Medicare Reimbursement for CPT 21120

CPT 21120 is a procedure code reported to Medicare and other payers; the specific clinical descriptor is omitted here because CPT descriptors are licensed by the AMA. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and adjusted for your locality, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$715.45	$488.66
ALASKA* (AK)	$818.37	$576.83
ALABAMA (AL)	$637.27	$438.83
ARKANSAS (AR)	$627.40	$432.59
ARIZONA (AZ)	$694.94	$475.18
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$926.22	$606.45
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$944.45	$617.42
OXNARD-THOUSAND OAKS-VENTURA (CA)	$802.92	$534.85
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$806.85	$538.56
NAPA (CA)	$875.74	$576.83
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$927.27	$607.49
VALLEJO (CA)	$874.23	$575.32
BAKERSFIELD (CA)	$756.38	$507.82
CHICO (CA)	$753.81	$505.24
FRESNO (CA)	$753.81	$505.24
HANFORD-CORCORAN (CA)	$753.81	$505.24
MADERA (CA)	$753.81	$505.24
MERCED (CA)	$753.81	$505.24
MODESTO (CA)	$753.81	$505.24
REDDING (CA)	$753.81	$505.24
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$763.71	$515.15
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$791.72	$527.96
SALINAS (CA)	$788.81	$525.96
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$948.72	$621.69
SANTA CRUZ-WATSONVILLE (CA)	$816.20	$540.65
SANTA ROSA-PETALUMA (CA)	$824.44	$545.94
STOCKTON (CA)	$753.81	$505.24
VISALIA (CA)	$753.81	$505.24
YUBA CITY (CA)	$753.81	$505.24
EL CENTRO (CA)	$753.96	$505.40
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$808.02	$536.78
SAN LUIS OBISPO-PASO ROBLES (CA)	$776.11	$517.80
SANTA MARIA-SANTA BARBARA (CA)	$791.94	$527.50
REST OF CALIFORNIA (CA)	$753.81	$505.24
COLORADO (CO)	$743.91	$502.60
CONNECTICUT (CT)	$765.16	$520.91
DC + MD/VA SUBURBS (DC)	$820.22	$553.05
DELAWARE (DE)	$706.95	$482.88
FORT LAUDERDALE (FL)	$747.02	$517.28
MIAMI (FL)	$783.70	$547.61
REST OF FLORIDA (FL)	$708.08	$491.27
ATLANTA (GA)	$730.42	$500.00
REST OF GEORGIA (GA)	$665.33	$463.03
HAWAII, GUAM (HI)	$773.57	$515.71
IOWA (IA)	$652.83	$445.31
IDAHO (ID)	$657.76	$449.11
EAST ST. LOUIS (IL)	$705.11	$496.46
SUBURBAN CHICAGO (IL)	$754.34	$521.42
CHICAGO (IL)	$759.00	$531.07
REST OF ILLINOIS (IL)	$687.62	$480.56
INDIANA (IN)	$661.79	$451.55
KANSAS (KS)	$650.41	$445.39
KENTUCKY (KY)	$655.26	$453.64
NEW ORLEANS (LA)	$689.02	$475.61
REST OF LOUISIANA (LA)	$654.50	$453.79
METROPOLITAN BOSTON (MA)	$819.50	$548.71
REST OF MASSACHUSETTS (MA)	$739.36	$500.55
BALTIMORE/SURR. CNTYS (MD)	$763.25	$519.90
REST OF MARYLAND (MD)	$720.81	$491.30
SOUTHERN MAINE (ME)	$699.44	$474.69
REST OF MAINE (ME)	$662.33	$453.69
DETROIT (MI)	$718.37	$499.52
REST OF MICHIGAN (MI)	$674.28	$467.22
MINNESOTA (MN)	$708.86	$475.49
METROPOLITAN ST. LOUIS (MO)	$690.61	$474.70
METROPOLITAN KANSAS CITY (MO)	$683.10	$470.14
REST OF MISSOURI (MO)	$643.07	$447.57
MISSISSIPPI (MS)	$635.33	$440.06
MONTANA** (MT)	$715.39	$488.59
NORTH CAROLINA (NC)	$669.60	$458.00
NORTH DAKOTA** (ND)	$697.19	$470.40
NEBRASKA (NE)	$656.39	$447.06
NEW HAMPSHIRE (NH)	$732.87	$496.78
NORTHERN NJ (NJ)	$810.99	$547.91
REST OF NEW JERSEY (NJ)	$772.79	$525.13
NEW MEXICO (NM)	$678.57	$470.60
NEVADA** (NV)	$710.83	$483.82
MANHATTAN (NY)	$828.11	$564.58
NYC SUBURBS/LONG ISLAND (NY)	$850.44	$580.79
POUGHKPSIE/N NYC SUBURBS (NY)	$778.65	$530.31
QUEENS (NY)	$834.06	$565.99
REST OF NEW YORK (NY)	$680.39	$464.93
OHIO (OH)	$670.56	$463.50
OKLAHOMA (OK)	$653.09	$450.57
PORTLAND (OR)	$767.81	$515.85
REST OF OREGON (OR)	$704.25	$478.36
METROPOLITAN PHILADELPHIA (PA)	$745.63	$509.54
REST OF PENNSYLVANIA (PA)	$671.22	$463.03
PUERTO RICO (PR)	$720.69	$491.41
RHODE ISLAND (RI)	$732.40	$498.12
SOUTH CAROLINA (SC)	$671.42	$461.86
SOUTH DAKOTA** (SD)	$695.04	$468.25
TENNESSEE (TN)	$654.02	$447.86
BRAZORIA (TX)	$705.35	$480.60
DALLAS (TX)	$710.50	$484.62
GALVESTON (TX)	$707.86	$482.65
HOUSTON (TX)	$724.70	$499.49
BEAUMONT (TX)	$666.58	$460.20
FORT WORTH (TX)	$705.72	$482.10
AUSTIN (TX)	$742.36	$502.42
REST OF TEXAS (TX)	$686.01	$470.79
UTAH (UT)	$681.19	$468.01
VIRGINIA (VA)	$697.59	$474.66
VIRGIN ISLANDS (VI)	$720.69	$491.41
VERMONT (VT)	$695.08	$470.56
SEATTLE (KING CNTY) (WA)	$835.87	$557.60
REST OF WASHINGTON (WA)	$737.75	$498.94
WISCONSIN (WI)	$672.40	$455.13
WEST VIRGINIA (WV)	$660.74	$463.66
WYOMING** (WY)	$707.46	$480.67

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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 fee schedule amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates differ mainly because the practice-expense RVU is lower in facility settings, since the facility (not the billing provider) absorbs certain overhead and resource costs.

RVUs — work 4.97, practice expense 15.53 (non-facility) / 8.74 (facility), malpractice 0.92 — × 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 the annual Part B deductible; the beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary based on modifiers, place of service, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC), as published fee schedules can be updated or corrected during the year.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

The facility rate uses a lower practice-expense RVU because the facility, rather than the billing physician or practice, incurs many of the overhead costs (equipment, supplies, staff) associated with the service.

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

No. This is a national or locality-adjusted estimate based on standard RVUs and the conversion factor. Your actual payment may differ due to modifiers, secondary payer coordination, sequestration, or local MAC policies.

Why do amounts differ by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to the work, practice expense, and malpractice RVUs to account for regional differences in wages, rent, and other costs, which changes the final allowed amount by location.

Will this fee change next year?

Yes, potentially. The conversion factor, RVUs, and GPCIs are reviewed and can be updated annually by CMS, which may increase or decrease the allowed amount for this code.

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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.