Medicare Reimbursement for CPT 21127

CPT 21127 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, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$3968.03	$695.74
ALASKA* (AK)	$4378.33	$893.34
ALABAMA (AL)	$3508.32	$645.07
ARKANSAS (AR)	$3449.69	$638.80
ARIZONA (AZ)	$3852.33	$681.49
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$5421.56	$807.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$5538.87	$820.23
OXNARD-THOUSAND OAKS-VENTURA (CA)	$4601.86	$734.02
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$4612.55	$741.43
NAPA (CA)	$5088.94	$776.07
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$5423.14	$809.22
VALLEJO (CA)	$5086.66	$773.79
BAKERSFIELD (CA)	$4295.15	$708.73
CHICO (CA)	$4290.95	$704.53
FRESNO (CA)	$4290.95	$704.53
HANFORD-CORCORAN (CA)	$4290.95	$704.53
MADERA (CA)	$4290.95	$704.53
MERCED (CA)	$4290.95	$704.53
MODESTO (CA)	$4290.95	$704.53
REDDING (CA)	$4290.95	$704.53
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$4306.07	$719.65
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$4534.25	$728.58
SALINAS (CA)	$4518.16	$725.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$5545.32	$826.68
SANTA CRUZ-WATSONVILLE (CA)	$4711.03	$735.20
SANTA ROSA-PETALUMA (CA)	$4760.39	$742.02
STOCKTON (CA)	$4290.95	$704.53
VISALIA (CA)	$4290.95	$704.53
YUBA CITY (CA)	$4290.95	$704.53
EL CENTRO (CA)	$4291.18	$704.76
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$4648.14	$734.49
SAN LUIS OBISPO-PASO ROBLES (CA)	$4442.16	$715.02
SANTA MARIA-SANTA BARBARA (CA)	$4541.56	$726.07
REST OF CALIFORNIA (CA)	$4290.95	$704.53
COLORADO (CO)	$4187.77	$706.06
CONNECTICUT (CT)	$4256.65	$732.39
DC + MD/VA SUBURBS (DC)	$4621.08	$766.33
DELAWARE (DE)	$3923.17	$690.15
FORT LAUDERDALE (FL)	$4051.25	$736.43
MIAMI (FL)	$4183.19	$776.74
REST OF FLORIDA (FL)	$3836.66	$708.35
ATLANTA (GA)	$4034.84	$710.19
REST OF GEORGIA (GA)	$3597.16	$678.29
HAWAII, GUAM (HI)	$4430.23	$709.64
IOWA (IA)	$3641.13	$646.99
IDAHO (ID)	$3662.24	$651.74
EAST ST. LOUIS (IL)	$3733.79	$723.29
SUBURBAN CHICAGO (IL)	$4101.65	$741.01
CHICAGO (IL)	$4048.57	$759.92
REST OF ILLINOIS (IL)	$3688.23	$700.64
INDIANA (IN)	$3687.46	$654.05
KANSAS (KS)	$3607.42	$649.27
KENTUCKY (KY)	$3573.76	$664.69
NEW ORLEANS (LA)	$3766.87	$687.65
REST OF LOUISIANA (LA)	$3561.69	$665.71
METROPOLITAN BOSTON (MA)	$4661.72	$754.61
REST OF MASSACHUSETTS (MA)	$4151.46	$705.74
BALTIMORE/SURR. CNTYS (MD)	$4242.21	$731.05
REST OF MARYLAND (MD)	$4010.47	$698.92
SOUTHERN MAINE (ME)	$3919.25	$676.41
REST OF MAINE (ME)	$3669.16	$658.66
DETROIT (MI)	$3876.80	$719.04
REST OF MICHIGAN (MI)	$3668.09	$680.49
MINNESOTA (MN)	$4037.32	$670.14
METROPOLITAN ST. LOUIS (MO)	$3799.33	$684.11
METROPOLITAN KANSAS CITY (MO)	$3752.46	$679.78
REST OF MISSOURI (MO)	$3481.55	$660.84
MISSISSIPPI (MS)	$3467.12	$649.68
MONTANA** (MT)	$3967.93	$695.65
NORTH CAROLINA (NC)	$3715.66	$662.62
NORTH DAKOTA** (ND)	$3940.45	$668.16
NEBRASKA (NE)	$3668.38	$648.06
NEW HAMPSHIRE (NH)	$4106.40	$699.95
NORTHERN NJ (NJ)	$4559.34	$763.49
REST OF NEW JERSEY (NJ)	$4312.25	$738.91
NEW MEXICO (NM)	$3685.49	$684.81
NEVADA** (NV)	$3963.79	$688.23
MANHATTAN (NY)	$4590.83	$788.43
NYC SUBURBS/LONG ISLAND (NY)	$4698.35	$807.61
POUGHKPSIE/N NYC SUBURBS (NY)	$4330.07	$746.92
QUEENS (NY)	$4654.47	$786.63
REST OF NEW YORK (NY)	$3778.42	$669.74
OHIO (OH)	$3662.47	$674.87
OKLAHOMA (OK)	$3581.41	$659.26
PORTLAND (OR)	$4352.95	$717.44
REST OF OREGON (OR)	$3940.17	$680.98
METROPOLITAN PHILADELPHIA (PA)	$4128.45	$722.00
REST OF PENNSYLVANIA (PA)	$3677.12	$673.17
PUERTO RICO (PR)	$4006.01	$697.73
RHODE ISLAND (RI)	$4086.75	$706.48
SOUTH CAROLINA (SC)	$3693.81	$670.22
SOUTH DAKOTA** (SD)	$3937.20	$664.91
TENNESSEE (TN)	$3626.53	$652.03
BRAZORIA (TX)	$3929.41	$686.57
DALLAS (TX)	$3951.01	$691.82
GALVESTON (TX)	$3938.67	$689.29
HOUSTON (TX)	$3964.11	$714.73
BEAUMONT (TX)	$3648.25	$670.47
FORT WORTH (TX)	$3916.45	$689.98
AUSTIN (TX)	$4167.50	$705.42
REST OF TEXAS (TX)	$3784.18	$678.79
UTAH (UT)	$3752.30	$676.36
VIRGINIA (VA)	$3894.60	$677.94
VIRGIN ISLANDS (VI)	$4006.01	$697.73
VERMONT (VT)	$3909.93	$670.36
SEATTLE (KING CNTY) (WA)	$4778.02	$762.93
REST OF WASHINGTON (WA)	$4148.57	$702.85
WISCONSIN (WI)	$3788.21	$653.36
WEST VIRGINIA (WV)	$3527.38	$683.77
WYOMING** (WY)	$3955.96	$683.67

