Medicare Reimbursement for CPT 21137

This page covers CPT code 21137, a physician procedure code recognized under the Medicare Physician Fee Schedule (PFS). Because CPT descriptors are proprietary to the AMA, we refer to it generically rather than reproducing the official description. Below you'll find the estimated Medicare-allowed amount nationally and by locality, shown separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$685.05	$685.05
ALASKA* (AK)	$842.82	$842.82
ALABAMA (AL)	$621.99	$621.99
ARKANSAS (AR)	$614.20	$614.20
ARIZONA (AZ)	$667.17	$667.17
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$800.06	$800.06
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$812.60	$812.60
OXNARD-THOUSAND OAKS-VENTURA (CA)	$723.86	$723.86
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$731.01	$731.01
NAPA (CA)	$767.85	$767.85
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$802.16	$802.16
VALLEJO (CA)	$764.82	$764.82
BAKERSFIELD (CA)	$695.06	$695.06
CHICO (CA)	$689.88	$689.88
FRESNO (CA)	$689.88	$689.88
HANFORD-CORCORAN (CA)	$689.88	$689.88
MADERA (CA)	$689.88	$689.88
MERCED (CA)	$689.88	$689.88
MODESTO (CA)	$689.88	$689.88
REDDING (CA)	$689.88	$689.88
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$709.80	$709.80
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$715.64	$715.64
SALINAS (CA)	$712.81	$712.81
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$821.19	$821.19
SANTA CRUZ-WATSONVILLE (CA)	$725.71	$725.71
SANTA ROSA-PETALUMA (CA)	$732.48	$732.48
STOCKTON (CA)	$689.88	$689.88
VISALIA (CA)	$689.88	$689.88
YUBA CITY (CA)	$689.88	$689.88
EL CENTRO (CA)	$690.19	$690.19
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$723.58	$723.58
SAN LUIS OBISPO-PASO ROBLES (CA)	$702.35	$702.35
SANTA MARIA-SANTA BARBARA (CA)	$713.84	$713.84
REST OF CALIFORNIA (CA)	$689.88	$689.88
COLORADO (CO)	$694.08	$694.08
CONNECTICUT (CT)	$727.02	$727.02
DC + MD/VA SUBURBS (DC)	$761.64	$761.64
DELAWARE (DE)	$677.00	$677.00
FORT LAUDERDALE (FL)	$738.75	$738.75
MIAMI (FL)	$791.42	$791.42
REST OF FLORIDA (FL)	$703.38	$703.38
ATLANTA (GA)	$703.11	$703.11
REST OF GEORGIA (GA)	$665.61	$665.61
HAWAII, GUAM (HI)	$698.76	$698.76
IOWA (IA)	$623.15	$623.15
IDAHO (ID)	$629.29	$629.29
EAST ST. LOUIS (IL)	$724.52	$724.52
SUBURBAN CHICAGO (IL)	$742.92	$742.92
CHICAGO (IL)	$768.86	$768.86
REST OF ILLINOIS (IL)	$694.62	$694.62
INDIANA (IN)	$632.13	$632.13
KANSAS (KS)	$626.57	$626.57
KENTUCKY (KY)	$647.62	$647.62
NEW ORLEANS (LA)	$676.35	$676.35
REST OF LOUISIANA (LA)	$649.12	$649.12
METROPOLITAN BOSTON (MA)	$748.17	$748.17
REST OF MASSACHUSETTS (MA)	$693.21	$693.21
BALTIMORE/SURR. CNTYS (MD)	$726.19	$726.19
REST OF MARYLAND (MD)	$686.80	$686.80
SOUTHERN MAINE (ME)	$659.64	$659.64
REST OF MAINE (ME)	$638.50	$638.50
DETROIT (MI)	$717.29	$717.29
REST OF MICHIGAN (MI)	$667.80	$667.80
MINNESOTA (MN)	$649.96	$649.96
METROPOLITAN ST. LOUIS (MO)	$671.26	$671.26
METROPOLITAN KANSAS CITY (MO)	$665.95	$665.95
REST OF MISSOURI (MO)	$643.44	$643.44
MISSISSIPPI (MS)	$628.63	$628.63
MONTANA** (MT)	$684.93	$684.93
NORTH CAROLINA (NC)	$643.32	$643.32
NORTH DAKOTA** (ND)	$648.35	$648.35
NEBRASKA (NE)	$624.29	$624.29
NEW HAMPSHIRE (NH)	$689.22	$689.22
