Medicare Reimbursement for CPT 21048

CPT 21048 is a procedure code reported to Medicare for professional services; the specific clinical description is maintained by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjusted for locality, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) settings. All figures are estimates based on published Medicare rate-setting inputs.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$906.83	$906.83
ALASKA* (AK)	$1143.91	$1143.91
ALABAMA (AL)	$835.19	$835.19
ARKANSAS (AR)	$826.28	$826.28
ARIZONA (AZ)	$886.93	$886.93
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1069.86	$1069.86
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1087.21	$1087.21
OXNARD-THOUSAND OAKS-VENTURA (CA)	$965.26	$965.26
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$974.26	$974.26
NAPA (CA)	$1025.45	$1025.45
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1071.86	$1071.86
VALLEJO (CA)	$1022.57	$1022.57
BAKERSFIELD (CA)	$928.38	$928.38
CHICO (CA)	$923.13	$923.13
FRESNO (CA)	$923.13	$923.13
HANFORD-CORCORAN (CA)	$923.13	$923.13
MADERA (CA)	$923.13	$923.13
MERCED (CA)	$923.13	$923.13
MODESTO (CA)	$923.13	$923.13
REDDING (CA)	$923.13	$923.13
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$942.25	$942.25
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$956.96	$956.96
SALINAS (CA)	$953.09	$953.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1095.38	$1095.38
SANTA CRUZ-WATSONVILLE (CA)	$968.97	$968.97
SANTA ROSA-PETALUMA (CA)	$978.08	$978.08
STOCKTON (CA)	$923.13	$923.13
VISALIA (CA)	$923.13	$923.13
YUBA CITY (CA)	$923.13	$923.13
EL CENTRO (CA)	$923.43	$923.43
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$966.62	$966.62
SAN LUIS OBISPO-PASO ROBLES (CA)	$939.00	$939.00
SANTA MARIA-SANTA BARBARA (CA)	$954.24	$954.24
REST OF CALIFORNIA (CA)	$923.13	$923.13
COLORADO (CO)	$923.33	$923.33
CONNECTICUT (CT)	$957.18	$957.18
DC + MD/VA SUBURBS (DC)	$1005.04	$1005.04
DELAWARE (DE)	$898.86	$898.86
FORT LAUDERDALE (FL)	$959.13	$959.13
MIAMI (FL)	$1011.85	$1011.85
REST OF FLORIDA (FL)	$920.16	$920.16
ATLANTA (GA)	$925.99	$925.99
REST OF GEORGIA (GA)	$878.26	$878.26
HAWAII, GUAM (HI)	$932.65	$932.65
IOWA (IA)	$840.01	$840.01
IDAHO (ID)	$846.33	$846.33
EAST ST. LOUIS (IL)	$936.92	$936.92
SUBURBAN CHICAGO (IL)	$965.53	$965.53
CHICAGO (IL)	$988.16	$988.16
REST OF ILLINOIS (IL)	$907.82	$907.82
INDIANA (IN)	$849.68	$849.68
KANSAS (KS)	$842.25	$842.25
KENTUCKY (KY)	$860.87	$860.87
NEW ORLEANS (LA)	$893.05	$893.05
REST OF LOUISIANA (LA)	$861.92	$861.92
METROPOLITAN BOSTON (MA)	$991.61	$991.61
REST OF MASSACHUSETTS (MA)	$922.13	$922.13
BALTIMORE/SURR. CNTYS (MD)	$955.37	$955.37
REST OF MARYLAND (MD)	$911.23	$911.23
SOUTHERN MAINE (ME)	$881.82	$881.82
REST OF MAINE (ME)	$855.09	$855.09
DETROIT (MI)	$934.24	$934.24
REST OF MICHIGAN (MI)	$882.31	$882.31
MINNESOTA (MN)	$876.15	$876.15
METROPOLITAN ST. LOUIS (MO)	$889.24	$889.24
METROPOLITAN KANSAS CITY (MO)	$882.97	$882.97
REST OF MISSOURI (MO)	$854.37	$854.37
MISSISSIPPI (MS)	$840.19	$840.19
MONTANA** (MT)	$906.72	$906.72
NORTH CAROLINA (NC)	$860.88	$860.88
NORTH DAKOTA** (ND)	$871.92	$871.92
NEBRASKA (NE)	$841.85	$841.85
NEW HAMPSHIRE (NH)	$914.62	$914.62
NORTHERN NJ (NJ)	$1000.06	$1000.06
REST OF NEW JERSEY (NJ)	$965.65	$965.65
NEW MEXICO (NM)	$888.02	$888.02
NEVADA** (NV)	$897.39	$897.39
MANHATTAN (NY)	$1031.73	$1031.73
NYC SUBURBS/LONG ISLAND (NY)	$1057.62	$1057.62
POUGHKPSIE/N NYC SUBURBS (NY)	$975.80	$975.80
QUEENS (NY)	$1030.64	$1030.64
REST OF NEW YORK (NY)	$870.92	$870.92
OHIO (OH)	$875.19	$875.19
OKLAHOMA (OK)	$854.23	$854.23
PORTLAND (OR)	$940.42	$940.42
REST OF OREGON (OR)	$887.90	$887.90
METROPOLITAN PHILADELPHIA (PA)	$941.93	$941.93
REST OF PENNSYLVANIA (PA)	$873.34	$873.34
PUERTO RICO (PR)	$910.01	$910.01
RHODE ISLAND (RI)	$921.77	$921.77
SOUTH CAROLINA (SC)	$869.97	$869.97
SOUTH DAKOTA** (SD)	$867.80	$867.80
TENNESSEE (TN)	$846.03	$846.03
BRAZORIA (TX)	$894.41	$894.41
DALLAS (TX)	$901.32	$901.32
GALVESTON (TX)	$897.97	$897.97
HOUSTON (TX)	$930.19	$930.19
BEAUMONT (TX)	$869.44	$869.44
FORT WORTH (TX)	$898.39	$898.39
AUSTIN (TX)	$922.50	$922.50
REST OF TEXAS (TX)	$882.31	$882.31
UTAH (UT)	$878.69	$878.69
VIRGINIA (VA)	$883.28	$883.28
VIRGIN ISLANDS (VI)	$910.01	$910.01
VERMONT (VT)	$874.10	$874.10
SEATTLE (KING CNTY) (WA)	$1003.81	$1003.81
REST OF WASHINGTON (WA)	$918.57	$918.57
WISCONSIN (WI)	$850.65	$850.65
WEST VIRGINIA (WV)	$883.82	$883.82
WYOMING** (WY)	$891.55	$891.55

