Medicare Reimbursement for CPT Code 21045

CPT code 21045 is a procedure code used in Medicare billing; the specific clinical description is proprietary to the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1061.15	$1061.15
ALASKA* (AK)	$1343.82	$1343.82
ALABAMA (AL)	$975.31	$975.31
ARKANSAS (AR)	$964.73	$964.73
ARIZONA (AZ)	$1036.57	$1036.57
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1218.62	$1218.62
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1236.98	$1236.98
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1111.55	$1111.55
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1123.41	$1123.41
NAPA (CA)	$1172.73	$1172.73
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1221.70	$1221.70
VALLEJO (CA)	$1168.29	$1168.29
BAKERSFIELD (CA)	$1072.87	$1072.87
CHICO (CA)	$1065.07	$1065.07
FRESNO (CA)	$1065.07	$1065.07
HANFORD-CORCORAN (CA)	$1065.07	$1065.07
MADERA (CA)	$1065.07	$1065.07
MERCED (CA)	$1065.07	$1065.07
MODESTO (CA)	$1065.07	$1065.07
REDDING (CA)	$1065.07	$1065.07
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1094.36	$1094.36
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1101.39	$1101.39
SALINAS (CA)	$1096.91	$1096.91
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1249.56	$1249.56
SANTA CRUZ-WATSONVILLE (CA)	$1111.78	$1111.78
SANTA ROSA-PETALUMA (CA)	$1122.01	$1122.01
STOCKTON (CA)	$1065.07	$1065.07
VISALIA (CA)	$1065.07	$1065.07
YUBA CITY (CA)	$1065.07	$1065.07
EL CENTRO (CA)	$1065.52	$1065.52
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1110.63	$1110.63
SAN LUIS OBISPO-PASO ROBLES (CA)	$1081.08	$1081.08
SANTA MARIA-SANTA BARBARA (CA)	$1097.72	$1097.72
REST OF CALIFORNIA (CA)	$1065.07	$1065.07
COLORADO (CO)	$1072.34	$1072.34
CONNECTICUT (CT)	$1120.80	$1120.80
DC + MD/VA SUBURBS (DC)	$1169.97	$1169.97
DELAWARE (DE)	$1050.53	$1050.53
FORT LAUDERDALE (FL)	$1139.13	$1139.13
MIAMI (FL)	$1214.82	$1214.82
REST OF FLORIDA (FL)	$1090.29	$1090.29
ATLANTA (GA)	$1087.09	$1087.09
REST OF GEORGIA (GA)	$1038.30	$1038.30
HAWAII, GUAM (HI)	$1074.06	$1074.06
IOWA (IA)	$974.91	$974.91
IDAHO (ID)	$983.65	$983.65
EAST ST. LOUIS (IL)	$1123.14	$1123.14
SUBURBAN CHICAGO (IL)	$1145.27	$1145.27
CHICAGO (IL)	$1184.41	$1184.41
REST OF ILLINOIS (IL)	$1079.71	$1079.71
INDIANA (IN)	$987.43	$987.43
KANSAS (KS)	$980.50	$980.50
KENTUCKY (KY)	$1012.11	$1012.11
NEW ORLEANS (LA)	$1051.48	$1051.48
REST OF LOUISIANA (LA)	$1014.52	$1014.52
METROPOLITAN BOSTON (MA)	$1147.97	$1147.97
REST OF MASSACHUSETTS (MA)	$1072.08	$1072.08
BALTIMORE/SURR. CNTYS (MD)	$1119.36	$1119.36
REST OF MARYLAND (MD)	$1064.18	$1064.18
SOUTHERN MAINE (ME)	$1024.39	$1024.39
REST OF MAINE (ME)	$997.14	$997.14
DETROIT (MI)	$1110.21	$1110.21
REST OF MICHIGAN (MI)	$1040.42	$1040.42
MINNESOTA (MN)	$1008.22	$1008.22
METROPOLITAN ST. LOUIS (MO)	$1043.45	$1043.45
METROPOLITAN KANSAS CITY (MO)	$1036.35	$1036.35
REST OF MISSOURI (MO)	$1007.40	$1007.40
MISSISSIPPI (MS)	$985.76	$985.76
MONTANA** (MT)	$1060.97	$1060.97
NORTH CAROLINA (NC)	$1003.52	$1003.52
NORTH DAKOTA** (ND)	$1007.38	$1007.38
NEBRASKA (NE)	$976.17	$976.17
NEW HAMPSHIRE (NH)	$1065.10	$1065.10
NORTHERN NJ (NJ)	$1164.58	$1164.58
REST OF NEW JERSEY (NJ)	$1128.12	$1128.12
