Medicare Reimbursement for CPT 21139

CPT 21139 is a surgical procedure code; the exact service it describes is defined by the AMA's CPT code set, which we cannot reproduce here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjusted for your locality, and compares non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$984.32	$984.32
ALASKA* (AK)	$1214.32	$1214.32
ALABAMA (AL)	$894.33	$894.33
ARKANSAS (AR)	$883.23	$883.23
ARIZONA (AZ)	$958.70	$958.70
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1144.38	$1144.38
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1162.11	$1162.11
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1037.38	$1037.38
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1047.87	$1047.87
NAPA (CA)	$1099.06	$1099.06
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1147.47	$1147.47
VALLEJO (CA)	$1094.61	$1094.61
BAKERSFIELD (CA)	$996.92	$996.92
CHICO (CA)	$989.31	$989.31
FRESNO (CA)	$989.31	$989.31
HANFORD-CORCORAN (CA)	$989.31	$989.31
MADERA (CA)	$989.31	$989.31
MERCED (CA)	$989.31	$989.31
MODESTO (CA)	$989.31	$989.31
REDDING (CA)	$989.31	$989.31
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1018.60	$1018.60
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1025.70	$1025.70
SALINAS (CA)	$1021.64	$1021.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1174.74	$1174.74
SANTA CRUZ-WATSONVILLE (CA)	$1039.40	$1039.40
SANTA ROSA-PETALUMA (CA)	$1049.06	$1049.06
STOCKTON (CA)	$989.31	$989.31
VISALIA (CA)	$989.31	$989.31
YUBA CITY (CA)	$989.31	$989.31
EL CENTRO (CA)	$989.77	$989.77
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1036.66	$1036.66
SAN LUIS OBISPO-PASO ROBLES (CA)	$1006.71	$1006.71
SANTA MARIA-SANTA BARBARA (CA)	$1023.01	$1023.01
REST OF CALIFORNIA (CA)	$989.31	$989.31
COLORADO (CO)	$996.18	$996.18
CONNECTICUT (CT)	$1044.33	$1044.33
DC + MD/VA SUBURBS (DC)	$1092.99	$1092.99
DELAWARE (DE)	$972.74	$972.74
FORT LAUDERDALE (FL)	$1062.99	$1062.99
MIAMI (FL)	$1139.82	$1139.82
REST OF FLORIDA (FL)	$1012.22	$1012.22
ATLANTA (GA)	$1010.52	$1010.52
REST OF GEORGIA (GA)	$958.08	$958.08
HAWAII, GUAM (HI)	$1001.49	$1001.49
IOWA (IA)	$895.16	$895.16
IDAHO (ID)	$904.09	$904.09
EAST ST. LOUIS (IL)	$1044.09	$1044.09
SUBURBAN CHICAGO (IL)	$1068.81	$1068.81
CHICAGO (IL)	$1107.42	$1107.42
REST OF ILLINOIS (IL)	$1000.28	$1000.28
INDIANA (IN)	$908.10	$908.10
KANSAS (KS)	$900.43	$900.43
KENTUCKY (KY)	$931.70	$931.70
NEW ORLEANS (LA)	$972.82	$972.82
REST OF LOUISIANA (LA)	$933.99	$933.99
METROPOLITAN BOSTON (MA)	$1072.85	$1072.85
REST OF MASSACHUSETTS (MA)	$995.14	$995.14
BALTIMORE/SURR. CNTYS (MD)	$1043.21	$1043.21
REST OF MARYLAND (MD)	$986.62	$986.62
SOUTHERN MAINE (ME)	$947.16	$947.16
REST OF MAINE (ME)	$917.62	$917.62
DETROIT (MI)	$1032.49	$1032.49
REST OF MICHIGAN (MI)	$960.85	$960.85
MINNESOTA (MN)	$932.10	$932.10
METROPOLITAN ST. LOUIS (MO)	$965.09	$965.09
METROPOLITAN KANSAS CITY (MO)	$957.56	$957.56
REST OF MISSOURI (MO)	$926.14	$926.14
MISSISSIPPI (MS)	$904.39	$904.39
MONTANA** (MT)	$984.14	$984.14
NORTH CAROLINA (NC)	$924.43	$924.43
NORTH DAKOTA** (ND)	$930.36	$930.36
