Medicare Reimbursement for CPT 21073
This page covers CPT code 21073, a procedure code defined by the American Medical Association. It shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and adjusted by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $429.87 | $223.45 |
| ALASKA* (AK) | $498.39 | $278.55 |
| ALABAMA (AL) | $385.21 | $204.59 |
| ARKANSAS (AR) | $379.57 | $202.25 |
| ARIZONA (AZ) | $418.21 | $218.19 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $554.97 | $263.92 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $565.86 | $268.20 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $481.86 | $237.88 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $484.28 | $240.09 |
| NAPA (CA) | $524.96 | $252.91 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $555.52 | $264.47 |
| VALLEJO (CA) | $524.18 | $252.12 |
| BAKERSFIELD (CA) | $454.69 | $228.45 |
| CHICO (CA) | $453.29 | $227.06 |
| FRESNO (CA) | $453.29 | $227.06 |
| HANFORD-CORCORAN (CA) | $453.29 | $227.06 |
| MADERA (CA) | $453.29 | $227.06 |
| MERCED (CA) | $453.29 | $227.06 |
| MODESTO (CA) | $453.29 | $227.06 |
| REDDING (CA) | $453.29 | $227.06 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $458.49 | $232.25 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $475.63 | $235.57 |
| SALINAS (CA) | $473.87 | $234.63 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $568.09 | $270.43 |
| SANTA CRUZ-WATSONVILLE (CA) | $489.63 | $238.84 |
| SANTA ROSA-PETALUMA (CA) | $494.56 | $241.08 |
| STOCKTON (CA) | $453.29 | $227.06 |
| VISALIA (CA) | $453.29 | $227.06 |
| YUBA CITY (CA) | $453.29 | $227.06 |
| EL CENTRO (CA) | $453.37 | $227.14 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $485.01 | $238.13 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $466.26 | $231.15 |
| SANTA MARIA-SANTA BARBARA (CA) | $475.64 | $234.96 |
| REST OF CALIFORNIA (CA) | $453.29 | $227.06 |
| COLORADO (CO) | $447.01 | $227.38 |
| CONNECTICUT (CT) | $458.70 | $236.39 |
| DC + MD/VA SUBURBS (DC) | $491.43 | $248.27 |
| DELAWARE (DE) | $425.19 | $221.25 |
| FORT LAUDERDALE (FL) | $446.74 | $237.64 |
| MIAMI (FL) | $466.75 | $251.87 |
| REST OF FLORIDA (FL) | $424.66 | $227.33 |
| ATLANTA (GA) | $438.25 | $228.53 |
| REST OF GEORGIA (GA) | $400.37 | $216.25 |
| HAWAII, GUAM (HI) | $464.44 | $229.74 |
| IOWA (IA) | $394.57 | $205.69 |
| IDAHO (ID) | $397.29 | $207.39 |
| EAST ST. LOUIS (IL) | $422.00 | $232.09 |
| SUBURBAN CHICAGO (IL) | $451.18 | $239.18 |
| CHICAGO (IL) | $452.93 | $245.48 |
| REST OF ILLINOIS (IL) | $412.66 | $224.20 |
| INDIANA (IN) | $399.61 | $208.26 |
| KANSAS (KS) | $392.96 | $206.36 |
| KENTUCKY (KY) | $395.03 | $211.52 |
| NEW ORLEANS (LA) | $414.25 | $220.02 |
| REST OF LOUISIANA (LA) | $394.51 | $211.83 |
| METROPOLITAN BOSTON (MA) | $491.22 | $244.76 |
| REST OF MASSACHUSETTS (MA) | $444.40 | $227.04 |
| BALTIMORE/SURR. CNTYS (MD) | $457.48 | $236.00 |
| REST OF MARYLAND (MD) | $433.30 | $224.40 |
| SOUTHERN MAINE (ME) | $421.24 | $216.68 |
| REST OF MAINE (ME) | $399.68 | $209.78 |
| DETROIT (MI) | $430.31 | $231.12 |
| REST OF MICHIGAN (MI) | $405.70 | $217.24 |
| MINNESOTA (MN) | $427.33 | $214.93 |
| METROPOLITAN ST. LOUIS (MO) | $415.42 | $218.91 |
| METROPOLITAN KANSAS CITY (MO) | $411.10 | $217.28 |
| REST OF MISSOURI (MO) | $387.83 | $209.90 |
| MISSISSIPPI (MS) | $383.76 | $206.04 |
| MONTANA** (MT) | $429.84 | $223.42 |
| NORTH CAROLINA (NC) | $403.87 | $211.29 |
| NORTH DAKOTA** (ND) | $420.35 | $213.93 |
| NEBRASKA (NE) | $396.67 | $206.15 |
| NEW HAMPSHIRE (NH) | $440.23 | $225.35 |
| NORTHERN NJ (NJ) | $486.29 | $246.84 |
| REST OF NEW JERSEY (NJ) | $463.66 | $238.25 |
