Medicare Reimbursement for CPT 21050

This page covers CPT code 21050, a physician procedure code billed to Medicare. It shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both at the national level and adjusted for a specific locality, and compares non-facility (office) versus facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$795.94	$795.94
ALASKA* (AK)	$985.83	$985.83
ALABAMA (AL)	$727.21	$727.21
ARKANSAS (AR)	$718.66	$718.66
ARIZONA (AZ)	$776.88	$776.88
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$946.99	$946.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$962.62	$962.62
OXNARD-THOUSAND OAKS-VENTURA (CA)	$850.81	$850.81
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$858.42	$858.42
NAPA (CA)	$906.45	$906.45
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$948.87	$948.87
VALLEJO (CA)	$903.73	$903.73
BAKERSFIELD (CA)	$815.85	$815.85
CHICO (CA)	$811.04	$811.04
FRESNO (CA)	$811.04	$811.04
HANFORD-CORCORAN (CA)	$811.04	$811.04
MADERA (CA)	$811.04	$811.04
MERCED (CA)	$811.04	$811.04
MODESTO (CA)	$811.04	$811.04
REDDING (CA)	$811.04	$811.04
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$829.00	$829.00
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$842.26	$842.26
SALINAS (CA)	$838.92	$838.92
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$970.32	$970.32
SANTA CRUZ-WATSONVILLE (CA)	$855.10	$855.10
SANTA ROSA-PETALUMA (CA)	$863.19	$863.19
STOCKTON (CA)	$811.04	$811.04
VISALIA (CA)	$811.04	$811.04
YUBA CITY (CA)	$811.04	$811.04
EL CENTRO (CA)	$811.32	$811.32
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$852.09	$852.09
SAN LUIS OBISPO-PASO ROBLES (CA)	$826.41	$826.41
SANTA MARIA-SANTA BARBARA (CA)	$840.27	$840.27
REST OF CALIFORNIA (CA)	$811.04	$811.04
COLORADO (CO)	$811.27	$811.27
CONNECTICUT (CT)	$842.77	$842.77
DC + MD/VA SUBURBS (DC)	$886.51	$886.51
DELAWARE (DE)	$787.97	$787.97
FORT LAUDERDALE (FL)	$845.39	$845.39
MIAMI (FL)	$895.37	$895.37
REST OF FLORIDA (FL)	$808.11	$808.11
ATLANTA (GA)	$813.96	$813.96
REST OF GEORGIA (GA)	$767.99	$767.99
HAWAII, GUAM (HI)	$821.56	$821.56
IOWA (IA)	$732.13	$732.13
IDAHO (ID)	$738.13	$738.13
EAST ST. LOUIS (IL)	$823.57	$823.57
SUBURBAN CHICAGO (IL)	$851.08	$851.08
CHICAGO (IL)	$872.21	$872.21
REST OF ILLINOIS (IL)	$796.07	$796.07
INDIANA (IN)	$741.36	$741.36
KANSAS (KS)	$734.13	$734.13
KENTUCKY (KY)	$751.56	$751.56
NEW ORLEANS (LA)	$782.40	$782.40
REST OF LOUISIANA (LA)	$752.51	$752.51
METROPOLITAN BOSTON (MA)	$874.89	$874.89
REST OF MASSACHUSETTS (MA)	$809.76	$809.76
BALTIMORE/SURR. CNTYS (MD)	$841.30	$841.30
REST OF MARYLAND (MD)	$799.52	$799.52
SOUTHERN MAINE (ME)	$772.27	$772.27
REST OF MAINE (ME)	$746.39	$746.39
DETROIT (MI)	$821.47	$821.47
REST OF MICHIGAN (MI)	$772.00	$772.00
MINNESOTA (MN)	$767.27	$767.27
METROPOLITAN ST. LOUIS (MO)	$778.90	$778.90
METROPOLITAN KANSAS CITY (MO)	$772.87	$772.87
REST OF MISSOURI (MO)	$745.18	$745.18
MISSISSIPPI (MS)	$731.80	$731.80
MONTANA** (MT)	$795.83	$795.83
NORTH CAROLINA (NC)	$751.98	$751.98
NORTH DAKOTA** (ND)	$763.01	$763.01
NEBRASKA (NE)	$733.94	$733.94
NEW HAMPSHIRE (NH)	$803.67	$803.67
NORTHERN NJ (NJ)	$881.03	$881.03
REST OF NEW JERSEY (NJ)	$849.53	$849.53
NEW MEXICO (NM)	$777.42	$777.42
NEVADA** (NV)	$787.04	$787.04
MANHATTAN (NY)	$910.85	$910.85
NYC SUBURBS/LONG ISLAND (NY)	$935.53	$935.53
POUGHKPSIE/N NYC SUBURBS (NY)	$858.78	$858.78
QUEENS (NY)	$910.01	$910.01
REST OF NEW YORK (NY)	$761.61	$761.61
OHIO (OH)	$765.29	$765.29
OKLAHOMA (OK)	$745.34	$745.34
PORTLAND (OR)	$827.55	$827.55
REST OF OREGON (OR)	$778.05	$778.05
METROPOLITAN PHILADELPHIA (PA)	$828.19	$828.19
REST OF PENNSYLVANIA (PA)	$763.59	$763.59
PUERTO RICO (PR)	$799.04	$799.04
RHODE ISLAND (RI)	$809.03	$809.03
SOUTH CAROLINA (SC)	$760.47	$760.47
SOUTH DAKOTA** (SD)	$759.13	$759.13
TENNESSEE (TN)	$737.75	$737.75
BRAZORIA (TX)	$783.59	$783.59
DALLAS (TX)	$790.09	$790.09
GALVESTON (TX)	$786.97	$786.97
HOUSTON (TX)	$817.35	$817.35
BEAUMONT (TX)	$759.84	$759.84
FORT WORTH (TX)	$787.24	$787.24
AUSTIN (TX)	$811.12	$811.12
REST OF TEXAS (TX)	$772.34	$772.34
UTAH (UT)	$768.84	$768.84
VIRGINIA (VA)	$773.57	$773.57
VIRGIN ISLANDS (VI)	$799.04	$799.04
VERMONT (VT)	$764.98	$764.98
SEATTLE (KING CNTY) (WA)	$886.08	$886.08
REST OF WASHINGTON (WA)	$806.61	$806.61
WISCONSIN (WI)	$742.56	$742.56
WEST VIRGINIA (WV)	$773.02	$773.02
WYOMING** (WY)	$781.53	$781.53