NEBRASKA (NE)	$896.67	$896.67
NEW HAMPSHIRE (NH)	$989.55	$989.55
NORTHERN NJ (NJ)	$1086.03	$1086.03
REST OF NEW JERSEY (NJ)	$1049.91	$1049.91
NEW MEXICO (NM)	$969.01	$969.01
NEVADA** (NV)	$969.56	$969.56
MANHATTAN (NY)	$1134.38	$1134.38
NYC SUBURBS/LONG ISLAND (NY)	$1169.93	$1169.93
POUGHKPSIE/N NYC SUBURBS (NY)	$1063.83	$1063.83
QUEENS (NY)	$1129.39	$1129.39
REST OF NEW YORK (NY)	$937.12	$937.12
OHIO (OH)	$949.86	$949.86
OKLAHOMA (OK)	$920.78	$920.78
PORTLAND (OR)	$1013.79	$1013.79
REST OF OREGON (OR)	$955.72	$955.72
METROPOLITAN PHILADELPHIA (PA)	$1027.24	$1027.24
REST OF PENNSYLVANIA (PA)	$946.16	$946.16
PUERTO RICO (PR)	$987.41	$987.41
RHODE ISLAND (RI)	$997.15	$997.15
SOUTH CAROLINA (SC)	$939.96	$939.96
SOUTH DAKOTA** (SD)	$924.00	$924.00
TENNESSEE (TN)	$905.45	$905.45
BRAZORIA (TX)	$964.61	$964.61
DALLAS (TX)	$974.21	$974.21
GALVESTON (TX)	$969.78	$969.78
HOUSTON (TX)	$1019.56	$1019.56
BEAUMONT (TX)	$941.47	$941.47
FORT WORTH (TX)	$971.34	$971.34
AUSTIN (TX)	$998.41	$998.41
REST OF TEXAS (TX)	$954.88	$954.88
UTAH (UT)	$950.79	$950.79
VIRGINIA (VA)	$950.74	$950.74
VIRGIN ISLANDS (VI)	$987.41	$987.41
VERMONT (VT)	$935.40	$935.40
SEATTLE (KING CNTY) (WA)	$1083.97	$1083.97
REST OF WASHINGTON (WA)	$990.41	$990.41
WISCONSIN (WI)	$904.47	$904.47
WEST VIRGINIA (WV)	$970.49	$970.49
WYOMING** (WY)	$960.70	$960.70

Look up another code or locality →

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 — each adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is performed. These geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often use different practice-expense RVUs, reflecting the overhead the physician does or does not bear; for this code those two RVU values are the same, so the resulting amounts match. The formula resets each year when CMS updates RVUs, GPCIs, and the conversion factor.

RVUs — work 14.64, practice expense 12.11 (non-facility) / 12.11 (facility), malpractice 2.72 — × 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's Part B deductible is met; 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.
Always confirm final pricing and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the amount differ by locality?

Medicare adjusts the work, practice expense, and malpractice RVUs using locality-specific GPCIs to reflect regional differences in costs, so the same code can pay differently in different areas.

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

The practice-expense RVU is identical in both settings for this code, so there is no difference between the facility and non-facility allowed amounts.

What conversion factor is used for this estimate?

The estimate uses the Medicare conversion factor in effect for the stated year, which CMS updates annually and which is applied uniformly across all RVU components.

Does this page tell me what CPT 21139 actually describes?

No. CPT code descriptors are copyrighted by the American Medical Association, so this page shows pricing only; refer to your CPT codebook or AMA resources for the official description.

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.