Medicare Reimbursement for CPT 21145

This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 21145, a procedure code defined by the AMA's CPT code set. Amounts are shown nationally and can vary by locality, and may differ depending on whether the service is reported in a non-facility (e.g., office) or facility (e.g., hospital) setting.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1390.81	$1390.81
ALASKA* (AK)	$1762.30	$1762.30
ALABAMA (AL)	$1279.52	$1279.52
ARKANSAS (AR)	$1265.79	$1265.79
ARIZONA (AZ)	$1359.11	$1359.11
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1604.28	$1604.28
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1628.76	$1628.76
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1460.78	$1460.78
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1476.04	$1476.04
NAPA (CA)	$1542.86	$1542.86
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1608.12	$1608.12
VALLEJO (CA)	$1537.32	$1537.32
BAKERSFIELD (CA)	$1409.32	$1409.32
CHICO (CA)	$1399.52	$1399.52
FRESNO (CA)	$1399.52	$1399.52
HANFORD-CORCORAN (CA)	$1399.52	$1399.52
MADERA (CA)	$1399.52	$1399.52
MERCED (CA)	$1399.52	$1399.52
MODESTO (CA)	$1399.52	$1399.52
REDDING (CA)	$1399.52	$1399.52
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1436.09	$1436.09
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1447.72	$1447.72
SALINAS (CA)	$1441.83	$1441.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1644.45	$1644.45
SANTA CRUZ-WATSONVILLE (CA)	$1461.94	$1461.94
SANTA ROSA-PETALUMA (CA)	$1475.44	$1475.44
STOCKTON (CA)	$1399.52	$1399.52
VISALIA (CA)	$1399.52	$1399.52
YUBA CITY (CA)	$1399.52	$1399.52
EL CENTRO (CA)	$1400.09	$1400.09
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1460.17	$1460.17
SAN LUIS OBISPO-PASO ROBLES (CA)	$1420.95	$1420.95
SANTA MARIA-SANTA BARBARA (CA)	$1442.98	$1442.98
REST OF CALIFORNIA (CA)	$1399.52	$1399.52
COLORADO (CO)	$1407.34	$1407.34
CONNECTICUT (CT)	$1468.49	$1468.49
DC + MD/VA SUBURBS (DC)	$1534.37	$1534.37
DELAWARE (DE)	$1377.33	$1377.33
FORT LAUDERDALE (FL)	$1488.51	$1488.51
MIAMI (FL)	$1583.86	$1583.86
REST OF FLORIDA (FL)	$1425.67	$1425.67
ATLANTA (GA)	$1423.82	$1423.82
REST OF GEORGIA (GA)	$1358.67	$1358.67
HAWAII, GUAM (HI)	$1411.56	$1411.56
IOWA (IA)	$1280.38	$1280.38
IDAHO (ID)	$1291.45	$1291.45
EAST ST. LOUIS (IL)	$1465.42	$1465.42
SUBURBAN CHICAGO (IL)	$1496.88	$1496.88
CHICAGO (IL)	$1544.96	$1544.96
REST OF ILLINOIS (IL)	$1411.02	$1411.02
INDIANA (IN)	$1296.41	$1296.41
KANSAS (KS)	$1286.98	$1286.98
KENTUCKY (KY)	$1325.90	$1325.90
NEW ORLEANS (LA)	$1376.77	$1376.77
REST OF LOUISIANA (LA)	$1328.76	$1328.76
METROPOLITAN BOSTON (MA)	$1507.04	$1507.04
REST OF MASSACHUSETTS (MA)	$1406.78	$1406.78
BALTIMORE/SURR. CNTYS (MD)	$1466.42	$1466.42
REST OF MARYLAND (MD)	$1395.33	$1395.33
SOUTHERN MAINE (ME)	$1344.67	$1344.67
REST OF MAINE (ME)	$1308.27	$1308.27
DETROIT (MI)	$1450.82	$1450.82
REST OF MICHIGAN (MI)	$1362.02	$1362.02
MINNESOTA (MN)	$1325.79	$1325.79
METROPOLITAN ST. LOUIS (MO)	$1367.12	$1367.12
METROPOLITAN KANSAS CITY (MO)	$1357.82	$1357.82
REST OF MISSOURI (MO)	$1319.11	$1319.11
MISSISSIPPI (MS)	$1292.08	$1292.08
MONTANA** (MT)	$1390.59	$1390.59
NORTH CAROLINA (NC)	$1316.67	$1316.67
NORTH DAKOTA** (ND)	$1323.75	$1323.75
