Medicare Reimbursement for CPT 21142

CPT 21142 is a procedure code billed to Medicare Part B; the specific clinical description is not reproduced here because CPT descriptors are licensed by the AMA. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and, where available, by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1238.17	$1238.17
ALASKA* (AK)	$1556.63	$1556.63
ALABAMA (AL)	$1136.32	$1136.32
ARKANSAS (AR)	$1123.72	$1123.72
ARIZONA (AZ)	$1209.43	$1209.43
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1443.39	$1443.39
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1466.04	$1466.04
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1308.24	$1308.24
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1321.24	$1321.24
NAPA (CA)	$1385.88	$1385.88
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1446.65	$1446.65
VALLEJO (CA)	$1381.18	$1381.18
BAKERSFIELD (CA)	$1259.51	$1259.51
CHICO (CA)	$1251.19	$1251.19
FRESNO (CA)	$1251.19	$1251.19
HANFORD-CORCORAN (CA)	$1251.19	$1251.19
MADERA (CA)	$1251.19	$1251.19
MERCED (CA)	$1251.19	$1251.19
MODESTO (CA)	$1251.19	$1251.19
REDDING (CA)	$1251.19	$1251.19
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1282.24	$1282.24
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1296.03	$1296.03
SALINAS (CA)	$1290.80	$1290.80
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1479.36	$1479.36
SANTA CRUZ-WATSONVILLE (CA)	$1311.18	$1311.18
SANTA ROSA-PETALUMA (CA)	$1323.39	$1323.39
STOCKTON (CA)	$1251.19	$1251.19
VISALIA (CA)	$1251.19	$1251.19
YUBA CITY (CA)	$1251.19	$1251.19
EL CENTRO (CA)	$1251.67	$1251.67
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1308.54	$1308.54
SAN LUIS OBISPO-PASO ROBLES (CA)	$1271.91	$1271.91
SANTA MARIA-SANTA BARBARA (CA)	$1292.19	$1292.19
REST OF CALIFORNIA (CA)	$1251.19	$1251.19
COLORADO (CO)	$1255.95	$1255.95
CONNECTICUT (CT)	$1308.62	$1308.62
DC + MD/VA SUBURBS (DC)	$1370.45	$1370.45
DELAWARE (DE)	$1226.01	$1226.01
FORT LAUDERDALE (FL)	$1321.89	$1321.89
MIAMI (FL)	$1404.50	$1404.50
REST OF FLORIDA (FL)	$1265.18	$1265.18
ATLANTA (GA)	$1267.13	$1267.13
REST OF GEORGIA (GA)	$1204.52	$1204.52
HAWAII, GUAM (HI)	$1263.84	$1263.84
IOWA (IA)	$1139.40	$1139.40
IDAHO (ID)	$1149.09	$1149.09
EAST ST. LOUIS (IL)	$1296.82	$1296.82
SUBURBAN CHICAGO (IL)	$1329.81	$1329.81
CHICAGO (IL)	$1369.34	$1369.34
REST OF ILLINOIS (IL)	$1250.21	$1250.21
INDIANA (IN)	$1153.71	$1153.71
KANSAS (KS)	$1144.35	$1144.35
KENTUCKY (KY)	$1176.52	$1176.52
NEW ORLEANS (LA)	$1222.77	$1222.77
REST OF LOUISIANA (LA)	$1178.72	$1178.72
METROPOLITAN BOSTON (MA)	$1348.20	$1348.20
REST OF MASSACHUSETTS (MA)	$1254.82	$1254.82
BALTIMORE/SURR. CNTYS (MD)	$1306.64	$1306.64
REST OF MARYLAND (MD)	$1242.70	$1242.70
SOUTHERN MAINE (ME)	$1198.46	$1198.46
REST OF MAINE (ME)	$1163.38	$1163.38
DETROIT (MI)	$1287.06	$1287.06
REST OF MICHIGAN (MI)	$1208.61	$1208.61
MINNESOTA (MN)	$1184.66	$1184.66
METROPOLITAN ST. LOUIS (MO)	$1215.23	$1215.23
METROPOLITAN KANSAS CITY (MO)	$1206.57	$1206.57
REST OF MISSOURI (MO)	$1169.17	$1169.17
MISSISSIPPI (MS)	$1146.16	$1146.16
MONTANA** (MT)	$1237.98	$1237.98
NORTH CAROLINA (NC)	$1171.27	$1171.27
NORTH DAKOTA** (ND)	$1181.23	$1181.23
NEBRASKA (NE)	$1141.43	$1141.43
NEW HAMPSHIRE (NH)	$1245.95	$1245.95
NORTHERN NJ (NJ)	$1363.41	$1363.41
REST OF NEW JERSEY (NJ)	$1318.22	$1318.22
NEW MEXICO (NM)	$1217.44	$1217.44
NEVADA** (NV)	$1222.64	$1222.64
MANHATTAN (NY)	$1414.69	$1414.69
NYC SUBURBS/LONG ISLAND (NY)	$1453.68	$1453.68
POUGHKPSIE/N NYC SUBURBS (NY)	$1333.80	$1333.80
QUEENS (NY)	$1410.52	$1410.52
REST OF NEW YORK (NY)	$1185.60	$1185.60
OHIO (OH)	$1197.01	$1197.01
OKLAHOMA (OK)	$1165.22	$1165.22
PORTLAND (OR)	$1277.70	$1277.70
REST OF OREGON (OR)	$1207.77	$1207.77
METROPOLITAN PHILADELPHIA (PA)	$1288.32	$1288.32
REST OF PENNSYLVANIA (PA)	$1193.38	$1193.38
PUERTO RICO (PR)	$1242.04	$1242.04
RHODE ISLAND (RI)	$1256.27	$1256.27
SOUTH CAROLINA (SC)	$1187.16	$1187.16
SOUTH DAKOTA** (SD)	$1174.52	$1174.52
TENNESSEE (TN)	$1149.93	$1149.93
BRAZORIA (TX)	$1218.03	$1218.03
DALLAS (TX)	$1228.57	$1228.57
GALVESTON (TX)	$1223.59	$1223.59
HOUSTON (TX)	$1276.12	$1276.12
BEAUMONT (TX)	$1187.99	$1187.99
FORT WORTH (TX)	$1225.00	$1225.00
AUSTIN (TX)	$1256.52	$1256.52
REST OF TEXAS (TX)	$1204.29	$1204.29
UTAH (UT)	$1199.48	$1199.48
VIRGINIA (VA)	$1201.79	$1201.79
VIRGIN ISLANDS (VI)	$1242.04	$1242.04
VERMONT (VT)	$1186.00	$1186.00
SEATTLE (KING CNTY) (WA)	$1363.05	$1363.05
REST OF WASHINGTON (WA)	$1249.39	$1249.39
WISCONSIN (WI)	$1151.59	$1151.59
WEST VIRGINIA (WV)	$1216.35	$1216.35
WYOMING** (WY)	$1213.25	$1213.25

