Medicare Reimbursement for CPT 21138

CPT 21138 is a procedure code reported to Medicare for physician and outpatient services; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, nationally and (where available) adjusted by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$826.67	$826.67
ALASKA* (AK)	$1022.58	$1022.58
ALABAMA (AL)	$751.59	$751.59
ARKANSAS (AR)	$742.33	$742.33
ARIZONA (AZ)	$805.21	$805.21
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$956.58	$956.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$971.22	$971.22
OXNARD-THOUSAND OAKS-VENTURA (CA)	$868.88	$868.88
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$877.87	$877.87
NAPA (CA)	$919.35	$919.35
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$959.24	$959.24
VALLEJO (CA)	$915.53	$915.53
BAKERSFIELD (CA)	$835.69	$835.69
CHICO (CA)	$829.15	$829.15
FRESNO (CA)	$829.15	$829.15
HANFORD-CORCORAN (CA)	$829.15	$829.15
MADERA (CA)	$829.15	$829.15
MERCED (CA)	$829.15	$829.15
MODESTO (CA)	$829.15	$829.15
REDDING (CA)	$829.15	$829.15
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$854.34	$854.34
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$859.18	$859.18
SALINAS (CA)	$855.77	$855.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$982.08	$982.08
SANTA CRUZ-WATSONVILLE (CA)	$870.02	$870.02
SANTA ROSA-PETALUMA (CA)	$878.07	$878.07
STOCKTON (CA)	$829.15	$829.15
VISALIA (CA)	$829.15	$829.15
YUBA CITY (CA)	$829.15	$829.15
EL CENTRO (CA)	$829.54	$829.54
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$868.00	$868.00
SAN LUIS OBISPO-PASO ROBLES (CA)	$843.31	$843.31
SANTA MARIA-SANTA BARBARA (CA)	$856.81	$856.81
REST OF CALIFORNIA (CA)	$829.15	$829.15
COLORADO (CO)	$835.66	$835.66
CONNECTICUT (CT)	$876.83	$876.83
DC + MD/VA SUBURBS (DC)	$916.76	$916.76
DELAWARE (DE)	$816.92	$816.92
FORT LAUDERDALE (FL)	$894.11	$894.11
MIAMI (FL)	$959.68	$959.68
REST OF FLORIDA (FL)	$851.50	$851.50
ATLANTA (GA)	$848.91	$848.91
REST OF GEORGIA (GA)	$806.11	$806.11
HAWAII, GUAM (HI)	$838.89	$838.89
IOWA (IA)	$751.55	$751.55
IDAHO (ID)	$759.14	$759.14
EAST ST. LOUIS (IL)	$879.58	$879.58
SUBURBAN CHICAGO (IL)	$898.84	$898.84
CHICAGO (IL)	$932.47	$932.47
REST OF ILLINOIS (IL)	$842.02	$842.02
INDIANA (IN)	$762.46	$762.46
KANSAS (KS)	$756.29	$756.29
KENTUCKY (KY)	$783.47	$783.47
NEW ORLEANS (LA)	$817.87	$817.87
REST OF LOUISIANA (LA)	$785.52	$785.52
METROPOLITAN BOSTON (MA)	$899.15	$899.15
REST OF MASSACHUSETTS (MA)	$834.97	$834.97
BALTIMORE/SURR. CNTYS (MD)	$875.94	$875.94
REST OF MARYLAND (MD)	$828.41	$828.41
SOUTHERN MAINE (ME)	$794.87	$794.87
REST OF MAINE (ME)	$770.78	$770.78
DETROIT (MI)	$868.76	$868.76
REST OF MICHIGAN (MI)	$808.10	$808.10
MINNESOTA (MN)	$781.20	$781.20
METROPOLITAN ST. LOUIS (MO)	$811.02	$811.02
METROPOLITAN KANSAS CITY (MO)	$804.79	$804.79
REST OF MISSOURI (MO)	$779.19	$779.19
MISSISSIPPI (MS)	$760.50	$760.50
MONTANA** (MT)	$826.52	$826.52
NORTH CAROLINA (NC)	$776.39	$776.39
NORTH DAKOTA** (ND)	$780.25	$780.25
NEBRASKA (NE)	$752.70	$752.70
NEW HAMPSHIRE (NH)	$830.41	$830.41
NORTHERN NJ (NJ)	$911.09	$911.09
REST OF NEW JERSEY (NJ)	$881.32	$881.32
NEW MEXICO (NM)	$815.05	$815.05
NEVADA** (NV)	$813.95	$813.95
MANHATTAN (NY)	$952.65	$952.65
NYC SUBURBS/LONG ISLAND (NY)	$982.73	$982.73
POUGHKPSIE/N NYC SUBURBS (NY)	$893.24	$893.24
QUEENS (NY)	$947.98	$947.98
REST OF NEW YORK (NY)	$786.99	$786.99
OHIO (OH)	$798.65	$798.65
OKLAHOMA (OK)	$774.00	$774.00
PORTLAND (OR)	$849.93	$849.93
REST OF OREGON (OR)	$802.14	$802.14
METROPOLITAN PHILADELPHIA (PA)	$862.80	$862.80
REST OF PENNSYLVANIA (PA)	$795.37	$795.37
PUERTO RICO (PR)	$829.12	$829.12
RHODE ISLAND (RI)	$837.06	$837.06
SOUTH CAROLINA (SC)	$789.92	$789.92
SOUTH DAKOTA** (SD)	$774.78	$774.78
TENNESSEE (TN)	$760.52	$760.52
BRAZORIA (TX)	$809.87	$809.87
DALLAS (TX)	$818.03	$818.03
GALVESTON (TX)	$814.28	$814.28
HOUSTON (TX)	$857.11	$857.11
BEAUMONT (TX)	$791.48	$791.48
FORT WORTH (TX)	$815.75	$815.75
AUSTIN (TX)	$837.70	$837.70
REST OF TEXAS (TX)	$802.29	$802.29
UTAH (UT)	$798.94	$798.94
VIRGINIA (VA)	$798.10	$798.10
VIRGIN ISLANDS (VI)	$829.12	$829.12
VERMONT (VT)	$784.77	$784.77
SEATTLE (KING CNTY) (WA)	$908.09	$908.09
REST OF WASHINGTON (WA)	$830.90	$830.90
WISCONSIN (WI)	$758.75	$758.75
WEST VIRGINIA (WV)	$817.22	$817.22
WYOMING** (WY)	$806.35	$806.35

