Medicare Reimbursement for CPT 21079

CPT 21079 is a procedure code defined by the AMA (the specific clinical descriptor is not reproduced here due to licensing restrictions). This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026 at the national level and by locality, broken out separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1521.75	$1036.10
ALASKA* (AK)	$1892.89	$1375.68
ALABAMA (AL)	$1396.02	$971.07
ARKANSAS (AR)	$1380.31	$963.14
ARIZONA (AZ)	$1487.47	$1016.87
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1832.93	$1148.16
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1864.16	$1163.86
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1639.21	$1065.18
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1652.86	$1078.34
NAPA (CA)	$1751.42	$1111.34
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1835.82	$1151.06
VALLEJO (CA)	$1747.25	$1107.16
BAKERSFIELD (CA)	$1570.42	$1038.14
CHICO (CA)	$1562.74	$1030.47
FRESNO (CA)	$1562.74	$1030.47
HANFORD-CORCORAN (CA)	$1562.74	$1030.47
MADERA (CA)	$1562.74	$1030.47
MERCED (CA)	$1562.74	$1030.47
MODESTO (CA)	$1562.74	$1030.47
REDDING (CA)	$1562.74	$1030.47
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1590.47	$1058.20
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1624.12	$1059.31
SALINAS (CA)	$1617.65	$1054.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1876.00	$1175.70
SANTA CRUZ-WATSONVILLE (CA)	$1650.15	$1060.09
SANTA ROSA-PETALUMA (CA)	$1665.92	$1069.55
STOCKTON (CA)	$1562.74	$1030.47
VISALIA (CA)	$1562.74	$1030.47
YUBA CITY (CA)	$1562.74	$1030.47
EL CENTRO (CA)	$1563.17	$1030.90
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1643.71	$1062.87
SAN LUIS OBISPO-PASO ROBLES (CA)	$1593.28	$1040.13
SANTA MARIA-SANTA BARBARA (CA)	$1620.44	$1054.18
REST OF CALIFORNIA (CA)	$1562.74	$1030.47
COLORADO (CO)	$1557.26	$1040.53
CONNECTICUT (CT)	$1608.84	$1085.79
DC + MD/VA SUBURBS (DC)	$1697.00	$1124.90
DELAWARE (DE)	$1508.25	$1028.43
FORT LAUDERDALE (FL)	$1599.80	$1107.83
MIAMI (FL)	$1681.09	$1175.53
REST OF FLORIDA (FL)	$1533.34	$1069.06
ATLANTA (GA)	$1552.41	$1058.99
REST OF GEORGIA (GA)	$1461.41	$1028.21
HAWAII, GUAM (HI)	$1583.17	$1030.99
IOWA (IA)	$1410.03	$965.66
IDAHO (ID)	$1420.05	$973.25
EAST ST. LOUIS (IL)	$1551.30	$1104.50
SUBURBAN CHICAGO (IL)	$1611.76	$1112.99
CHICAGO (IL)	$1640.68	$1152.60
REST OF ILLINOIS (IL)	$1507.92	$1064.52
INDIANA (IN)	$1426.13	$975.93
KANSAS (KS)	$1411.33	$972.30
KENTUCKY (KY)	$1435.68	$1003.94
NEW ORLEANS (LA)	$1491.43	$1034.44
REST OF LOUISIANA (LA)	$1436.51	$1006.71
METROPOLITAN BOSTON (MA)	$1679.92	$1100.06
REST OF MASSACHUSETTS (MA)	$1553.71	$1042.33
BALTIMORE/SURR. CNTYS (MD)	$1605.39	$1084.29
REST OF MARYLAND (MD)	$1530.55	$1039.07
SOUTHERN MAINE (ME)	$1483.93	$1002.65
REST OF MAINE (ME)	$1432.74	$985.94
DETROIT (MI)	$1555.32	$1086.67
REST OF MICHIGAN (MI)	$1470.95	$1027.56
MINNESOTA (MN)	$1482.38	$982.64
METROPOLITAN ST. LOUIS (MO)	$1487.83	$1025.49
METROPOLITAN KANSAS CITY (MO)	$1476.47	$1020.45
REST OF MISSOURI (MO)	$1421.54	$1002.91
MISSISSIPPI (MS)	$1400.81	$982.67
MONTANA** (MT)	$1521.57	$1035.93
NORTH CAROLINA (NC)	$1443.42	$990.31
NORTH DAKOTA** (ND)	$1471.15	$985.50
NEBRASKA (NE)	$1414.09	$965.84
NEW HAMPSHIRE (NH)	$1540.21	$1034.65
NORTHERN NJ (NJ)	$1686.92	$1123.57
REST OF NEW JERSEY (NJ)	$1624.39	$1094.07
NEW MEXICO (NM)	$1479.93	$1034.59
NEVADA** (NV)	$1508.23	$1022.10
MANHATTAN (NY)	$1733.19	$1168.86
NYC SUBURBS/LONG ISLAND (NY)	$1775.44	$1198.00
POUGHKPSIE/N NYC SUBURBS (NY)	$1639.78	$1108.00
QUEENS (NY)	$1735.12	$1161.09
REST OF NEW YORK (NY)	$1460.94	$999.58
OHIO (OH)	$1460.65	$1017.25
OKLAHOMA (OK)	$1426.77	$993.09
PORTLAND (OR)	$1590.39	$1050.83
REST OF OREGON (OR)	$1493.61	$1009.90
METROPOLITAN PHILADELPHIA (PA)	$1580.37	$1074.81
REST OF PENNSYLVANIA (PA)	$1458.83	$1013.01
PUERTO RICO (PR)	$1528.28	$1037.29
RHODE ISLAND (RI)	$1549.78	$1048.11
SOUTH CAROLINA (SC)	$1455.00	$1006.26
SOUTH DAKOTA** (SD)	$1465.19	$979.54
TENNESSEE (TN)	$1417.69	$976.24
BRAZORIA (TX)	$1502.43	$1021.15
DALLAS (TX)	$1513.35	$1029.64
GALVESTON (TX)	$1507.94	$1025.69
HOUSTON (TX)	$1554.61	$1072.36
BEAUMONT (TX)	$1451.79	$1009.85
FORT WORTH (TX)	$1507.35	$1028.50
AUSTIN (TX)	$1554.67	$1040.86
REST OF TEXAS (TX)	$1477.27	$1016.39
UTAH (UT)	$1470.45	$1013.94
VIRGINIA (VA)	$1484.63	$1007.24
VIRGIN ISLANDS (VI)	$1528.28	$1037.29
VERMONT (VT)	$1472.57	$991.78
SEATTLE (KING CNTY) (WA)	$1703.68	$1107.78
REST OF WASHINGTON (WA)	$1548.47	$1037.08
WISCONSIN (WI)	$1432.98	$967.73
WEST VIRGINIA (WV)	$1465.43	$1043.40
WYOMING** (WY)	$1499.60	$1013.95

