Medicare Reimbursement for CPT 21110

CPT 21110 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount for this code nationally and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$872.77	$674.70
ALASKA* (AK)	$1002.16	$791.22
ALABAMA (AL)	$780.72	$607.42
ARKANSAS (AR)	$769.05	$598.91
ARIZONA (AZ)	$849.08	$657.15
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1145.80	$866.52
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1168.99	$883.37
OXNARD-THOUSAND OAKS-VENTURA (CA)	$988.31	$754.20
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$992.48	$758.16
NAPA (CA)	$1081.36	$820.30
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1146.60	$867.33
VALLEJO (CA)	$1080.19	$819.14
BAKERSFIELD (CA)	$929.98	$712.90
CHICO (CA)	$927.86	$710.78
FRESNO (CA)	$927.86	$710.78
HANFORD-CORCORAN (CA)	$927.86	$710.78
MADERA (CA)	$927.86	$710.78
MERCED (CA)	$927.86	$710.78
MODESTO (CA)	$927.86	$710.78
REDDING (CA)	$927.86	$710.78
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$935.57	$718.49
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$975.38	$745.03
SALINAS (CA)	$971.79	$742.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1172.28	$886.67
SANTA CRUZ-WATSONVILLE (CA)	$1006.47	$765.81
SANTA ROSA-PETALUMA (CA)	$1016.72	$773.50
STOCKTON (CA)	$927.86	$710.78
VISALIA (CA)	$927.86	$710.78
YUBA CITY (CA)	$927.86	$710.78
EL CENTRO (CA)	$927.98	$710.90
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$995.94	$759.05
SAN LUIS OBISPO-PASO ROBLES (CA)	$955.98	$730.38
SANTA MARIA-SANTA BARBARA (CA)	$975.79	$744.84
REST OF CALIFORNIA (CA)	$927.86	$710.78
COLORADO (CO)	$911.77	$701.02
CONNECTICUT (CT)	$932.00	$718.69
DC + MD/VA SUBURBS (DC)	$1002.39	$769.07
DELAWARE (DE)	$863.50	$667.81
FORT LAUDERDALE (FL)	$900.43	$699.79
MIAMI (FL)	$935.84	$729.65
REST OF FLORIDA (FL)	$855.92	$666.57
ATLANTA (GA)	$888.58	$687.34
REST OF GEORGIA (GA)	$806.69	$630.01
HAWAII, GUAM (HI)	$952.38	$727.18
IOWA (IA)	$802.88	$621.64
IDAHO (ID)	$807.95	$625.73
EAST ST. LOUIS (IL)	$844.49	$662.27
SUBURBAN CHICAGO (IL)	$910.10	$706.68
CHICAGO (IL)	$908.11	$709.05
REST OF ILLINOIS (IL)	$829.22	$648.38
INDIANA (IN)	$812.83	$629.23
KANSAS (KS)	$798.22	$619.17
KENTUCKY (KY)	$798.16	$622.08
NEW ORLEANS (LA)	$837.41	$651.02
REST OF LOUISIANA (LA)	$796.56	$621.27
METROPOLITAN BOSTON (MA)	$1005.03	$768.54
REST OF MASSACHUSETTS (MA)	$905.73	$697.17
BALTIMORE/SURR. CNTYS (MD)	$929.25	$716.72
REST OF MARYLAND (MD)	$880.62	$680.18
SOUTHERN MAINE (ME)	$858.13	$661.84
REST OF MAINE (ME)	$811.48	$629.26
DETROIT (MI)	$866.14	$675.01
REST OF MICHIGAN (MI)	$818.93	$638.09
MINNESOTA (MN)	$875.04	$671.22
METROPOLITAN ST. LOUIS (MO)	$841.42	$652.86
METROPOLITAN KANSAS CITY (MO)	$832.33	$646.34
REST OF MISSOURI (MO)	$781.90	$611.16
MISSISSIPPI (MS)	$775.67	$605.14
MONTANA** (MT)	$872.72	$674.65
NORTH CAROLINA (NC)	$820.39	$635.59
NORTH DAKOTA** (ND)	$858.68	$660.61
NEBRASKA (NE)	$807.66	$624.84
NEW HAMPSHIRE (NH)	$896.61	$690.43
NORTHERN NJ (NJ)	$991.31	$761.55
REST OF NEW JERSEY (NJ)	$943.04	$726.75
NEW MEXICO (NM)	$823.25	$641.62
NEVADA** (NV)	$869.46	$671.19
MANHATTAN (NY)	$1005.09	$774.94
NYC SUBURBS/LONG ISLAND (NY)	$1029.18	$793.67
POUGHKPSIE/N NYC SUBURBS (NY)	$948.65	$731.77
QUEENS (NY)	$1014.76	$780.64
REST OF NEW YORK (NY)	$833.02	$644.86
OHIO (OH)	$816.06	$635.22
OKLAHOMA (OK)	$797.50	$620.63
PORTLAND (OR)	$942.41	$722.36
REST OF OREGON (OR)	$863.11	$665.83
METROPOLITAN PHILADELPHIA (PA)	$907.67	$701.48
REST OF PENNSYLVANIA (PA)	$817.83	$636.01
PUERTO RICO (PR)	$879.60	$679.36
RHODE ISLAND (RI)	$895.49	$690.89
SOUTH CAROLINA (SC)	$819.51	$636.49
SOUTH DAKOTA** (SD)	$857.02	$658.95
TENNESSEE (TN)	$802.27	$622.23
BRAZORIA (TX)	$863.22	$666.94
DALLAS (TX)	$868.54	$671.26
GALVESTON (TX)	$865.67	$668.99
HOUSTON (TX)	$878.66	$681.98
BEAUMONT (TX)	$812.22	$631.98
FORT WORTH (TX)	$862.31	$667.01
AUSTIN (TX)	$908.38	$698.83
REST OF TEXAS (TX)	$837.11	$649.15
UTAH (UT)	$831.11	$644.92
VIRGINIA (VA)	$854.68	$659.98
VIRGIN ISLANDS (VI)	$879.60	$679.36
VERMONT (VT)	$854.51	$658.42
SEATTLE (KING CNTY) (WA)	$1026.63	$783.61
REST OF WASHINGTON (WA)	$904.29	$695.73
WISCONSIN (WI)	$828.89	$639.14
WEST VIRGINIA (WV)	$797.31	$625.19
WYOMING** (WY)	$866.60	$668.53

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

Medicare's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility settings differ mainly in the practice-expense RVU, since overhead costs assumed by the physician are lower when a facility (like a hospital) incurs those costs instead.

RVUs — work 5.84, practice expense 19.58 (non-facility) / 13.65 (facility), malpractice 0.71 — × 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 vary by locality-specific GPCIs, applicable modifiers, multiple-procedure or bilateral payment rules, sequestration, and annual budget-neutrality adjustments.
Always verify the current allowed amount and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The facility rate uses a lower practice-expense RVU because the facility (not the physician's office) bears certain overhead costs like equipment and supplies.

Why might my local Medicare payment differ from the national amount shown here?

Local wage, rent, and malpractice cost indices (GPCIs) adjust the RVUs for each geographic locality, so the same code can pay differently depending on where the service is performed.

Does this amount reflect what the patient will owe?

No. This figure represents the full Medicare-allowed amount; patient responsibility typically includes 20% coinsurance plus any unmet deductible, unless modified by secondary coverage.

Will modifiers change this amount?

Yes. Modifiers such as those for bilateral procedures, multiple procedures, or reduced services can increase or decrease the final payment relative to the base PFS amount shown here.

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.