NEBRASKA (NE)	$1282.22	$1282.22
NEW HAMPSHIRE (NH)	$1397.13	$1397.13
NORTHERN NJ (NJ)	$1527.34	$1527.34
REST OF NEW JERSEY (NJ)	$1478.79	$1478.79
NEW MEXICO (NM)	$1372.14	$1372.14
NEVADA** (NV)	$1372.46	$1372.46
MANHATTAN (NY)	$1587.59	$1587.59
NYC SUBURBS/LONG ISLAND (NY)	$1631.64	$1631.64
POUGHKPSIE/N NYC SUBURBS (NY)	$1496.94	$1496.94
QUEENS (NY)	$1581.30	$1581.30
REST OF NEW YORK (NY)	$1332.37	$1332.37
OHIO (OH)	$1348.36	$1348.36
OKLAHOMA (OK)	$1312.32	$1312.32
PORTLAND (OR)	$1429.70	$1429.70
REST OF OREGON (OR)	$1355.29	$1355.29
METROPOLITAN PHILADELPHIA (PA)	$1447.07	$1447.07
REST OF PENNSYLVANIA (PA)	$1343.74	$1343.74
PUERTO RICO (PR)	$1394.60	$1394.60
RHODE ISLAND (RI)	$1409.88	$1409.88
SOUTH CAROLINA (SC)	$1336.01	$1336.01
SOUTH DAKOTA** (SD)	$1315.85	$1315.85
TENNESSEE (TN)	$1293.19	$1293.19
BRAZORIA (TX)	$1367.73	$1367.73
DALLAS (TX)	$1379.81	$1379.81
GALVESTON (TX)	$1374.14	$1374.14
HOUSTON (TX)	$1436.01	$1436.01
BEAUMONT (TX)	$1337.95	$1337.95
FORT WORTH (TX)	$1376.29	$1376.29
AUSTIN (TX)	$1408.41	$1408.41
REST OF TEXAS (TX)	$1354.45	$1354.45
UTAH (UT)	$1349.40	$1349.40
VIRGINIA (VA)	$1349.15	$1349.15
VIRGIN ISLANDS (VI)	$1394.60	$1394.60
VERMONT (VT)	$1330.06	$1330.06
SEATTLE (KING CNTY) (WA)	$1522.26	$1522.26
REST OF WASHINGTON (WA)	$1400.38	$1400.38
WISCONSIN (WI)	$1291.76	$1291.76
WEST VIRGINIA (WV)	$1374.19	$1374.19
WYOMING** (WY)	$1361.46	$1361.46

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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) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice expense RVUs often differ between non-facility and facility settings because overhead costs differ, which can make the same code pay differently depending on place of service.

RVUs — work 23.34, practice expense 14.92 (non-facility) / 14.92 (facility), malpractice 3.38 — × 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 patient or secondary payer is generally responsible for the rest.
Actual payment can be affected by modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Allowed amounts vary by locality due to GPCI differences and may change if the conversion factor is updated mid-year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The two settings use different practice expense RVUs because overhead costs (equipment, staff, supplies) are typically borne by the facility rather than the billing physician when the service is performed in a facility setting.

Does this amount reflect what my practice will actually be paid?

No. It's a national/locality estimate based on standard RVUs and the conversion factor. Your actual payment depends on your specific Medicare Administrative Contractor's locality, any applicable modifiers, and patient-specific factors like deductible status.

Why do Medicare fee amounts change each year?

CMS updates RVUs, GPCIs, and the conversion factor annually (and sometimes mid-year) as part of rulemaking, which can increase or decrease the allowed amount for a given code.

Can modifiers change this amount?

Yes. Modifiers such as bilateral, multiple-procedure, or assistant-at-surgery indicators can increase or reduce the base PFS amount; this page shows the unmodified base rate.

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.