Medicare Reimbursement for CPT 21122

CPT 21122 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, with non-facility and facility rates shown separately where they differ.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$700.08	$700.08
ALASKA* (AK)	$841.99	$841.99
ALABAMA (AL)	$631.82	$631.82
ARKANSAS (AR)	$623.32	$623.32
ARIZONA (AZ)	$681.25	$681.25
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$846.14	$846.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$860.57	$860.57
OXNARD-THOUSAND OAKS-VENTURA (CA)	$754.51	$754.51
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$760.71	$760.71
NAPA (CA)	$807.92	$807.92
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$847.92	$847.92
VALLEJO (CA)	$805.35	$805.35
BAKERSFIELD (CA)	$719.92	$719.92
CHICO (CA)	$715.52	$715.52
FRESNO (CA)	$715.52	$715.52
HANFORD-CORCORAN (CA)	$715.52	$715.52
MADERA (CA)	$715.52	$715.52
MERCED (CA)	$715.52	$715.52
MODESTO (CA)	$715.52	$715.52
REDDING (CA)	$715.52	$715.52
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$732.43	$732.43
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$745.30	$745.30
SALINAS (CA)	$742.43	$742.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$867.86	$867.86
SANTA CRUZ-WATSONVILLE (CA)	$759.98	$759.98
SANTA ROSA-PETALUMA (CA)	$767.27	$767.27
STOCKTON (CA)	$715.52	$715.52
VISALIA (CA)	$715.52	$715.52
YUBA CITY (CA)	$715.52	$715.52
EL CENTRO (CA)	$715.78	$715.78
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$755.93	$755.93
SAN LUIS OBISPO-PASO ROBLES (CA)	$731.18	$731.18
SANTA MARIA-SANTA BARBARA (CA)	$744.13	$744.13
REST OF CALIFORNIA (CA)	$715.52	$715.52
COLORADO (CO)	$715.30	$715.30
CONNECTICUT (CT)	$744.80	$744.80
DC + MD/VA SUBURBS (DC)	$786.13	$786.13
DELAWARE (DE)	$691.84	$691.84
FORT LAUDERDALE (FL)	$747.19	$747.19
MIAMI (FL)	$795.19	$795.19
REST OF FLORIDA (FL)	$710.44	$710.44
ATLANTA (GA)	$717.30	$717.30
REST OF GEORGIA (GA)	$670.83	$670.83
HAWAII, GUAM (HI)	$727.88	$727.88
IOWA (IA)	$637.52	$637.52
IDAHO (ID)	$643.32	$643.32
EAST ST. LOUIS (IL)	$724.13	$724.13
SUBURBAN CHICAGO (IL)	$752.38	$752.38
CHICAGO (IL)	$771.80	$771.80
REST OF ILLINOIS (IL)	$697.93	$697.93
INDIANA (IN)	$646.55	$646.55
KANSAS (KS)	$639.12	$639.12
KENTUCKY (KY)	$655.21	$655.21
NEW ORLEANS (LA)	$685.73	$685.73
REST OF LOUISIANA (LA)	$656.01	$656.01
METROPOLITAN BOSTON (MA)	$776.57	$776.57
REST OF MASSACHUSETTS (MA)	$713.27	$713.27
BALTIMORE/SURR. CNTYS (MD)	$743.63	$743.63
REST OF MARYLAND (MD)	$702.99	$702.99
SOUTHERN MAINE (ME)	$677.46	$677.46
REST OF MAINE (ME)	$651.14	$651.14
DETROIT (MI)	$723.31	$723.31
REST OF MICHIGAN (MI)	$675.17	$675.17
MINNESOTA (MN)	$673.72	$673.72
METROPOLITAN ST. LOUIS (MO)	$682.71	$682.71
METROPOLITAN KANSAS CITY (MO)	$676.67	$676.67
REST OF MISSOURI (MO)	$648.48	$648.48
MISSISSIPPI (MS)	$635.79	$635.79
MONTANA** (MT)	$699.98	$699.98
NORTH CAROLINA (NC)	$656.76	$656.76
NORTH DAKOTA** (ND)	$668.93	$668.93
NEBRASKA (NE)	$639.43	$639.43
NEW HAMPSHIRE (NH)	$708.45	$708.45
NORTHERN NJ (NJ)	$779.77	$779.77
REST OF NEW JERSEY (NJ)	$750.01	$750.01
NEW MEXICO (NM)	$680.41	$680.41
NEVADA** (NV)	$691.69	$691.69
MANHATTAN (NY)	$807.94	$807.94
NYC SUBURBS/LONG ISLAND (NY)	$831.98	$831.98
POUGHKPSIE/N NYC SUBURBS (NY)	$758.44	$758.44
QUEENS (NY)	$807.67	$807.67
REST OF NEW YORK (NY)	$666.30	$666.30
OHIO (OH)	$668.83	$668.83
OKLAHOMA (OK)	$649.43	$649.43
PORTLAND (OR)	$731.61	$731.61
REST OF OREGON (OR)	$683.05	$683.05
METROPOLITAN PHILADELPHIA (PA)	$730.23	$730.23
REST OF PENNSYLVANIA (PA)	$667.34	$667.34
PUERTO RICO (PR)	$703.30	$703.30
RHODE ISLAND (RI)	$711.82	$711.82
SOUTH CAROLINA (SC)	$664.55	$664.55
SOUTH DAKOTA** (SD)	$665.26	$665.26
TENNESSEE (TN)	$642.67	$642.67
BRAZORIA (TX)	$687.54	$687.54
DALLAS (TX)	$693.73	$693.73
GALVESTON (TX)	$690.78	$690.78
HOUSTON (TX)	$719.52	$719.52
BEAUMONT (TX)	$663.59	$663.59
FORT WORTH (TX)	$690.77	$690.77
AUSTIN (TX)	$715.79	$715.79
REST OF TEXAS (TX)	$676.43	$676.43
UTAH (UT)	$672.89	$672.89
VIRGINIA (VA)	$678.48	$678.48
VIRGIN ISLANDS (VI)	$703.30	$703.30
VERMONT (VT)	$670.54	$670.54
SEATTLE (KING CNTY) (WA)	$787.31	$787.31
REST OF WASHINGTON (WA)	$710.53	$710.53
WISCONSIN (WI)	$648.50	$648.50
WEST VIRGINIA (WV)	$674.99	$674.99
WYOMING** (WY)	$686.45	$686.45

