Medicare Reimbursement for CPT 21125

CPT code 21125 is a surgical procedure code; because its official descriptor is licensed by the AMA, it is referred to here generically as 'this procedure code.' This page shows the Medicare Physician Fee Schedule (PFS) allowed amount nationally and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2595.58	$605.56
ALASKA* (AK)	$2896.52	$777.14
ALABAMA (AL)	$2302.61	$561.34
ARKANSAS (AR)	$2265.30	$555.86
ARIZONA (AZ)	$2521.46	$593.12
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$3509.18	$703.24
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$3583.83	$714.21
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2991.22	$639.01
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2999.66	$645.46
NAPA (CA)	$3298.56	$675.70
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$3510.55	$704.61
VALLEJO (CA)	$3296.58	$673.72
BAKERSFIELD (CA)	$2798.00	$616.93
CHICO (CA)	$2794.34	$613.27
FRESNO (CA)	$2794.34	$613.27
HANFORD-CORCORAN (CA)	$2794.34	$613.27
MADERA (CA)	$2794.34	$613.27
MERCED (CA)	$2794.34	$613.27
MODESTO (CA)	$2794.34	$613.27
REDDING (CA)	$2794.34	$613.27
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2807.51	$626.44
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2948.66	$634.26
SALINAS (CA)	$2938.08	$631.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$3589.45	$719.83
SANTA CRUZ-WATSONVILLE (CA)	$3057.96	$640.08
SANTA ROSA-PETALUMA (CA)	$3089.77	$646.02
STOCKTON (CA)	$2794.34	$613.27
VISALIA (CA)	$2794.34	$613.27
YUBA CITY (CA)	$2794.34	$613.27
EL CENTRO (CA)	$2794.54	$613.48
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$3019.50	$639.43
SAN LUIS OBISPO-PASO ROBLES (CA)	$2889.09	$622.45
SANTA MARIA-SANTA BARBARA (CA)	$2952.45	$632.08
REST OF CALIFORNIA (CA)	$2794.34	$613.27
COLORADO (CO)	$2731.97	$614.59
CONNECTICUT (CT)	$2780.77	$637.51
DC + MD/VA SUBURBS (DC)	$3011.36	$667.11
DELAWARE (DE)	$2566.82	$600.67
FORT LAUDERDALE (FL)	$2656.88	$640.99
MIAMI (FL)	$2747.72	$676.10
REST OF FLORIDA (FL)	$2518.96	$616.50
ATLANTA (GA)	$2640.02	$618.15
REST OF GEORGIA (GA)	$2365.37	$590.27
HAWAII, GUAM (HI)	$2880.44	$617.78
IOWA (IA)	$2383.92	$563.05
IDAHO (ID)	$2398.01	$567.19
EAST ST. LOUIS (IL)	$2460.29	$629.46
SUBURBAN CHICAGO (IL)	$2688.74	$644.98
CHICAGO (IL)	$2661.40	$661.42
REST OF ILLINOIS (IL)	$2426.64	$609.74
INDIANA (IN)	$2413.96	$569.20
KANSAS (KS)	$2364.01	$565.02
KENTUCKY (KY)	$2347.56	$578.43
NEW ORLEANS (LA)	$2471.08	$598.46
REST OF LOUISIANA (LA)	$2340.49	$579.32
METROPOLITAN BOSTON (MA)	$3033.03	$656.94
REST OF MASSACHUSETTS (MA)	$2709.79	$614.29
BALTIMORE/SURR. CNTYS (MD)	$2771.64	$636.34
REST OF MARYLAND (MD)	$2622.23	$608.32
SOUTHERN MAINE (ME)	$2560.84	$588.72
REST OF MAINE (ME)	$2404.03	$573.21
DETROIT (MI)	$2546.19	$625.81
REST OF MICHIGAN (MI)	$2409.10	$592.20
MINNESOTA (MN)	$2631.03	$583.30
METROPOLITAN ST. LOUIS (MO)	$2489.90	$595.39
METROPOLITAN KANSAS CITY (MO)	$2460.24	$591.61
REST OF MISSOURI (MO)	$2290.46	$575.05
MISSISSIPPI (MS)	$2278.76	$565.34
MONTANA** (MT)	$2595.50	$605.48
NORTH CAROLINA (NC)	$2433.36	$576.67
NORTH DAKOTA** (ND)	$2571.58	$581.55
NEBRASKA (NE)	$2400.78	$563.99
NEW HAMPSHIRE (NH)	$2680.87	$609.26
NORTHERN NJ (NJ)	$2973.04	$664.61
REST OF NEW JERSEY (NJ)	$2816.29	$643.18
NEW MEXICO (NM)	$2420.82	$595.97
NEVADA** (NV)	$2591.04	$599.02
MANHATTAN (NY)	$2998.74	$686.33
NYC SUBURBS/LONG ISLAND (NY)	$3069.18	$703.04
POUGHKPSIE/N NYC SUBURBS (NY)	$2829.23	$650.15
QUEENS (NY)	$3036.99	$684.78
REST OF NEW YORK (NY)	$2473.41	$582.88
OHIO (OH)	$2404.21	$587.31
OKLAHOMA (OK)	$2350.80	$573.71
PORTLAND (OR)	$2835.45	$624.53
REST OF OREGON (OR)	$2574.77	$592.70
METROPOLITAN PHILADELPHIA (PA)	$2700.06	$628.44
REST OF PENNSYLVANIA (PA)	$2412.68	$585.83
PUERTO RICO (PR)	$2619.22	$607.30
RHODE ISLAND (RI)	$2670.62	$614.92
SOUTH CAROLINA (SC)	$2422.06	$583.28
SOUTH DAKOTA** (SD)	$2568.75	$578.72
TENNESSEE (TN)	$2376.36	$567.42
BRAZORIA (TX)	$2569.68	$597.56
DALLAS (TX)	$2584.20	$602.13
GALVESTON (TX)	$2576.02	$599.93
HOUSTON (TX)	$2598.17	$622.07
BEAUMONT (TX)	$2394.40	$583.48
FORT WORTH (TX)	$2562.69	$600.52
AUSTIN (TX)	$2719.48	$614.03
REST OF TEXAS (TX)	$2479.29	$590.75
UTAH (UT)	$2459.25	$588.63
VIRGINIA (VA)	$2546.24	$590.05
VIRGIN ISLANDS (VI)	$2619.22	$607.30
VERMONT (VT)	$2553.58	$583.46
SEATTLE (KING CNTY) (WA)	$3105.96	$664.20
REST OF WASHINGTON (WA)	$2707.28	$611.78
WISCONSIN (WI)	$2475.07	$568.63
WEST VIRGINIA (WV)	$2324.35	$595.02
WYOMING** (WY)	$2585.08	$595.05