| NEW MEXICO (NM) | $408.06 | $218.77 |
| NEVADA** (NV) | $427.49 | $220.87 |
| MANHATTAN (NY) | $495.31 | $255.45 |
| NYC SUBURBS/LONG ISLAND (NY) | $507.80 | $262.37 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $466.94 | $240.91 |
| QUEENS (NY) | $499.03 | $255.05 |
| REST OF NEW YORK (NY) | $410.03 | $213.93 |
| OHIO (OH) | $403.76 | $215.30 |
| OKLAHOMA (OK) | $394.02 | $209.69 |
| PORTLAND (OR) | $461.04 | $231.71 |
| REST OF OREGON (OR) | $423.90 | $218.31 |
| METROPOLITAN PHILADELPHIA (PA) | $447.35 | $232.47 |
| REST OF PENNSYLVANIA (PA) | $404.26 | $214.76 |
| PUERTO RICO (PR) | $432.95 | $224.26 |
| RHODE ISLAND (RI) | $440.22 | $226.99 |
| SOUTH CAROLINA (SC) | $404.54 | $213.81 |
| SOUTH DAKOTA** (SD) | $419.22 | $212.81 |
| TENNESSEE (TN) | $395.00 | $207.37 |
| BRAZORIA (TX) | $424.53 | $219.97 |
| DALLAS (TX) | $427.40 | $221.80 |
| GALVESTON (TX) | $425.90 | $220.93 |
| HOUSTON (TX) | $434.68 | $229.71 |
| BEAUMONT (TX) | $401.59 | $213.75 |
| FORT WORTH (TX) | $424.59 | $221.06 |
| AUSTIN (TX) | $445.76 | $227.37 |
| REST OF TEXAS (TX) | $412.93 | $217.04 |
| UTAH (UT) | $410.14 | $216.11 |
| VIRGINIA (VA) | $420.03 | $217.12 |
| VIRGIN ISLANDS (VI) | $432.95 | $224.26 |
| VERMONT (VT) | $418.93 | $214.58 |
| SEATTLE (KING CNTY) (WA) | $501.01 | $247.74 |
| REST OF WASHINGTON (WA) | $443.48 | $226.12 |
| WISCONSIN (WI) | $406.11 | $208.36 |
| WEST VIRGINIA (WV) | $397.27 | $217.89 |
| WYOMING** (WY) | $425.70 | $219.28 |
Look up another code or locality →
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
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 Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then 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, staff, supplies) are treated differently depending on where the service is rendered, which is why the same code can show two different allowed amounts. These calculations are updated annually and can shift due to policy changes, even if the RVUs themselves stay constant.
RVUs — work 3.36, practice expense 9.03 (non-facility) / 2.85 (facility), malpractice 0.48 — × 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 insurer is generally responsible for the rest.
- Modifiers, place-of-service codes, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
- Local Medicare Administrative Contractors (MACs) may apply additional edits or coverage policies that affect payment.
- Always verify current-year rates and locality-specific amounts directly with your MAC before billing or appealing a claim.
Frequently asked
Why does the facility amount differ from the non-facility amount for the same code?
The practice-expense RVU component is lower in the facility setting because the facility (e.g., hospital) absorbs certain overhead costs separately, whereas in non-facility settings the billing provider absorbs those costs directly.
Does this amount reflect what Medicare will actually pay?
No. The figure shown is the Medicare-allowed amount before the standard 80/20 split, deductible status, modifiers, and any local adjustments are applied.
Why do allowed amounts vary by locality?
Geographic Practice Cost Indices (GPCIs) adjust the RVUs to reflect regional differences in labor, rent, and malpractice costs, so the same code can be reimbursed differently across localities.
Can this amount change during the year?
The conversion factor and RVUs are generally set annually, but mid-year corrections, legislative changes, or budget-neutrality adjustments can occasionally alter published rates.
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.
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