Medicare Reimbursement for CPT 21100

CPT 21100 is a procedure code used for billing Medicare Part B services; the official descriptor is not reproduced here due to AMA licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$630.94	$332.34
ALASKA* (AK)	$730.18	$412.17
ALABAMA (AL)	$566.06	$304.78
ARKANSAS (AR)	$557.83	$301.33
ARIZONA (AZ)	$614.23	$324.88
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$824.35	$403.32
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$840.90	$410.31
OXNARD-THOUSAND OAKS-VENTURA (CA)	$712.54	$359.59
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$715.70	$362.45
NAPA (CA)	$778.52	$384.96
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$824.93	$403.90
VALLEJO (CA)	$777.69	$384.13
BAKERSFIELD (CA)	$671.36	$344.09
CHICO (CA)	$669.81	$342.54
FRESNO (CA)	$669.81	$342.54
HANFORD-CORCORAN (CA)	$669.81	$342.54
MADERA (CA)	$669.81	$342.54
MERCED (CA)	$669.81	$342.54
MODESTO (CA)	$669.81	$342.54
REDDING (CA)	$669.81	$342.54
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$675.36	$348.09
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$703.55	$356.27
SALINAS (CA)	$700.94	$354.86
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$843.27	$412.68
SANTA CRUZ-WATSONVILLE (CA)	$725.16	$362.35
SANTA ROSA-PETALUMA (CA)	$732.52	$365.84
STOCKTON (CA)	$669.81	$342.54
VISALIA (CA)	$669.81	$342.54
YUBA CITY (CA)	$669.81	$342.54
EL CENTRO (CA)	$669.90	$342.63
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$717.91	$360.78
SAN LUIS OBISPO-PASO ROBLES (CA)	$689.59	$349.48
SANTA MARIA-SANTA BARBARA (CA)	$703.70	$355.53
REST OF CALIFORNIA (CA)	$669.81	$342.54
COLORADO (CO)	$658.50	$340.78
CONNECTICUT (CT)	$673.01	$351.42
DC + MD/VA SUBURBS (DC)	$723.05	$371.29
DELAWARE (DE)	$624.47	$329.45
FORT LAUDERDALE (FL)	$650.69	$348.20
MIAMI (FL)	$675.85	$365.00
REST OF FLORIDA (FL)	$619.27	$333.81
ATLANTA (GA)	$642.19	$338.81
REST OF GEORGIA (GA)	$584.54	$318.19
HAWAII, GUAM (HI)	$686.78	$347.27
IOWA (IA)	$581.58	$308.35
IDAHO (ID)	$585.17	$310.46
EAST ST. LOUIS (IL)	$611.42	$336.71
SUBURBAN CHICAGO (IL)	$657.59	$350.92
CHICAGO (IL)	$656.38	$356.28
REST OF ILLINOIS (IL)	$600.52	$327.89
INDIANA (IN)	$588.61	$311.81
KANSAS (KS)	$578.34	$308.40
KENTUCKY (KY)	$578.44	$312.98
NEW ORLEANS (LA)	$606.12	$325.14
REST OF LOUISIANA (LA)	$577.34	$313.07
METROPOLITAN BOSTON (MA)	$724.61	$368.08
REST OF MASSACHUSETTS (MA)	$654.32	$339.89
BALTIMORE/SURR. CNTYS (MD)	$671.02	$350.62
REST OF MARYLAND (MD)	$636.61	$334.42
SOUTHERN MAINE (ME)	$620.52	$324.60
REST OF MAINE (ME)	$587.71	$312.99
DETROIT (MI)	$626.53	$338.38
REST OF MICHIGAN (MI)	$593.13	$320.50
MINNESOTA (MN)	$632.29	$325.03
METROPOLITAN ST. LOUIS (MO)	$608.90	$324.63
METROPOLITAN KANSAS CITY (MO)	$602.50	$322.11
REST OF MISSOURI (MO)	$567.03	$309.63
MISSISSIPPI (MS)	$562.57	$305.47
MONTANA** (MT)	$630.91	$332.30
NORTH CAROLINA (NC)	$593.98	$315.38
NORTH DAKOTA** (ND)	$620.82	$322.22
NEBRASKA (NE)	$584.93	$309.32
NEW HAMPSHIRE (NH)	$647.67	$336.82
NORTHERN NJ (NJ)	$715.39	$369.01
REST OF NEW JERSEY (NJ)	$681.07	$354.99
NEW MEXICO (NM)	$596.19	$322.37
