Medicare Reimbursement for CPT 21085

CPT 21085 is a physician procedure code (descriptor not shown due to AMA licensing restrictions). This page displays the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and provides a framework for how it differs by locality and by non-facility versus facility setting.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$710.10	$429.87
ALASKA* (AK)	$865.31	$566.86
ALABAMA (AL)	$646.91	$401.71
ARKANSAS (AR)	$638.99	$398.27
ARIZONA (AZ)	$693.13	$421.59
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$873.77	$478.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$889.37	$485.27
OXNARD-THOUSAND OAKS-VENTURA (CA)	$774.25	$443.02
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$779.91	$448.39
NAPA (CA)	$832.27	$462.92
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$874.99	$479.86
VALLEJO (CA)	$830.52	$461.17
BAKERSFIELD (CA)	$738.31	$431.18
CHICO (CA)	$735.12	$427.98
FRESNO (CA)	$735.12	$427.98
HANFORD-CORCORAN (CA)	$735.12	$427.98
MADERA (CA)	$735.12	$427.98
MERCED (CA)	$735.12	$427.98
MODESTO (CA)	$735.12	$427.98
REDDING (CA)	$735.12	$427.98
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$746.74	$439.60
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$766.24	$440.33
SALINAS (CA)	$763.25	$438.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$894.34	$490.24
SANTA CRUZ-WATSONVILLE (CA)	$781.68	$441.20
SANTA ROSA-PETALUMA (CA)	$789.28	$445.15
STOCKTON (CA)	$735.12	$427.98
VISALIA (CA)	$735.12	$427.98
YUBA CITY (CA)	$735.12	$427.98
EL CENTRO (CA)	$735.30	$428.16
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$777.28	$442.13
SAN LUIS OBISPO-PASO ROBLES (CA)	$751.52	$432.33
SANTA MARIA-SANTA BARBARA (CA)	$765.04	$438.29
REST OF CALIFORNIA (CA)	$735.12	$427.98
COLORADO (CO)	$730.20	$432.03
CONNECTICUT (CT)	$752.84	$451.03
DC + MD/VA SUBURBS (DC)	$797.86	$467.74
DELAWARE (DE)	$703.38	$426.51
FORT LAUDERDALE (FL)	$743.94	$460.06
MIAMI (FL)	$780.39	$488.66
REST OF FLORIDA (FL)	$711.30	$443.39
ATLANTA (GA)	$724.27	$439.55
REST OF GEORGIA (GA)	$675.77	$425.80
HAWAII, GUAM (HI)	$747.31	$428.69
IOWA (IA)	$656.13	$399.72
IDAHO (ID)	$660.75	$402.94
EAST ST. LOUIS (IL)	$715.83	$458.01
SUBURBAN CHICAGO (IL)	$750.04	$462.24
CHICAGO (IL)	$760.34	$478.71
REST OF ILLINOIS (IL)	$697.04	$441.19
INDIANA (IN)	$663.89	$404.11
KANSAS (KS)	$655.76	$402.43
KENTUCKY (KY)	$664.73	$415.60
NEW ORLEANS (LA)	$692.46	$428.76
REST OF LOUISIANA (LA)	$664.74	$416.73
METROPOLITAN BOSTON (MA)	$792.18	$457.58
REST OF MASSACHUSETTS (MA)	$727.75	$432.67
BALTIMORE/SURR. CNTYS (MD)	$751.11	$450.41
REST OF MARYLAND (MD)	$714.68	$431.08
SOUTHERN MAINE (ME)	$693.48	$415.77
REST OF MAINE (ME)	$666.08	$408.26
DETROIT (MI)	$721.27	$450.84
REST OF MICHIGAN (MI)	$681.53	$425.68
MINNESOTA (MN)	$696.00	$407.64
METROPOLITAN ST. LOUIS (MO)	$691.87	$425.08
METROPOLITAN KANSAS CITY (MO)	$686.01	$422.87
REST OF MISSOURI (MO)	$656.54	$414.97
MISSISSIPPI (MS)	$647.76	$406.47
MONTANA** (MT)	$710.03	$429.80
NORTH CAROLINA (NC)	$671.65	$410.19
NORTH DAKOTA** (ND)	$688.87	$408.64
NEBRASKA (NE)	$658.50	$399.85
NEW HAMPSHIRE (NH)	$721.27	$429.55
NORTHERN NJ (NJ)	$792.02	$466.95
REST OF NEW JERSEY (NJ)	$760.38	$454.36
NEW MEXICO (NM)	$685.63	$428.65
NEVADA** (NV)	$704.52	$424.00
MANHATTAN (NY)	$811.59	$485.96
NYC SUBURBS/LONG ISLAND (NY)	$831.57	$498.37
POUGHKPSIE/N NYC SUBURBS (NY)	$767.03	$460.17
QUEENS (NY)	$814.07	$482.83
REST OF NEW YORK (NY)	$680.42	$414.19
OHIO (OH)	$677.20	$421.35
OKLAHOMA (OK)	$661.32	$411.07
PORTLAND (OR)	$747.98	$436.64
REST OF OREGON (OR)	$697.96	$418.85
METROPOLITAN PHILADELPHIA (PA)	$737.91	$446.19
REST OF PENNSYLVANIA (PA)	$676.86	$419.61
PUERTO RICO (PR)	$713.76	$430.45
RHODE ISLAND (RI)	$724.40	$434.92
SOUTH CAROLINA (SC)	$675.75	$416.82
SOUTH DAKOTA** (SD)	$686.37	$406.14
TENNESSEE (TN)	$658.85	$404.11
BRAZORIA (TX)	$701.15	$423.44
DALLAS (TX)	$706.14	$427.03
GALVESTON (TX)	$703.63	$425.36
HOUSTON (TX)	$723.21	$444.94
BEAUMONT (TX)	$673.24	$418.22
FORT WORTH (TX)	$702.79	$426.48
AUSTIN (TX)	$728.74	$432.25
REST OF TEXAS (TX)	$687.18	$421.24
UTAH (UT)	$683.57	$420.15
VIRGINIA (VA)	$693.11	$417.64
VIRGIN ISLANDS (VI)	$713.76	$430.45
VERMONT (VT)	$688.63	$411.20
SEATTLE (KING CNTY) (WA)	$804.80	$460.95
REST OF WASHINGTON (WA)	$725.59	$430.50
WISCONSIN (WI)	$669.35	$400.89
WEST VIRGINIA (WV)	$675.54	$432.02
WYOMING** (WY)	$700.81	$420.58

