Medicare Reimbursement for CPT 21080

CPT 21080 is a procedure code defined by the AMA; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjustable 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)	$1729.83	$1163.02
ALASKA* (AK)	$2147.27	$1543.61
ALABAMA (AL)	$1585.57	$1089.61
ARKANSAS (AR)	$1567.54	$1080.65
ARIZONA (AZ)	$1690.52	$1141.28
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2086.29	$1287.08
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2121.94	$1304.60
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1864.67	$1194.69
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1880.08	$1209.54
NAPA (CA)	$1993.11	$1246.05
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2089.60	$1290.39
VALLEJO (CA)	$1988.35	$1241.29
BAKERSFIELD (CA)	$1785.73	$1164.50
CHICO (CA)	$1777.00	$1155.78
FRESNO (CA)	$1777.00	$1155.78
HANFORD-CORCORAN (CA)	$1777.00	$1155.78
MADERA (CA)	$1777.00	$1155.78
MERCED (CA)	$1777.00	$1155.78
MODESTO (CA)	$1777.00	$1155.78
REDDING (CA)	$1777.00	$1155.78
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1808.63	$1187.40
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1847.22	$1188.02
SALINAS (CA)	$1839.88	$1182.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2135.45	$1318.11
SANTA CRUZ-WATSONVILLE (CA)	$1877.45	$1188.77
SANTA ROSA-PETALUMA (CA)	$1895.41	$1199.36
STOCKTON (CA)	$1777.00	$1155.78
VISALIA (CA)	$1777.00	$1155.78
YUBA CITY (CA)	$1777.00	$1155.78
EL CENTRO (CA)	$1777.49	$1156.26
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1869.86	$1191.95
SAN LUIS OBISPO-PASO ROBLES (CA)	$1812.12	$1166.52
SANTA MARIA-SANTA BARBARA (CA)	$1843.15	$1182.24
REST OF CALIFORNIA (CA)	$1777.00	$1155.78
COLORADO (CO)	$1770.60	$1167.51
CONNECTICUT (CT)	$1829.45	$1218.99
DC + MD/VA SUBURBS (DC)	$1930.24	$1262.54
DELAWARE (DE)	$1714.30	$1154.28
FORT LAUDERDALE (FL)	$1818.98	$1244.80
MIAMI (FL)	$1911.93	$1321.88
REST OF FLORIDA (FL)	$1742.79	$1200.92
ATLANTA (GA)	$1764.88	$1189.00
REST OF GEORGIA (GA)	$1660.30	$1154.70
HAWAII, GUAM (HI)	$1800.79	$1156.33
IOWA (IA)	$1601.81	$1083.17
IDAHO (ID)	$1613.28	$1091.81
EAST ST. LOUIS (IL)	$1763.06	$1241.59
SUBURBAN CHICAGO (IL)	$1832.63	$1250.51
CHICAGO (IL)	$1865.50	$1295.85
REST OF ILLINOIS (IL)	$1713.51	$1196.01
INDIANA (IN)	$1620.26	$1094.82
KANSAS (KS)	$1603.22	$1090.83
KENTUCKY (KY)	$1630.92	$1127.03
NEW ORLEANS (LA)	$1694.87	$1161.50
REST OF LOUISIANA (LA)	$1631.84	$1130.21
METROPOLITAN BOSTON (MA)	$1911.03	$1234.25
REST OF MASSACHUSETTS (MA)	$1766.44	$1169.59
BALTIMORE/SURR. CNTYS (MD)	$1825.54	$1217.35
REST OF MARYLAND (MD)	$1739.82	$1166.21
SOUTHERN MAINE (ME)	$1686.62	$1124.91
REST OF MAINE (ME)	$1627.76	$1106.29
DETROIT (MI)	$1767.93	$1220.95
REST OF MICHIGAN (MI)	$1671.32	$1153.82
MINNESOTA (MN)	$1685.09	$1101.84
METROPOLITAN ST. LOUIS (MO)	$1690.83	$1151.22
METROPOLITAN KANSAS CITY (MO)	$1677.78	$1145.54
REST OF MISSOURI (MO)	$1614.61	$1126.01
MISSISSIPPI (MS)	$1590.95	$1102.92
MONTANA** (MT)	$1729.64	$1162.82
NORTH CAROLINA (NC)	$1640.03	$1111.19
NORTH DAKOTA** (ND)	$1672.10	$1105.28
NEBRASKA (NE)	$1606.49	$1083.33
NEW HAMPSHIRE (NH)	$1751.17	$1161.11
NORTHERN NJ (NJ)	$1918.51	$1261.01
REST OF NEW JERSEY (NJ)	$1847.03	$1228.07
