Medicare Reimbursement for CPT 21046

This page covers the Medicare Physician Fee Schedule (PFS) estimated allowed amount for CPT code 21046, a procedure code defined by the American Medical Association. Amounts are shown nationally and can vary by locality, as well as by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$899.49	$899.49
ALASKA* (AK)	$1128.97	$1128.97
ALABAMA (AL)	$826.71	$826.71
ARKANSAS (AR)	$817.66	$817.66
ARIZONA (AZ)	$879.30	$879.30
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1064.65	$1064.65
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1082.04	$1082.04
OXNARD-THOUSAND OAKS-VENTURA (CA)	$959.09	$959.09
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$967.89	$967.89
NAPA (CA)	$1019.94	$1019.94
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1066.65	$1066.65
VALLEJO (CA)	$1017.06	$1017.06
BAKERSFIELD (CA)	$921.59	$921.59
CHICO (CA)	$916.37	$916.37
FRESNO (CA)	$916.37	$916.37
HANFORD-CORCORAN (CA)	$916.37	$916.37
MADERA (CA)	$916.37	$916.37
MERCED (CA)	$916.37	$916.37
MODESTO (CA)	$916.37	$916.37
REDDING (CA)	$916.37	$916.37
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$935.47	$935.47
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$950.49	$950.49
SALINAS (CA)	$946.67	$946.67
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1090.22	$1090.22
SANTA CRUZ-WATSONVILLE (CA)	$963.22	$963.22
SANTA ROSA-PETALUMA (CA)	$972.29	$972.29
STOCKTON (CA)	$916.37	$916.37
VISALIA (CA)	$916.37	$916.37
YUBA CITY (CA)	$916.37	$916.37
EL CENTRO (CA)	$916.67	$916.67
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$960.55	$960.55
SAN LUIS OBISPO-PASO ROBLES (CA)	$932.63	$932.63
SANTA MARIA-SANTA BARBARA (CA)	$947.93	$947.93
REST OF CALIFORNIA (CA)	$916.37	$916.37
COLORADO (CO)	$916.36	$916.36
CONNECTICUT (CT)	$950.20	$950.20
DC + MD/VA SUBURBS (DC)	$998.41	$998.41
DELAWARE (DE)	$891.32	$891.32
FORT LAUDERDALE (FL)	$951.90	$951.90
MIAMI (FL)	$1004.87	$1004.87
REST OF FLORIDA (FL)	$912.42	$912.42
ATLANTA (GA)	$918.74	$918.74
REST OF GEORGIA (GA)	$869.94	$869.94
HAWAII, GUAM (HI)	$926.54	$926.54
IOWA (IA)	$831.90	$831.90
IDAHO (ID)	$838.26	$838.26
EAST ST. LOUIS (IL)	$928.85	$928.85
SUBURBAN CHICAGO (IL)	$958.32	$958.32
CHICAGO (IL)	$980.74	$980.74
REST OF ILLINOIS (IL)	$899.69	$899.69
INDIANA (IN)	$841.67	$841.67
KANSAS (KS)	$834.03	$834.03
KENTUCKY (KY)	$852.52	$852.52
NEW ORLEANS (LA)	$885.17	$885.17
REST OF LOUISIANA (LA)	$853.54	$853.54
METROPOLITAN BOSTON (MA)	$985.34	$985.34
REST OF MASSACHUSETTS (MA)	$914.99	$914.99
BALTIMORE/SURR. CNTYS (MD)	$948.42	$948.42
REST OF MARYLAND (MD)	$903.83	$903.83
SOUTHERN MAINE (ME)	$874.39	$874.39
REST OF MAINE (ME)	$847.02	$847.02
DETROIT (MI)	$926.58	$926.58
REST OF MICHIGAN (MI)	$874.18	$874.18
MINNESOTA (MN)	$869.07	$869.07
METROPOLITAN ST. LOUIS (MO)	$881.46	$881.46
METROPOLITAN KANSAS CITY (MO)	$875.07	$875.07
REST OF MISSOURI (MO)	$845.78	$845.78
MISSISSIPPI (MS)	$831.59	$831.59
MONTANA** (MT)	$899.37	$899.37
NORTH CAROLINA (NC)	$852.93	$852.93
NORTH DAKOTA** (ND)	$864.57	$864.57
NEBRASKA (NE)	$833.81	$833.81
NEW HAMPSHIRE (NH)	$907.64	$907.64
NORTHERN NJ (NJ)	$993.12	$993.12
REST OF NEW JERSEY (NJ)	$958.48	$958.48