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: 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 — assigned to each code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect 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 higher when the physician's own office bears the overhead, versus lower when the service is furnished in a facility that bills its own costs separately.

RVUs — work 10.53, practice expense 65.97 (non-facility) / 6.39 (facility), malpractice 1.21 — × 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 deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Rates vary by locality based on GPCI values; confirm the exact locality mapping and current fee schedule with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the non-facility amount higher than the facility amount?

The non-facility rate includes a larger practice-expense RVU because the billing provider is covering office overhead, supplies, and staff costs. In a facility setting, those overhead costs are billed separately by the facility, so the physician's practice-expense RVU—and the resulting payment—is lower.

Does this amount apply to every state or locality?

No. The national figures shown are references only. Actual payment depends on the Geographic Practice Cost Indices (GPCIs) for the specific Medicare locality where the service is performed, so amounts will vary by region.

How much will Medicare actually pay on a claim?

Medicare generally reimburses 80% of the PFS allowed amount after the deductible is met, with the remaining 20% owed by the patient or a secondary payer. Modifiers, multiple-procedure reductions, and sequestration can further adjust the final payment.

Why might the conversion factor or RVUs change next year?

The conversion factor and RVUs are updated annually by CMS through rulemaking, often reflecting budget-neutrality adjustments, legislative changes, or revised relative value assignments. Always confirm figures for the current fee schedule year.

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.