NEW MEXICO (NM)	$1681.59	$1161.82
NEVADA** (NV)	$1714.42	$1147.04
MANHATTAN (NY)	$1971.31	$1312.67
NYC SUBURBS/LONG ISLAND (NY)	$2019.70	$1345.76
POUGHKPSIE/N NYC SUBURBS (NY)	$1864.55	$1243.88
QUEENS (NY)	$1973.65	$1303.67
REST OF NEW YORK (NY)	$1660.13	$1121.66
OHIO (OH)	$1659.56	$1142.06
OKLAHOMA (OK)	$1620.78	$1114.61
PORTLAND (OR)	$1808.65	$1178.92
REST OF OREGON (OR)	$1697.70	$1133.15
METROPOLITAN PHILADELPHIA (PA)	$1796.76	$1206.71
REST OF PENNSYLVANIA (PA)	$1657.52	$1137.19
PUERTO RICO (PR)	$1737.36	$1164.31
RHODE ISLAND (RI)	$1761.79	$1176.27
SOUTH CAROLINA (SC)	$1653.19	$1129.45
SOUTH DAKOTA** (SD)	$1665.29	$1098.48
TENNESSEE (TN)	$1610.52	$1095.28
BRAZORIA (TX)	$1707.63	$1145.92
DALLAS (TX)	$1720.11	$1155.56
GALVESTON (TX)	$1713.93	$1151.08
HOUSTON (TX)	$1767.19	$1204.34
BEAUMONT (TX)	$1649.43	$1133.63
FORT WORTH (TX)	$1713.20	$1154.33
AUSTIN (TX)	$1767.75	$1168.06
REST OF TEXAS (TX)	$1678.76	$1140.85
UTAH (UT)	$1670.92	$1138.11
VIRGINIA (VA)	$1687.37	$1130.20
VIRGIN ISLANDS (VI)	$1737.36	$1164.31
VERMONT (VT)	$1673.65	$1112.51
SEATTLE (KING CNTY) (WA)	$1938.22	$1242.74
REST OF WASHINGTON (WA)	$1760.49	$1163.64
WISCONSIN (WI)	$1628.27	$1085.27
WEST VIRGINIA (WV)	$1664.74	$1172.18
WYOMING** (WY)	$1704.56	$1137.75

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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'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 service locality. The adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar allowed amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (equipment, supplies, staff time) are typically higher when a service is performed in a physician's own office versus a hospital or facility where the facility absorbs some of those costs. This is why the same code can show two different national or locality-adjusted amounts depending on place of service.

RVUs — work 24.43, practice expense 24.45 (non-facility) / 7.48 (facility), malpractice 2.91 — × 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 responsible for the remainder.
Actual payment can vary by locality GPCIs, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why do the facility and non-facility amounts differ for the same code?

The practice-expense RVU component is lower in the facility setting because the facility (e.g., hospital) bears more of the overhead and resource costs, while in a non-facility setting the billing physician's practice absorbs those costs.

Does this amount reflect what Medicare will actually pay?

No. This is an estimated allowed amount based on standard PFS inputs. Medicare generally pays 80% of this figure after the deductible, and the final payment can be affected by modifiers, sequestration, and locality-specific adjustments.

Why can't you show the CPT code's description?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so this page refers to the code generically rather than reproducing the official descriptor.

Will this rate change next year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can shift amounts even if the relative value of the service does not change.

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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.