Medicare Reimbursement for CPT 21040

CPT 21040 is a physician procedure code reported under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$479.97	$337.68
ALASKA* (AK)	$570.64	$419.10
ALABAMA (AL)	$433.88	$309.38
ARKANSAS (AR)	$428.07	$305.85
ARIZONA (AZ)	$467.82	$329.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$606.95	$406.33
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$618.41	$413.23
OXNARD-THOUSAND OAKS-VENTURA (CA)	$531.67	$363.49
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$534.86	$366.53
NAPA (CA)	$575.84	$388.31
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$607.62	$407.00
VALLEJO (CA)	$574.88	$387.34
BAKERSFIELD (CA)	$504.13	$348.18
CHICO (CA)	$502.37	$346.43
FRESNO (CA)	$502.37	$346.43
HANFORD-CORCORAN (CA)	$502.37	$346.43
MADERA (CA)	$502.37	$346.43
MERCED (CA)	$502.37	$346.43
MODESTO (CA)	$502.37	$346.43
REDDING (CA)	$502.37	$346.43
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$508.78	$352.83
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$525.53	$360.05
SALINAS (CA)	$523.53	$358.62
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$621.15	$415.97
SANTA CRUZ-WATSONVILLE (CA)	$538.75	$365.87
SANTA ROSA-PETALUMA (CA)	$544.09	$369.36
STOCKTON (CA)	$502.37	$346.43
VISALIA (CA)	$502.37	$346.43
YUBA CITY (CA)	$502.37	$346.43
EL CENTRO (CA)	$502.47	$346.52
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$534.60	$364.42
SAN LUIS OBISPO-PASO ROBLES (CA)	$515.29	$353.22
SANTA MARIA-SANTA BARBARA (CA)	$525.15	$359.24
REST OF CALIFORNIA (CA)	$502.37	$346.43
COLORADO (CO)	$496.79	$345.40
CONNECTICUT (CT)	$510.43	$357.19
DC + MD/VA SUBURBS (DC)	$544.29	$376.67
DELAWARE (DE)	$475.18	$334.60
FORT LAUDERDALE (FL)	$499.80	$355.66
MIAMI (FL)	$522.41	$374.29
REST OF FLORIDA (FL)	$476.67	$340.64
ATLANTA (GA)	$489.22	$344.65
REST OF GEORGIA (GA)	$451.32	$324.40
HAWAII, GUAM (HI)	$512.81	$351.03
IOWA (IA)	$442.56	$312.37
IDAHO (ID)	$445.56	$314.66
EAST ST. LOUIS (IL)	$475.93	$345.03
SUBURBAN CHICAGO (IL)	$504.41	$358.28
CHICAGO (IL)	$508.11	$365.11
REST OF ILLINOIS (IL)	$464.94	$335.03
INDIANA (IN)	$447.92	$316.02
KANSAS (KS)	$441.37	$312.74
KENTUCKY (KY)	$444.97	$318.47
NEW ORLEANS (LA)	$464.93	$331.04
REST OF LOUISIANA (LA)	$444.61	$318.69
METROPOLITAN BOSTON (MA)	$542.62	$372.72
REST OF MASSACHUSETTS (MA)	$494.44	$344.62
BALTIMORE/SURR. CNTYS (MD)	$509.12	$356.45
REST OF MARYLAND (MD)	$483.56	$339.56
SOUTHERN MAINE (ME)	$470.00	$328.99
REST OF MAINE (ME)	$448.50	$317.60
DETROIT (MI)	$482.98	$345.67
REST OF MICHIGAN (MI)	$456.39	$326.48
MINNESOTA (MN)	$474.81	$328.39
METROPOLITAN ST. LOUIS (MO)	$465.60	$330.14
METROPOLITAN KANSAS CITY (MO)	$461.20	$327.59
REST OF MISSOURI (MO)	$438.02	$315.37
MISSISSIPPI (MS)	$433.09	$310.58
MONTANA** (MT)	$479.93	$337.64
NORTH CAROLINA (NC)	$452.74	$319.98
NORTH DAKOTA** (ND)	$468.27	$325.98
NEBRASKA (NE)	$444.59	$313.26
NEW HAMPSHIRE (NH)	$489.82	$341.70
NORTHERN NJ (NJ)	$539.43	$374.38
REST OF NEW JERSEY (NJ)	$515.91	$360.53
NEW MEXICO (NM)	$459.01	$328.53
NEVADA** (NV)	$476.98	$334.55
MANHATTAN (NY)	$550.40	$385.06
NYC SUBURBS/LONG ISLAND (NY)	$563.85	$394.67
POUGHKPSIE/N NYC SUBURBS (NY)	$519.83	$364.03
QUEENS (NY)	$553.57	$385.39
REST OF NEW YORK (NY)	$459.10	$323.93
OHIO (OH)	$454.00	$324.10
OKLAHOMA (OK)	$443.45	$316.38
PORTLAND (OR)	$510.82	$352.73
REST OF OREGON (OR)	$472.92	$331.20
METROPOLITAN PHILADELPHIA (PA)	$498.97	$350.84
REST OF PENNSYLVANIA (PA)	$454.26	$323.64
PUERTO RICO (PR)	$482.98	$339.13
RHODE ISLAND (RI)	$490.79	$343.81
SOUTH CAROLINA (SC)	$454.19	$322.72
SOUTH DAKOTA** (SD)	$466.89	$324.60
TENNESSEE (TN)	$443.52	$314.18
BRAZORIA (TX)	$474.21	$333.21
DALLAS (TX)	$477.41	$335.69
GALVESTON (TX)	$475.76	$334.47
HOUSTON (TX)	$486.56	$345.27
BEAUMONT (TX)	$451.55	$322.07
FORT WORTH (TX)	$474.66	$334.37
AUSTIN (TX)	$495.46	$344.92
REST OF TEXAS (TX)	$462.75	$327.71
UTAH (UT)	$459.94	$326.19
VIRGINIA (VA)	$469.07	$329.20
VIRGIN ISLANDS (VI)	$482.98	$339.13
VERMONT (VT)	$467.23	$326.37
SEATTLE (KING CNTY) (WA)	$552.53	$377.94
REST OF WASHINGTON (WA)	$493.26	$343.43
WISCONSIN (WI)	$453.72	$317.41
WEST VIRGINIA (WV)	$449.13	$325.48
WYOMING** (WY)	$474.85	$332.56

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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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. 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 national 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 furnished.

RVUs — work 4.79, practice expense 8.99 (non-facility) / 4.73 (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 beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The facility rate uses lower practice-expense RVUs because overhead costs like equipment and supplies are typically borne by the facility (e.g., hospital) rather than the billing physician's practice.

Why might the amount for my locality differ from the national figure?

Locality-specific GPCIs adjust the work, practice-expense, and malpractice RVUs to reflect regional differences in costs, so the final allowed amount can be higher or lower than the national average.

Does this amount reflect what Medicare will actually pay?

No. The figure shown is the Medicare-allowed amount before the standard 80/20 cost-sharing split, deductible application, modifiers, and any sequestration or other adjustments are applied.

Why isn't the CPT code description shown here?

CPT code descriptors are copyrighted by the American Medical Association and are not reproduced on this page; consult your CPT codebook or EHR for 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.