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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 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 typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which can make the allowed amount vary by place of service. The conversion factor is updated annually and can change due to legislation or budget-neutrality adjustments across the fee schedule.

RVUs — work 19.77, practice expense 14.43 (non-facility) / 14.43 (facility), malpractice 2.87 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national averages and standard GPCI/RVU inputs — not a guarantee of payment.
Medicare typically pays 80% of the approved amount after the 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 all change the final paid amount.
Amounts vary by Medicare Administrative Contractor (MAC) locality; always verify current-year figures with your MAC or official CMS fee schedule files before billing or appealing a denial.

Frequently asked

Why is the facility amount sometimes the same as the non-facility amount?

When the practice expense RVU is identical for both settings, the resulting PFS amount can be the same in non-facility and facility settings; otherwise, facility amounts are usually lower because Medicare assumes the facility, not the physician's practice, bears more of the overhead cost.

Why can the allowed amount differ by locality even for the same code?

Geographic Practice Cost Indices adjust the work, practice expense, and malpractice RVUs to reflect regional cost-of-living and labor cost differences, so the same code can price differently from one locality to another.

Does this page tell me what my payer will actually reimburse?

No — this reflects the Medicare PFS national/locality estimate only. Commercial payers, Medicare Advantage plans, and state Medicaid programs may use different fee schedules or contracted rates.

What should I do if a claim for this code was denied or paid differently than expected?

Confirm the place of service, modifiers, and locality used on the claim, then compare against your MAC's current fee schedule; discrepancies are often due to modifier logic, bundling edits, or locality misassignment rather than the base fee schedule 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.