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units per patient per day — Date of Service Edit: Clinical. 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) — physician work, practice expense (PE), and malpractice (MP) — assigned to this procedure code. Each RVU component is adjusted using the locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different PE RVUs because overhead costs differ depending on where the service is performed, which is why two separate national amounts are shown. Final payment also depends on additional factors such as modifiers and claim-specific adjustments applied by the Medicare Administrative Contractor (MAC).

RVUs — work 8.77, practice expense 11.42 (non-facility) / 3.03 (facility), malpractice 1.07 — × 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 patient meets their deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment varies by locality GPCIs, applicable modifiers, claim-level adjustments, and annual sequestration or budget-neutrality changes.
Always verify the exact allowed amount and coverage policy with your specific Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The facility amount uses a lower practice expense RVU because overhead costs (like staff, equipment, and supplies) are assumed to be borne by the facility rather than the billing provider, while non-facility assumes the provider covers these costs.

Does this amount reflect what my specific practice will be paid?

No. The posted amount is a national estimate; actual reimbursement depends on your locality's GPCI adjustments, any modifiers applied, and MAC-specific policies.

Why isn't the CPT code description shown on this page?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so only the code number is shown without the official descriptor text.

Can this amount change during the year?

Yes. Amounts can be affected by mid-year policy updates, sequestration, or annual conversion factor changes set by CMS, so figures should be periodically reverified.

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.