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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 (PE), and malpractice (MP) — that reflect the relative resources involved in furnishing the service. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Conversion Factor (CF) to produce a dollar amount. Non-facility and facility settings can use different PE RVUs because overhead costs differ depending on where the service is rendered (e.g., physician office vs. hospital). The resulting total is the Medicare-allowed amount before any applicable modifiers, sequestration, or beneficiary cost-sharing are applied.

RVUs — work 14.34, practice expense 11.05 (non-facility) / 11.05 (facility), malpractice 1.76 — × 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.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the amount shown nationally will differ from what is paid in a specific Medicare Administrative Contractor (MAC) jurisdiction.
Always confirm current rates and coverage rules with your MAC before billing or appealing a denial.

Frequently asked

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

The two settings can use different practice-expense RVUs because Medicare assumes different overhead costs depending on whether the service is performed in a physician office versus a facility like a hospital or ASC.

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

The national amount uses a standardized GPCI baseline, while actual payments are adjusted using the GPCIs specific to the locality where the service was furnished, which can raise or lower the final rate.

Does this amount reflect what Medicare will actually pay?

No — this is the PFS allowed amount estimate. Actual payment is typically 80% of this amount after the deductible, and can be further affected by modifiers, sequestration, and claim-specific adjustments.

Why isn't the CPT code description shown on this page?

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.

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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.