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units per patient per day — Date of Service Edit: Clinical. 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 PFS amounts are built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the 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) typically have lower physician overhead, since the facility bills separately for its own costs. This is why the same code can show a notably different allowed amount depending on place of service.

RVUs — work 12.13, practice expense 105.28 (non-facility) / 7.31 (facility), malpractice 1.39 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimated allowed amount only, 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, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts vary by locality due to GPCI differences and are updated annually with the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount lower than the non-facility amount for CPT 21127?

The facility amount uses a lower practice-expense RVU because the facility (such as a hospital) bills separately for overhead costs like equipment, supplies, and staff. In the non-facility setting, the physician's practice absorbs those costs, so the practice-expense RVU — and the resulting allowed amount — is higher.

Does this amount reflect what my specific Medicare contractor will pay?

Not exactly. The PFS amount shown is a national estimate adjusted for locality GPCIs, but your MAC may apply additional locality-specific pricing rules, modifiers, or policy edits that change the final payment.

Why do Medicare rates change each year?

CMS updates the conversion factor and RVUs annually, and may apply budget-neutrality adjustments across all codes to keep total Medicare spending within statutory limits, which can raise or lower individual code payments year over year.

What does the patient owe for this code?

After the Part B deductible is met, Medicare generally pays 80% of the allowed amount, and the patient (or a secondary payer) is responsible for the remaining 20% coinsurance, subject to any applicable modifiers or policy exceptions.

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.