03	$243.61
MINNESOTA (MN)	$387.10	$246.87
METROPOLITAN ST. LOUIS (MO)	$376.64	$246.91
METROPOLITAN KANSAS CITY (MO)	$372.80	$244.84
REST OF MISSOURI (MO)	$352.16	$234.69
MISSISSIPPI (MS)	$348.52	$231.18
MONTANA** (MT)	$389.43	$253.15
NORTH CAROLINA (NC)	$366.34	$239.20
NORTH DAKOTA** (ND)	$380.92	$244.65
NEBRASKA (NE)	$359.92	$234.14
NEW HAMPSHIRE (NH)	$398.63	$256.77
NORTHERN NJ (NJ)	$440.01	$281.93
REST OF NEW JERSEY (NJ)	$419.76	$270.95
NEW MEXICO (NM)	$370.14	$245.17
NEVADA** (NV)	$387.32	$250.91
MANHATTAN (NY)	$448.10	$289.74
NYC SUBURBS/LONG ISLAND (NY)	$459.21	$297.18
POUGHKPSIE/N NYC SUBURBS (NY)	$422.73	$273.50
QUEENS (NY)	$451.38	$290.30
REST OF NEW YORK (NY)	$371.81	$242.35
OHIO (OH)	$366.29	$241.87
OKLAHOMA (OK)	$357.62	$235.93
PORTLAND (OR)	$417.20	$265.79
REST OF OREGON (OR)	$384.12	$248.39
METROPOLITAN PHILADELPHIA (PA)	$405.13	$263.27
REST OF PENNSYLVANIA (PA)	$366.73	$241.63
PUERTO RICO (PR)	$392.18	$254.41
RHODE ISLAND (RI)	$398.78	$258.00
SOUTH CAROLINA (SC)	$366.97	$241.05
SOUTH DAKOTA** (SD)	$379.92	$243.64
TENNESSEE (TN)	$358.46	$234.58
BRAZORIA (TX)	$384.75	$249.70
DALLAS (TX)	$387.31	$251.58
GALVESTON (TX)	$385.97	$250.65
HOUSTON (TX)	$393.84	$258.52
BEAUMONT (TX)	$364.36	$240.35
FORT WORTH (TX)	$384.82	$250.46
AUSTIN (TX)	$403.55	$259.37
REST OF TEXAS (TX)	$374.42	$245.09
UTAH (UT)	$371.94	$243.84
VIRGINIA (VA)	$380.68	$246.72
VIRGIN ISLANDS (VI)	$392.18	$254.41
VERMONT (VT)	$379.68	$244.77
SEATTLE (KING CNTY) (WA)	$452.94	$285.73
REST OF WASHINGTON (WA)	$401.60	$258.10
WISCONSIN (WI)	$368.28	$237.73
WEST VIRGINIA (WV)	$360.60	$242.17
WYOMING** (WY)	$385.72	$249.44

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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) assigned to a code: physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for 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 estimate. Non-facility (e.g., office) and facility (e.g., hospital) settings use different PE RVUs because overhead costs differ, which is why two national and locality amounts are shown.

RVUs — work 3.22, practice expense 8.01 (non-facility) / 3.93 (facility), malpractice 0.43 — × 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, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the real payment can differ from the national figure shown here.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount different from the non-facility amount?

The facility amount uses a lower practice expense RVU because overhead costs (equipment, staff, supplies) are assumed to be covered by the facility rather than the billing provider.

Does this amount reflect what my specific MAC will pay?

Not exactly. The figure shown is based on national RVUs and GPCIs; actual payment depends on the specific locality, any applicable modifiers, and current sequestration or budget-neutrality adjustments.

Why can't you show the CPT code description?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page refers to the code generically rather than reproducing the official descriptor.

How often does the conversion factor change?

The conversion factor is updated annually by CMS, typically through rulemaking that also incorporates budget-neutrality adjustments across all codes.

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.