NORTHERN NJ (NJ)	$756.64	$756.64
REST OF NEW JERSEY (NJ)	$731.05	$731.05
NEW MEXICO (NM)	$673.41	$673.41
NEVADA** (NV)	$675.02	$675.02
MANHATTAN (NY)	$789.56	$789.56
NYC SUBURBS/LONG ISLAND (NY)	$814.14	$814.14
POUGHKPSIE/N NYC SUBURBS (NY)	$740.57	$740.57
QUEENS (NY)	$786.46	$786.46
REST OF NEW YORK (NY)	$652.20	$652.20
OHIO (OH)	$660.32	$660.32
OKLAHOMA (OK)	$640.25	$640.25
PORTLAND (OR)	$706.75	$706.75
REST OF OREGON (OR)	$665.54	$665.54
METROPOLITAN PHILADELPHIA (PA)	$714.87	$714.87
REST OF PENNSYLVANIA (PA)	$657.88	$657.88
PUERTO RICO (PR)	$687.31	$687.31
RHODE ISLAND (RI)	$694.28	$694.28
SOUTH CAROLINA (SC)	$653.75	$653.75
SOUTH DAKOTA** (SD)	$644.02	$644.02
TENNESSEE (TN)	$630.06	$630.06
BRAZORIA (TX)	$671.52	$671.52
DALLAS (TX)	$678.12	$678.12
GALVESTON (TX)	$675.06	$675.06
HOUSTON (TX)	$708.92	$708.92
BEAUMONT (TX)	$654.57	$654.57
FORT WORTH (TX)	$676.02	$676.02
AUSTIN (TX)	$695.49	$695.49
REST OF TEXAS (TX)	$664.27	$664.27
UTAH (UT)	$661.35	$661.35
VIRGINIA (VA)	$661.96	$661.96
VIRGIN ISLANDS (VI)	$687.31	$687.31
VERMONT (VT)	$651.63	$651.63
SEATTLE (KING CNTY) (WA)	$756.22	$756.22
REST OF WASHINGTON (WA)	$689.98	$689.98
WISCONSIN (WI)	$630.12	$630.12
WEST VIRGINIA (WV)	$673.71	$673.71
WYOMING** (WY)	$668.99	$668.99

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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 — assigned to each code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare Conversion Factor to produce a dollar amount. Non-facility and facility settings can have different practice-expense RVUs because facility settings (like hospitals) typically have lower overhead for the billing physician; for this code, the practice-expense RVU is the same in both settings, so the national amounts match.

RVUs — work 9.98, practice expense 8.68 (non-facility) / 8.68 (facility), malpractice 1.85 — × 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 annual Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean the actual allowed amount can differ from the national figure shown here.
Always confirm current rates and edits with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why do the non-facility and facility amounts look the same for this code?

The practice-expense RVU used in the formula is identical for both settings for this particular code, so the calculated amounts match. This isn't the case for every CPT code.

Why does the allowed amount change by locality?

Each Medicare locality has its own GPCI values for work, practice expense, and malpractice, reflecting local cost-of-living and practice cost differences, which are applied to the RVUs before the conversion factor is applied.

Does this amount reflect what Medicare will actually pay?

It's an estimate of the allowed amount. Actual payment is typically 80% of this figure after the deductible, and can be further affected by modifiers, sequestration, or policy-specific adjustments.

Where can I find the official descriptor for CPT 21137?

CPT descriptors are copyrighted by the American Medical Association. You can look up the official language in your CPT codebook or through a licensed AMA data source.

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.