NEW MEXICO (NM)	$879.92	$879.92
NEVADA** (NV)	$890.05	$890.05
MANHATTAN (NY)	$1024.79	$1024.79
NYC SUBURBS/LONG ISLAND (NY)	$1050.93	$1050.93
POUGHKPSIE/N NYC SUBURBS (NY)	$968.57	$968.57
QUEENS (NY)	$1023.89	$1023.89
REST OF NEW YORK (NY)	$863.12	$863.12
OHIO (OH)	$867.06	$867.06
OKLAHOMA (OK)	$845.92	$845.92
PORTLAND (OR)	$933.81	$933.81
REST OF OREGON (OR)	$880.51	$880.51
METROPOLITAN PHILADELPHIA (PA)	$934.66	$934.66
REST OF PENNSYLVANIA (PA)	$865.25	$865.25
PUERTO RICO (PR)	$902.76	$902.76
RHODE ISLAND (RI)	$914.40	$914.40
SOUTH CAROLINA (SC)	$861.93	$861.93
SOUTH DAKOTA** (SD)	$860.45	$860.45
TENNESSEE (TN)	$837.86	$837.86
BRAZORIA (TX)	$886.85	$886.85
DALLAS (TX)	$893.79	$893.79
GALVESTON (TX)	$890.43	$890.43
HOUSTON (TX)	$922.64	$922.64
BEAUMONT (TX)	$861.28	$861.28
FORT WORTH (TX)	$890.77	$890.77
AUSTIN (TX)	$915.64	$915.64
REST OF TEXAS (TX)	$874.50	$874.50
UTAH (UT)	$870.80	$870.80
VIRGINIA (VA)	$875.78	$875.78
VIRGIN ISLANDS (VI)	$902.76	$902.76
VERMONT (VT)	$866.67	$866.67
SEATTLE (KING CNTY) (WA)	$997.69	$997.69
REST OF WASHINGTON (WA)	$911.49	$911.49
WISCONSIN (WI)	$842.93	$842.93
WEST VIRGINIA (WV)	$875.29	$875.29
WYOMING** (WY)	$884.20	$884.20

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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) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The geographically adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs, reflecting whether the practice bears overhead costs (e.g., office setting) versus a facility (e.g., hospital) bearing them; for this code, those practice-expense RVUs are the same in both settings. The final figure represents the full allowed amount before any patient cost-sharing is applied.

RVUs — work 13.85, practice expense 11.32 (non-facility) / 11.32 (facility), malpractice 1.76 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national PFS data and the inputs shown; actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient meets their annual Part B deductible.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify current, locality-specific rates with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does this code show the same amount for non-facility and facility settings?

The practice-expense RVU used in this calculation is identical for both settings, so the geographically adjusted totals come out the same. This isn't true for every code.

Is this the amount Medicare will actually pay?

No. This is the PFS allowed amount estimate. Medicare generally pays 80% of this figure after the deductible, and the patient or secondary insurer is typically responsible for the remainder.

Why might my locality's amount differ from the national figure?

Local GPCIs adjust the work, practice-expense, and malpractice RVUs to reflect regional cost differences, so the geographically adjusted amount can be higher or lower than the national average.

Can I get the exact CPT descriptor for 21046 on this page?

No. CPT code descriptors are licensed by the AMA and are not reproduced here; consult your CPT codebook or AMA resources for the official language.

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.