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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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. These locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs (and therefore the total) can differ between non-facility settings (e.g., a physician's office) and facility settings (e.g., a hospital), reflecting different overhead costs. The conversion factor is updated annually and applies uniformly across all codes before locality adjustment.

RVUs — work 8.49, practice expense 10.9 (non-facility) / 10.9 (facility), malpractice 1.57 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate based on the national PFS formula; actual payment depends on your specific Medicare Administrative Contractor (MAC) and locality.
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, bilateral billing rules, and sequestration can increase or decrease the final payment.
Annual budget-neutrality adjustments and RVU updates mean these figures change year to year and should be reverified each calendar year.
This information is for general reference only and is not billing, coding, or reimbursement advice — confirm specifics with your MAC or CMS.

Frequently asked

Why is the facility rate different from the non-facility rate for this code?

The two rates differ because practice-expense RVUs vary by site of service — non-facility (e.g., office) rates account for the physician's overhead, while facility (e.g., hospital) rates assume the facility bears those costs.

Does this amount reflect what Medicare actually pays?

No. The figure shown is the full Medicare-allowed amount before the standard 80/20 split; Medicare generally pays 80% after the patient meets their deductible.

Will the amount be the same in every state?

No. The national amount is adjusted using locality-specific GPCIs, so the final allowed amount can vary meaningfully by geographic area.

Why might my MAC's payment differ from this estimate?

Differences can arise from modifiers, multiple-procedure payment reductions, sequestration, claim-specific adjustments, or mid-year/annual rule changes not reflected in this baseline calculation.

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.