Medicare Reimbursement for CPT 21081

CPT 21081 is a procedure code defined by the American Medical Association; 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 adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1592.22	$1065.82
ALASKA* (AK)	$1973.42	$1412.81
ALABAMA (AL)	$1458.55	$997.96
ARKANSAS (AR)	$1441.85	$989.68
ARIZONA (AZ)	$1555.82	$1045.74
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1922.45	$1180.22
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1955.37	$1196.31
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1717.36	$1095.16
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1731.47	$1108.74
NAPA (CA)	$1836.28	$1142.48
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1925.49	$1183.27
VALLEJO (CA)	$1831.89	$1138.10
BAKERSFIELD (CA)	$1644.18	$1067.25
CHICO (CA)	$1636.16	$1059.22
FRESNO (CA)	$1636.16	$1059.22
HANFORD-CORCORAN (CA)	$1636.16	$1059.22
MADERA (CA)	$1636.16	$1059.22
MERCED (CA)	$1636.16	$1059.22
MODESTO (CA)	$1636.16	$1059.22
REDDING (CA)	$1636.16	$1059.22
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1665.28	$1088.34
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1701.12	$1088.92
SALINAS (CA)	$1694.36	$1084.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1967.82	$1208.75
SANTA CRUZ-WATSONVILLE (CA)	$1729.40	$1089.82
SANTA ROSA-PETALUMA (CA)	$1745.96	$1099.54
STOCKTON (CA)	$1636.16	$1059.22
VISALIA (CA)	$1636.16	$1059.22
YUBA CITY (CA)	$1636.16	$1059.22
EL CENTRO (CA)	$1636.60	$1059.67
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1722.22	$1092.65
SAN LUIS OBISPO-PASO ROBLES (CA)	$1668.77	$1069.21
SANTA MARIA-SANTA BARBARA (CA)	$1697.44	$1083.66
REST OF CALIFORNIA (CA)	$1636.16	$1059.22
COLORADO (CO)	$1630.09	$1070.01
CONNECTICUT (CT)	$1684.31	$1117.38
DC + MD/VA SUBURBS (DC)	$1777.54	$1157.44
DELAWARE (DE)	$1577.80	$1057.72
FORT LAUDERDALE (FL)	$1674.41	$1141.17
MIAMI (FL)	$1760.19	$1212.21
REST OF FLORIDA (FL)	$1603.87	$1100.63
ATLANTA (GA)	$1624.58	$1089.76
REST OF GEORGIA (GA)	$1527.49	$1057.94
HAWAII, GUAM (HI)	$1658.45	$1059.94
IOWA (IA)	$1473.77	$992.11
IDAHO (ID)	$1484.36	$1000.08
EAST ST. LOUIS (IL)	$1622.31	$1138.02
SUBURBAN CHICAGO (IL)	$1687.02	$1146.40
CHICAGO (IL)	$1717.14	$1188.11
REST OF ILLINOIS (IL)	$1576.63	$1096.02
INDIANA (IN)	$1490.84	$1002.87
KANSAS (KS)	$1475.00	$999.14
KENTUCKY (KY)	$1500.41	$1032.45
NEW ORLEANS (LA)	$1559.64	$1064.30
REST OF LOUISIANA (LA)	$1501.23	$1035.37
METROPOLITAN BOSTON (MA)	$1760.04	$1131.52
REST OF MASSACHUSETTS (MA)	$1626.16	$1071.86
BALTIMORE/SURR. CNTYS (MD)	$1680.72	$1115.89
REST OF MARYLAND (MD)	$1601.42	$1068.71
SOUTHERN MAINE (ME)	$1552.36	$1030.70
REST OF MAINE (ME)	$1497.70	$1013.42
DETROIT (MI)	$1627.08	$1119.10
REST OF MICHIGAN (MI)	$1537.78	$1057.17
MINNESOTA (MN)	$1551.20	$1009.54
METROPOLITAN ST. LOUIS (MO)	$1555.99	$1054.86
METROPOLITAN KANSAS CITY (MO)	$1543.89	$1049.60
REST OF MISSOURI (MO)	$1485.22	$1031.46
MISSISSIPPI (MS)	$1463.42	$1010.19
MONTANA** (MT)	$1592.04	$1065.64
NORTH CAROLINA (NC)	$1509.08	$1017.95
NORTH DAKOTA** (ND)	$1539.05	$1012.65
NEBRASKA (NE)	$1478.14	$992.27
NEW HAMPSHIRE (NH)	$1612.13	$1064.15
NORTHERN NJ (NJ)	$1766.56	$1155.93
REST OF NEW JERSEY (NJ)	$1700.46	$1125.63
NEW MEXICO (NM)	$1547.25	$1064.55
NEVADA** (NV)	$1578.03	$1051.11
MANHATTAN (NY)	$1815.19	$1203.51
NYC SUBURBS/LONG ISLAND (NY)	$1859.92	$1234.04
POUGHKPSIE/N NYC SUBURBS (NY)	$1716.57	$1140.16
QUEENS (NY)	$1817.47	$1195.26
REST OF NEW YORK (NY)	$1527.71	$1027.63
OHIO (OH)	$1526.94	$1046.34
OKLAHOMA (OK)	$1491.10	$1021.02
PORTLAND (OR)	$1665.41	$1080.58
REST OF OREGON (OR)	$1562.60	$1038.31
METROPOLITAN PHILADELPHIA (PA)	$1653.99	$1106.01
REST OF PENNSYLVANIA (PA)	$1525.10	$1041.86
PUERTO RICO (PR)	$1599.22	$1067.03
RHODE ISLAND (RI)	$1621.72	$1077.95
SOUTH CAROLINA (SC)	$1521.15	$1034.75
SOUTH DAKOTA** (SD)	$1532.78	$1006.39
TENNESSEE (TN)	$1481.75	$1003.25
BRAZORIA (TX)	$1571.65	$1049.99
DALLAS (TX)	$1583.17	$1058.88
GALVESTON (TX)	$1577.47	$1054.75
HOUSTON (TX)	$1626.52	$1103.81
BEAUMONT (TX)	$1517.60	$1038.57
FORT WORTH (TX)	$1576.75	$1057.72
AUSTIN (TX)	$1627.50	$1070.57
REST OF TEXAS (TX)	$1544.85	$1045.30
UTAH (UT)	$1537.58	$1042.76
VIRGINIA (VA)	$1553.01	$1035.56
VIRGIN ISLANDS (VI)	$1599.22	$1067.03
VERMONT (VT)	$1540.42	$1019.28
SEATTLE (KING CNTY) (WA)	$1785.24	$1139.35
REST OF WASHINGTON (WA)	$1620.70	$1066.41
WISCONSIN (WI)	$1498.42	$994.13
WEST VIRGINIA (WV)	$1531.43	$1073.99
WYOMING** (WY)	$1568.95	$1042.55