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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 (PE), and malpractice (MP) — which are each adjusted by the Geographic Practice Cost Index (GPCI) for the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can have different PE RVUs because practice expense is treated differently depending on where overhead costs are incurred; for this code, the PE RVU is the same in both settings, so the national non-facility and facility amounts shown are identical. Locality-specific amounts will differ from the national figures because GPCIs vary by region.

RVUs — work 12.55, practice expense 9.86 (non-facility) / 9.86 (facility), malpractice 2.34 — × 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 the Part B deductible; the remainder is patient or secondary-payer responsibility.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts can vary by Medicare Administrative Contractor (MAC) and locality; always verify against your local MAC's published fee schedule before billing or appealing a denial.

Frequently asked

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

When the practice expense RVU is identical for both settings, the calculated PFS amount comes out the same regardless of where the service is performed.

Does this amount reflect what Medicare will actually pay?

No — it's an estimate based on standard RVUs, GPCIs, and the conversion factor. Actual payment depends on the patient's deductible status, applicable modifiers, and any claim-specific adjustments.

Why might the amount differ by locality?

Medicare adjusts work, practice expense, and malpractice RVUs using locality-specific GPCIs to account for regional cost differences, so the same code can have different allowed amounts in different areas.

Where can I find the official rate for my area?

Check your Medicare Administrative Contractor's (MAC) published fee schedule or the CMS Physician Fee Schedule Look-Up Tool for the most current, locality-specific amount.

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.