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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: Policy. 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

The Medicare PFS amount is built from three Relative Value Units (RVUs) assigned to this procedure code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs typically differ between non-facility (e.g., physician office) and facility (e.g., hospital, ASC) settings because overhead costs differ, which is why the two allowed amounts can vary. For this code, work and malpractice RVUs stay constant across settings, while practice-expense RVU may shift depending on where the service is performed.

RVUs — work 11.47, practice expense 10.7 (non-facility) / 10.7 (facility), malpractice 1.66 — × 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 generally responsible for the remainder.
Actual payment varies by locality, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify the current allowed amount and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

The practice-expense RVU component often differs because Medicare assumes different overhead costs when a service is performed in a facility (like a hospital) versus a non-facility setting (like a physician's office).

Does this amount reflect what Medicare will actually pay?

No. This is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the patient's deductible, and actual payment can be affected by modifiers, place of service, and other claim-specific factors.

Why do amounts change year to year?

The conversion factor and RVUs are updated annually by CMS, often due to legislative changes, budget-neutrality adjustments, and periodic revaluation of specific codes.

Can I use this number to predict secondary insurance payment?

Not reliably. Secondary payers may use different allowed amounts, coordination-of-benefits rules, or contracted rates that differ from the Medicare PFS amount shown here.

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.