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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 locality where the service is billed. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Practice-expense RVUs differ depending on whether the service is reported as non-facility (e.g., physician office) or facility (e.g., hospital, ASC), which is why the two settings show different totals. These amounts are recalculated annually and can shift due to rulemaking, budget-neutrality adjustments, or RVU revaluation.

RVUs — work 22.28, practice expense 22.71 (non-facility) / 6.95 (facility), malpractice 2.68 — × 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 responsible for the remainder.
Actual payment can be affected by modifiers, place of service, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Locality-adjusted amounts depend on where the service is actually furnished and billed.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The practice-expense RVU component is lower in the facility setting because the facility (e.g., hospital) absorbs certain overhead costs, while non-facility settings like a physician's office include those costs in the code's valuation.

Will every Medicare Administrative Contractor pay exactly this amount?

No. The amount shown is calculated using national RVUs and the conversion factor adjusted by locality GPICs, but actual claims processing can vary slightly due to MAC-specific edits, modifiers, and other claim-level factors.

Does this amount include the patient's share?

No. The figure represents the total Medicare-allowed amount. Medicare generally pays 80% of this after the deductible, with the remaining 20% owed by the patient or a secondary payer.

Why might this amount change next year?

The PFS conversion factor and RVUs are updated annually through Medicare rulemaking, and budget-neutrality adjustments or code revaluations can increase or decrease the allowed amount.

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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.