NEW MEXICO (NM)	$1048.43	$1048.43
NEVADA** (NV)	$1046.40	$1046.40
MANHATTAN (NY)	$1212.81	$1212.81
NYC SUBURBS/LONG ISLAND (NY)	$1247.39	$1247.39
POUGHKPSIE/N NYC SUBURBS (NY)	$1142.45	$1142.45
QUEENS (NY)	$1207.22	$1207.22
REST OF NEW YORK (NY)	$1015.64	$1015.64
OHIO (OH)	$1029.47	$1029.47
OKLAHOMA (OK)	$1001.11	$1001.11
PORTLAND (OR)	$1088.88	$1088.88
REST OF OREGON (OR)	$1032.77	$1032.77
METROPOLITAN PHILADELPHIA (PA)	$1104.65	$1104.65
REST OF PENNSYLVANIA (PA)	$1025.63	$1025.63
PUERTO RICO (PR)	$1063.89	$1063.89
RHODE ISLAND (RI)	$1075.03	$1075.03
SOUTH CAROLINA (SC)	$1019.27	$1019.27
SOUTH DAKOTA** (SD)	$1001.04	$1001.04
TENNESSEE (TN)	$985.35	$985.35
BRAZORIA (TX)	$1042.67	$1042.67
DALLAS (TX)	$1052.19	$1052.19
GALVESTON (TX)	$1047.76	$1047.76
HOUSTON (TX)	$1097.36	$1097.36
BEAUMONT (TX)	$1021.20	$1021.20
FORT WORTH (TX)	$1049.64	$1049.64
AUSTIN (TX)	$1073.62	$1073.62
REST OF TEXAS (TX)	$1033.37	$1033.37
UTAH (UT)	$1029.57	$1029.57
VIRGINIA (VA)	$1028.20	$1028.20
VIRGIN ISLANDS (VI)	$1063.89	$1063.89
VERMONT (VT)	$1012.71	$1012.71
SEATTLE (KING CNTY) (WA)	$1159.03	$1159.03
REST OF WASHINGTON (WA)	$1067.03	$1067.03
WISCONSIN (WI)	$982.87	$982.87
WEST VIRGINIA (WV)	$1051.37	$1051.37
WYOMING** (WY)	$1037.61	$1037.61

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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 PFS amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by a locality-specific Geographic Practice Cost Index (GPCI) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs because overhead costs differ by site of service, which is why the two amounts can diverge. For this code, the non-facility and facility PE RVUs are the same, so the national allowed amounts are identical for both settings — though locality adjustments may still cause them to differ once geographic indices are applied.

RVUs — work 17.91, practice expense 11.15 (non-facility) / 11.15 (facility), malpractice 2.71 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure 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 rest.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does this code show different amounts by locality?

The Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs to reflect regional cost-of-living and cost-of-practice differences, so the same code can yield different allowed amounts in different areas.

Why are the non-facility and facility amounts the same for this code?

Because the practice-expense RVU is identical for both settings in this case, the national calculation produces the same total RVUs and therefore the same allowed amount before locality adjustment.

Is this the amount my practice will actually be paid?

No. This is an estimated PFS allowed amount. Actual payment depends on your specific locality, any applicable modifiers, the patient's deductible status, sequestration, and Medicare's annual budget-neutrality adjustments.

Where can I find the official rate for my area?

Your Medicare Administrative Contractor (MAC) publishes the finalized, locality-specific fee schedule, which should be used for authoritative billing decisions.

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.