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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

Medicare PFS payments are built from three Relative Value Units (RVUs) assigned to each code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice expense RVUs differ depending on whether the service is performed in a non-facility setting (such as a physician's office) or a facility setting (such as a hospital), which is why this code typically shows two different national and locality-specific amounts. The conversion factor and RVUs are updated annually and are subject to budget-neutrality adjustments mandated by CMS.

RVUs — work 21.75, practice expense 21.26 (non-facility) / 6.72 (facility), malpractice 2.55 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures shown are estimates based on the published PFS formula, 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 generally responsible for the remainder.
Actual payment can be affected by modifiers, place of service, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Locality-specific amounts depend on the GPCI values for that area and may differ from the national figure shown.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why are there two different amounts for this code?

Medicare calculates separate allowed amounts for non-facility (e.g., office) and facility (e.g., hospital) settings because the practice expense RVU — reflecting overhead costs like staff and equipment — differs between the two settings.

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

The national amount uses a GPCI value of 1.0 for all three RVU components, while locality-specific amounts apply actual geographic cost indices for that area, which can raise or lower the final payment.

Does this amount reflect what Medicare will actually pay?

No. This is an estimate based on the standard PFS formula. Actual reimbursement can vary due to modifiers, deductible status, sequestration, secondary payer rules, and annual CMS adjustments.

Where can I find the official descriptor for CPT 21079?

CPT code descriptors are copyrighted by the American Medical Association (AMA) and must be obtained through a licensed CPT code book or AMA resource, not reproduced on this page.

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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.