Medicare Reimbursement for CPT 21143

This page covers a CPT procedure code billed under Medicare Part B. It shows the Medicare Physician Fee Schedule (PFS) allowed amount at the national level and estimates how that amount can vary by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1273.58	$1273.58
ALASKA* (AK)	$1603.34	$1603.34
ALABAMA (AL)	$1169.30	$1169.30
ARKANSAS (AR)	$1156.40	$1156.40
ARIZONA (AZ)	$1244.10	$1244.10
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1481.80	$1481.80
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1504.93	$1504.93
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1344.18	$1344.18
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1357.66	$1357.66
NAPA (CA)	$1423.18	$1423.18
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1485.19	$1485.19
VALLEJO (CA)	$1418.30	$1418.30
BAKERSFIELD (CA)	$1294.59	$1294.59
CHICO (CA)	$1285.95	$1285.95
FRESNO (CA)	$1285.95	$1285.95
HANFORD-CORCORAN (CA)	$1285.95	$1285.95
MADERA (CA)	$1285.95	$1285.95
MERCED (CA)	$1285.95	$1285.95
MODESTO (CA)	$1285.95	$1285.95
REDDING (CA)	$1285.95	$1285.95
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1318.19	$1318.19
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1331.72	$1331.72
SALINAS (CA)	$1326.34	$1326.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1518.77	$1518.77
SANTA CRUZ-WATSONVILLE (CA)	$1346.85	$1346.85
SANTA ROSA-PETALUMA (CA)	$1359.37	$1359.37
STOCKTON (CA)	$1285.95	$1285.95
VISALIA (CA)	$1285.95	$1285.95
YUBA CITY (CA)	$1285.95	$1285.95
EL CENTRO (CA)	$1286.45	$1286.45
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1344.33	$1344.33
SAN LUIS OBISPO-PASO ROBLES (CA)	$1306.97	$1306.97
SANTA MARIA-SANTA BARBARA (CA)	$1327.70	$1327.70
REST OF CALIFORNIA (CA)	$1285.95	$1285.95
COLORADO (CO)	$1291.28	$1291.28
CONNECTICUT (CT)	$1345.81	$1345.81
DC + MD/VA SUBURBS (DC)	$1408.82	$1408.82
DELAWARE (DE)	$1261.09	$1261.09
FORT LAUDERDALE (FL)	$1360.35	$1360.35
MIAMI (FL)	$1445.80	$1445.80
REST OF FLORIDA (FL)	$1302.14	$1302.14
ATLANTA (GA)	$1303.46	$1303.46
REST OF GEORGIA (GA)	$1239.91	$1239.91
HAWAII, GUAM (HI)	$1298.62	$1298.62
IOWA (IA)	$1172.02	$1172.02
IDAHO (ID)	$1182.03	$1182.03
EAST ST. LOUIS (IL)	$1335.41	$1335.41
SUBURBAN CHICAGO (IL)	$1368.41	$1368.41
CHICAGO (IL)	$1409.71	$1409.71
REST OF ILLINOIS (IL)	$1287.10	$1287.10
INDIANA (IN)	$1186.74	$1186.74
KANSAS (KS)	$1177.30	$1177.30
KENTUCKY (KY)	$1210.88	$1210.88
NEW ORLEANS (LA)	$1258.28	$1258.28
REST OF LOUISIANA (LA)	$1213.20	$1213.20
METROPOLITAN BOSTON (MA)	$1385.53	$1385.53
REST OF MASSACHUSETTS (MA)	$1290.24	$1290.24
BALTIMORE/SURR. CNTYS (MD)	$1343.80	$1343.80
REST OF MARYLAND (MD)	$1278.13	$1278.13
SOUTHERN MAINE (ME)	$1232.45	$1232.45
REST OF MAINE (ME)	$1196.86	$1196.86
DETROIT (MI)	$1324.75	$1324.75
REST OF MICHIGAN (MI)	$1243.90	$1243.90
MINNESOTA (MN)	$1217.67	$1217.67
METROPOLITAN ST. LOUIS (MO)	$1250.32	$1250.32
METROPOLITAN KANSAS CITY (MO)	$1241.48	$1241.48
REST OF MISSOURI (MO)	$1203.55	$1203.55
MISSISSIPPI (MS)	$1179.67	$1179.67
MONTANA** (MT)	$1273.38	$1273.38
NORTH CAROLINA (NC)	$1204.90	$1204.90
NORTH DAKOTA** (ND)	$1214.45	$1214.45
NEBRASKA (NE)	$1174.04	$1174.04
NEW HAMPSHIRE (NH)	$1281.17	$1281.17
NORTHERN NJ (NJ)	$1401.71	$1401.71
REST OF NEW JERSEY (NJ)	$1355.60	$1355.60
NEW MEXICO (NM)	$1253.02	$1253.02
NEVADA** (NV)	$1257.44	$1257.44
MANHATTAN (NY)	$1454.93	$1454.93
NYC SUBURBS/LONG ISLAND (NY)	$1495.10	$1495.10
POUGHKPSIE/N NYC SUBURBS (NY)	$1371.74	$1371.74
QUEENS (NY)	$1450.37	$1450.37
REST OF NEW YORK (NY)	$1219.58	$1219.58
OHIO (OH)	$1231.86	$1231.86
OKLAHOMA (OK)	$1199.09	$1199.09
PORTLAND (OR)	$1313.30	$1313.30
REST OF OREGON (OR)	$1242.06	$1242.06
METROPOLITAN PHILADELPHIA (PA)	$1325.16	$1325.16
REST OF PENNSYLVANIA (PA)	$1228.03	$1228.03
PUERTO RICO (PR)	$1277.46	$1277.46
RHODE ISLAND (RI)	$1291.97	$1291.97
SOUTH CAROLINA (SC)	$1221.51	$1221.51
SOUTH DAKOTA** (SD)	$1207.49	$1207.49
TENNESSEE (TN)	$1183.02	$1183.02
BRAZORIA (TX)	$1252.76	$1252.76
DALLAS (TX)	$1263.66	$1263.66
GALVESTON (TX)	$1258.52	$1258.52
HOUSTON (TX)	$1313.06	$1313.06
BEAUMONT (TX)	$1222.53	$1222.53
FORT WORTH (TX)	$1260.06	$1260.06
AUSTIN (TX)	$1291.94	$1291.94
REST OF TEXAS (TX)	$1239.00	$1239.00
UTAH (UT)	$1234.10	$1234.10
VIRGINIA (VA)	$1236.01	$1236.01
VIRGIN ISLANDS (VI)	$1277.46	$1277.46
VERMONT (VT)	$1219.52	$1219.52
SEATTLE (KING CNTY) (WA)	$1400.56	$1400.56
REST OF WASHINGTON (WA)	$1284.60	$1284.60
WISCONSIN (WI)	$1184.17	$1184.17
WEST VIRGINIA (WV)	$1252.46	$1252.46
WYOMING** (WY)	$1247.70	$1247.70