NEVADA** (NV)	$628.56	$329.66
MANHATTAN (NY)	$725.29	$378.31
NYC SUBURBS/LONG ISLAND (NY)	$742.32	$387.28
POUGHKPSIE/N NYC SUBURBS (NY)	$685.14	$358.17
QUEENS (NY)	$732.03	$379.08
REST OF NEW YORK (NY)	$602.89	$319.21
OHIO (OH)	$591.07	$318.44
OKLAHOMA (OK)	$577.93	$311.28
PORTLAND (OR)	$680.10	$348.35
REST OF OREGON (OR)	$624.04	$326.63
METROPOLITAN PHILADELPHIA (PA)	$655.86	$345.01
REST OF PENNSYLVANIA (PA)	$592.29	$318.17
PUERTO RICO (PR)	$635.75	$333.86
RHODE ISLAND (RI)	$647.21	$338.75
SOUTH CAROLINA (SC)	$593.43	$317.52
SOUTH DAKOTA** (SD)	$619.63	$321.03
TENNESSEE (TN)	$581.20	$309.77
BRAZORIA (TX)	$624.29	$328.37
DALLAS (TX)	$628.07	$330.66
GALVESTON (TX)	$626.03	$329.51
HOUSTON (TX)	$635.36	$338.85
BEAUMONT (TX)	$588.34	$316.61
FORT WORTH (TX)	$623.69	$329.27
AUSTIN (TX)	$655.98	$340.06
REST OF TEXAS (TX)	$605.83	$322.46
UTAH (UT)	$601.61	$320.92
VIRGINIA (VA)	$618.12	$324.59
VIRGIN ISLANDS (VI)	$635.75	$333.86
VERMONT (VT)	$617.93	$322.31
SEATTLE (KING CNTY) (WA)	$739.93	$373.54
REST OF WASHINGTON (WA)	$653.25	$338.82
WISCONSIN (WI)	$599.84	$313.78
WEST VIRGINIA (WV)	$578.03	$318.55
WYOMING** (WY)	$626.51	$327.91

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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

The Medicare PFS amount is derived from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) specific to a locality. These locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two amounts shown differ. Because GPCIs vary by region, the same code can have different allowed amounts depending on where the service is furnished.

RVUs — work 4.61, practice expense 13.77 (non-facility) / 4.83 (facility), malpractice 0.51 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national CMS data; actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible.
Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can change the final amount.
Confirm the exact payment with your Medicare Administrative Contractor (MAC) before relying on this figure for billing.

Frequently asked

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

Facility settings have lower practice expense RVUs because the facility (not the physician's office) absorbs certain overhead costs like equipment and staff, while non-facility settings reflect the full overhead of an office-based practice.

Will my locality's payment match the national amount shown?

Not necessarily. The national amount uses a GPCI value of 1.0, while actual payments are adjusted using locality-specific GPCIs, which can raise or lower the amount compared to the national figure.

Does this amount reflect what the patient or secondary insurer will pay?

No. This figure is the total Medicare-allowed amount. Medicare generally pays 80% after the deductible, with the remaining portion owed by the patient or a secondary payer.

Can modifiers change this amount?

Yes. Modifiers (e.g., bilateral, multiple procedure, or reduced services) can increase or decrease the allowed amount, and those adjustments are not reflected in this base estimate.

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.