Medicare Reimbursement for CPT 21123

CPT 21123 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, under non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$777.91	$777.91
ALASKA* (AK)	$961.53	$961.53
ALABAMA (AL)	$710.23	$710.23
ARKANSAS (AR)	$701.81	$701.81
ARIZONA (AZ)	$759.17	$759.17
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$927.51	$927.51
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$942.90	$942.90
OXNARD-THOUSAND OAKS-VENTURA (CA)	$832.54	$832.54
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$839.90	$839.90
NAPA (CA)	$887.52	$887.52
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$929.34	$929.34
VALLEJO (CA)	$884.89	$884.89
BAKERSFIELD (CA)	$797.95	$797.95
CHICO (CA)	$793.29	$793.29
FRESNO (CA)	$793.29	$793.29
HANFORD-CORCORAN (CA)	$793.29	$793.29
MADERA (CA)	$793.29	$793.29
MERCED (CA)	$793.29	$793.29
MODESTO (CA)	$793.29	$793.29
REDDING (CA)	$793.29	$793.29
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$810.70	$810.70
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$824.07	$824.07
SALINAS (CA)	$820.81	$820.81
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$950.38	$950.38
SANTA CRUZ-WATSONVILLE (CA)	$836.98	$836.98
SANTA ROSA-PETALUMA (CA)	$844.91	$844.91
STOCKTON (CA)	$793.29	$793.29
VISALIA (CA)	$793.29	$793.29
YUBA CITY (CA)	$793.29	$793.29
EL CENTRO (CA)	$793.56	$793.56
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$833.88	$833.88
SAN LUIS OBISPO-PASO ROBLES (CA)	$808.54	$808.54
SANTA MARIA-SANTA BARBARA (CA)	$822.18	$822.18
REST OF CALIFORNIA (CA)	$793.29	$793.29
COLORADO (CO)	$793.27	$793.27
CONNECTICUT (CT)	$823.90	$823.90
DC + MD/VA SUBURBS (DC)	$867.07	$867.07
DELAWARE (DE)	$770.07	$770.07
FORT LAUDERDALE (FL)	$825.97	$825.97
MIAMI (FL)	$874.67	$874.67
REST OF FLORIDA (FL)	$789.35	$789.35
ATLANTA (GA)	$795.50	$795.50
REST OF GEORGIA (GA)	$749.92	$749.92
HAWAII, GUAM (HI)	$803.86	$803.86
IOWA (IA)	$715.33	$715.33
IDAHO (ID)	$721.19	$721.19
EAST ST. LOUIS (IL)	$804.06	$804.06
SUBURBAN CHICAGO (IL)	$831.58	$831.58
CHICAGO (IL)	$851.91	$851.91
REST OF ILLINOIS (IL)	$777.32	$777.32
INDIANA (IN)	$724.37	$724.37
KANSAS (KS)	$717.18	$717.18
KENTUCKY (KY)	$733.96	$733.96
NEW ORLEANS (LA)	$764.29	$764.29
REST OF LOUISIANA (LA)	$734.86	$734.86
METROPOLITAN BOSTON (MA)	$855.95	$855.95
REST OF MASSACHUSETTS (MA)	$791.70	$791.70
BALTIMORE/SURR. CNTYS (MD)	$822.46	$822.46
REST OF MARYLAND (MD)	$781.45	$781.45
SOUTHERN MAINE (ME)	$754.87	$754.87
REST OF MAINE (ME)	$729.20	$729.20
DETROIT (MI)	$802.38	$802.38
REST OF MICHIGAN (MI)	$753.98	$753.98
MINNESOTA (MN)	$750.34	$750.34
METROPOLITAN ST. LOUIS (MO)	$760.99	$760.99
METROPOLITAN KANSAS CITY (MO)	$755.03	$755.03
REST OF MISSOURI (MO)	$727.56	$727.56
MISSISSIPPI (MS)	$714.57	$714.57
MONTANA** (MT)	$777.80	$777.80
NORTH CAROLINA (NC)	$734.73	$734.73
NORTH DAKOTA** (ND)	$745.96	$745.96
NEBRASKA (NE)	$717.15	$717.15
NEW HAMPSHIRE (NH)	$785.73	$785.73
NORTHERN NJ (NJ)	$861.59	$861.59
REST OF NEW JERSEY (NJ)	$830.53	$830.53
NEW MEXICO (NM)	$759.27	$759.27
NEVADA** (NV)	$769.28	$769.28
MANHATTAN (NY)	$890.53	$890.53
NYC SUBURBS/LONG ISLAND (NY)	$914.68	$914.68
POUGHKPSIE/N NYC SUBURBS (NY)	$839.52	$839.52
QUEENS (NY)	$889.88	$889.88
REST OF NEW YORK (NY)	$744.20	$744.20
OHIO (OH)	$747.48	$747.48
OKLAHOMA (OK)	$727.96	$727.96
PORTLAND (OR)	$809.42	$809.42
REST OF OREGON (OR)	$760.52	$760.52
METROPOLITAN PHILADELPHIA (PA)	$809.48	$809.48
REST OF PENNSYLVANIA (PA)	$745.86	$745.86
PUERTO RICO (PR)	$781.00	$781.00
RHODE ISLAND (RI)	$790.82	$790.82
SOUTH CAROLINA (SC)	$742.88	$742.88
SOUTH DAKOTA** (SD)	$742.20	$742.20
TENNESSEE (TN)	$720.73	$720.73
BRAZORIA (TX)	$765.84	$765.84
DALLAS (TX)	$772.18	$772.18
GALVESTON (TX)	$769.13	$769.13
HOUSTON (TX)	$798.60	$798.60
BEAUMONT (TX)	$742.16	$742.16
FORT WORTH (TX)	$769.33	$769.33
AUSTIN (TX)	$793.09	$793.09
REST OF TEXAS (TX)	$754.60	$754.60
UTAH (UT)	$751.14	$751.14
VIRGINIA (VA)	$756.07	$756.07
VIRGIN ISLANDS (VI)	$781.00	$781.00
VERMONT (VT)	$747.79	$747.79
SEATTLE (KING CNTY) (WA)	$867.06	$867.06
REST OF WASHINGTON (WA)	$788.66	$788.66
WISCONSIN (WI)	$725.80	$725.80
WEST VIRGINIA (WV)	$754.62	$754.62
WYOMING** (WY)	$763.93	$763.93

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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 — which reflect the relative resources involved in furnishing a service. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility and facility rates can differ because practice-expense RVUs are typically lower in facility settings, where the facility itself bears some overhead costs.

RVUs — work 11.06, practice expense 10.62 (non-facility) / 10.62 (facility), malpractice 1.61 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only and not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual updates to RVUs, GPCIs, and the conversion factor — including budget-neutrality adjustments — mean amounts can change year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility and non-facility amount the same for this code?

When the practice-expense RVUs are identical for non-facility and facility settings, the resulting PFS amounts will also be the same, since the other RVU components (work and malpractice) do not vary by setting.

Does this amount reflect what my specific MAC will pay?

Not exactly. The national amount uses standard GPCI values; actual payment depends on the locality-adjusted GPCIs applicable to where the service was rendered, which may differ from the national figure shown here.

Can I bill the patient the difference between my charge and this amount?

For Medicare-assigned claims, providers generally cannot balance-bill beyond the Medicare-approved amount, though cost-sharing (deductible and coinsurance) still applies. Check specific billing rules with your MAC or compliance resources.

Will this amount change next year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can shift payment amounts even if the code's RVUs stay the same.

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.