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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 pricing for this code starts with three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — which reflect the relative resources involved in furnishing the service. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to account for regional cost differences. The 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 use different practice-expense RVUs, which can cause the allowed amount to differ between the two settings, though in some cases they may be the same.

RVUs — work 20.52, practice expense 14.63 (non-facility) / 14.63 (facility), malpractice 2.98 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates based on the national PFS formula and standard GPCIs; your actual payment may differ.
Medicare typically pays 80% of the allowed amount after the Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can all change the final payment.
Annual updates to RVUs, GPCIs, and the conversion factor — including budget-neutrality adjustments — mean amounts can change year to year.
Always confirm the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

When the practice-expense RVUs used for non-facility and facility settings are identical for a given code, the two allowed amounts calculate to the same figure. This is determined by CMS's published RVU tables, not by site-of-service billing rules.

Why does the Medicare amount differ by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs) for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost-of-living and practice cost differences before the conversion factor is applied.

Is this the amount my practice will actually be paid?

No. This is an estimated PFS allowed amount. Actual payment depends on the patient's deductible/coinsurance status, applicable modifiers, secondary insurance, and any claim-specific adjustments made by the MAC.

Does this figure already reflect sequestration or other federal adjustments?

Not necessarily. Standard sequestration reductions and other federal payment adjustments may be applied after the base PFS calculation and are not always reflected in a generic allowed-amount estimate.

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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.