Medicare Reimbursement for CPT 21116

CPT 21116 is a physician procedure code reported under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted for locality, and distinguishes between non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$222.45	$38.75
ALASKA* (AK)	$246.33	$50.68
ALABAMA (AL)	$196.70	$35.96
ARKANSAS (AR)	$193.43	$35.62
ARIZONA (AZ)	$215.92	$37.91
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$301.39	$42.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$307.82	$42.92
OXNARD-THOUSAND OAKS-VENTURA (CA)	$256.63	$39.49
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$257.33	$40.01
NAPA (CA)	$283.21	$41.09
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$301.53	$42.51
VALLEJO (CA)	$283.02	$40.89
BAKERSFIELD (CA)	$239.82	$38.48
CHICO (CA)	$239.48	$38.14
FRESNO (CA)	$239.48	$38.14
HANFORD-CORCORAN (CA)	$239.48	$38.14
MADERA (CA)	$239.48	$38.14
MERCED (CA)	$239.48	$38.14
MODESTO (CA)	$239.48	$38.14
REDDING (CA)	$239.48	$38.14
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$240.77	$39.43
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$252.85	$39.20
SALINAS (CA)	$251.94	$39.03
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$308.38	$43.48
SANTA CRUZ-WATSONVILLE (CA)	$262.44	$39.23
SANTA ROSA-PETALUMA (CA)	$265.17	$39.58
STOCKTON (CA)	$239.48	$38.14
VISALIA (CA)	$239.48	$38.14
YUBA CITY (CA)	$239.48	$38.14
EL CENTRO (CA)	$239.50	$38.16
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$259.05	$39.34
SAN LUIS OBISPO-PASO ROBLES (CA)	$247.73	$38.49
SANTA MARIA-SANTA BARBARA (CA)	$253.21	$39.01
REST OF CALIFORNIA (CA)	$239.48	$38.14
COLORADO (CO)	$234.18	$38.72
CONNECTICUT (CT)	$238.61	$40.76
DC + MD/VA SUBURBS (DC)	$258.51	$42.11
DELAWARE (DE)	$219.87	$38.37
FORT LAUDERDALE (FL)	$228.19	$42.09
MIAMI (FL)	$236.45	$45.22
REST OF FLORIDA (FL)	$216.02	$40.39
ATLANTA (GA)	$226.41	$39.76
REST OF GEORGIA (GA)	$202.48	$38.61
HAWAII, GUAM (HI)	$247.07	$38.20
IOWA (IA)	$203.71	$35.62
IDAHO (ID)	$204.97	$35.96
EAST ST. LOUIS (IL)	$211.15	$42.14
SUBURBAN CHICAGO (IL)	$230.91	$42.25
CHICAGO (IL)	$228.79	$44.16
REST OF ILLINOIS (IL)	$208.00	$40.28
INDIANA (IN)	$206.37	$36.08
KANSAS (KS)	$202.02	$35.96
KENTUCKY (KY)	$200.79	$37.48
NEW ORLEANS (LA)	$211.66	$38.80
REST OF LOUISIANA (LA)	$200.20	$37.62
METROPOLITAN BOSTON (MA)	$260.35	$41.01
REST OF MASSACHUSETTS (MA)	$232.24	$38.80
BALTIMORE/SURR. CNTYS (MD)	$237.84	$40.73
REST OF MARYLAND (MD)	$224.69	$38.78
SOUTHERN MAINE (ME)	$219.24	$37.19
REST OF MAINE (ME)	$205.57	$36.56
DETROIT (MI)	$218.48	$41.20
REST OF MICHIGAN (MI)	$206.26	$38.54
MINNESOTA (MN)	$225.20	$36.17
METROPOLITAN ST. LOUIS (MO)	$213.24	$38.35
METROPOLITAN KANSAS CITY (MO)	$210.64	$38.14
REST OF MISSOURI (MO)	$195.84	$37.49
MISSISSIPPI (MS)	$194.71	$36.54
MONTANA** (MT)	$222.44	$38.74
NORTH CAROLINA (NC)	$208.14	$36.74
NORTH DAKOTA** (ND)	$220.07	$36.36
NEBRASKA (NE)	$205.17	$35.61
NEW HAMPSHIRE (NH)	$229.82	$38.59
NORTHERN NJ (NJ)	$255.11	$42.02
REST OF NEW JERSEY (NJ)	$241.56	$40.96
NEW MEXICO (NM)	$207.32	$38.86
NEVADA** (NV)	$221.97	$38.08
MANHATTAN (NY)	$257.60	$44.14
NYC SUBURBS/LONG ISLAND (NY)	$263.87	$45.45
POUGHKPSIE/N NYC SUBURBS (NY)	$242.72	$41.57
QUEENS (NY)	$260.86	$43.73
REST OF NEW YORK (NY)	$211.66	$37.14
OHIO (OH)	$205.77	$38.05
OKLAHOMA (OK)	$201.01	$36.96
PORTLAND (OR)	$243.16	$39.07
REST OF OREGON (OR)	$220.49	$37.52
METROPOLITAN PHILADELPHIA (PA)	$231.57	$40.34
REST OF PENNSYLVANIA (PA)	$206.48	$37.84
PUERTO RICO (PR)	$224.50	$38.78
RHODE ISLAND (RI)	$228.86	$39.09
SOUTH CAROLINA (SC)	$207.25	$37.51
SOUTH DAKOTA** (SD)	$219.79	$36.08
TENNESSEE (TN)	$203.12	$36.13
BRAZORIA (TX)	$220.05	$38.00
DALLAS (TX)	$221.35	$38.38
GALVESTON (TX)	$220.63	$38.21
HOUSTON (TX)	$222.82	$40.40
BEAUMONT (TX)	$204.88	$37.71
FORT WORTH (TX)	$219.48	$38.35
AUSTIN (TX)	$233.19	$38.83
REST OF TEXAS (TX)	$212.27	$37.93
UTAH (UT)	$210.52	$37.84
VIRGINIA (VA)	$218.01	$37.42
VIRGIN ISLANDS (VI)	$224.50	$38.78
VERMONT (VT)	$218.55	$36.68
SEATTLE (KING CNTY) (WA)	$266.63	$41.23
REST OF WASHINGTON (WA)	$232.01	$38.57
WISCONSIN (WI)	$211.61	$35.62
WEST VIRGINIA (WV)	$199.02	$39.38
WYOMING** (WY)	$221.41	$37.70

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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 allowed amount for a procedure is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because facility settings (like hospitals) shift certain overhead costs to the facility rather than the billing physician, typically resulting in a lower facility rate. The resulting PFS amount represents the total allowed charge before any patient cost-sharing is applied.

RVUs — work 0.79, practice expense 5.75 (non-facility) / 0.25 (facility), malpractice 0.12 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount 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.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Actual payment varies by locality and Medicare Administrative Contractor (MAC); verify current rates with your local MAC before billing or appealing a denial.

Frequently asked

Why does the facility rate differ from the non-facility rate for this code?

The facility rate uses lower practice-expense RVUs because overhead costs (equipment, supplies, staff time) are assumed to be borne by the facility rather than the billing physician's practice.

Does this amount reflect what the patient will owe?

No. The figure shown is the Medicare-allowed amount before cost-sharing. Patients are generally responsible for 20% coinsurance after meeting the Part B deductible, unless secondary coverage applies.

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

Not exactly. The national amount uses a baseline GPCI; actual payment in your area is adjusted using locality-specific GPCIs, which can raise or lower the final amount.

Can this amount change during the year?

Yes. CMS can apply mid-year adjustments, sequestration, or correct the conversion factor through rulemaking, so the amount shown should be treated as an estimate tied to the stated year.

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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.