Medicare Reimbursement for CPT 21146

CPT 21146 is a physician procedure code reimbursed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount nationally and by locality, broken out for non-facility and facility settings. Amounts are derived from the code's relative value units (RVUs) and standard Medicare pricing inputs.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1452.94	$1452.94
ALASKA* (AK)	$1839.46	$1839.46
ALABAMA (AL)	$1336.34	$1336.34
ARKANSAS (AR)	$1321.95	$1321.95
ARIZONA (AZ)	$1419.76	$1419.76
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1678.02	$1678.02
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1703.71	$1703.71
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1527.10	$1527.10
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1542.96	$1542.96
NAPA (CA)	$1613.47	$1613.47
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1682.01	$1682.01
VALLEJO (CA)	$1607.72	$1607.72
BAKERSFIELD (CA)	$1472.96	$1472.96
CHICO (CA)	$1462.78	$1462.78
FRESNO (CA)	$1462.78	$1462.78
HANFORD-CORCORAN (CA)	$1462.78	$1462.78
MADERA (CA)	$1462.78	$1462.78
MERCED (CA)	$1462.78	$1462.78
MODESTO (CA)	$1462.78	$1462.78
REDDING (CA)	$1462.78	$1462.78
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1500.75	$1500.75
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1513.39	$1513.39
SALINAS (CA)	$1507.24	$1507.24
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1720.01	$1720.01
SANTA CRUZ-WATSONVILLE (CA)	$1528.58	$1528.58
SANTA ROSA-PETALUMA (CA)	$1542.71	$1542.71
STOCKTON (CA)	$1462.78	$1462.78
VISALIA (CA)	$1462.78	$1462.78
YUBA CITY (CA)	$1462.78	$1462.78
EL CENTRO (CA)	$1463.37	$1463.37
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1526.59	$1526.59
SAN LUIS OBISPO-PASO ROBLES (CA)	$1485.39	$1485.39
SANTA MARIA-SANTA BARBARA (CA)	$1508.49	$1508.49
REST OF CALIFORNIA (CA)	$1462.78	$1462.78
COLORADO (CO)	$1470.63	$1470.63
CONNECTICUT (CT)	$1534.24	$1534.24
DC + MD/VA SUBURBS (DC)	$1603.51	$1603.51
DELAWARE (DE)	$1438.84	$1438.84
FORT LAUDERDALE (FL)	$1554.50	$1554.50
MIAMI (FL)	$1653.75	$1653.75
REST OF FLORIDA (FL)	$1488.78	$1488.78
ATLANTA (GA)	$1487.35	$1487.35
REST OF GEORGIA (GA)	$1418.67	$1418.67
HAWAII, GUAM (HI)	$1475.61	$1475.61
IOWA (IA)	$1337.56	$1337.56
IDAHO (ID)	$1349.10	$1349.10
EAST ST. LOUIS (IL)	$1529.76	$1529.76
SUBURBAN CHICAGO (IL)	$1563.31	$1563.31
CHICAGO (IL)	$1613.06	$1613.06
REST OF ILLINOIS (IL)	$1473.21	$1473.21
INDIANA (IN)	$1354.30	$1354.30
KANSAS (KS)	$1344.32	$1344.32
KENTUCKY (KY)	$1384.62	$1384.62
NEW ORLEANS (LA)	$1437.87	$1437.87
REST OF LOUISIANA (LA)	$1387.56	$1387.56
METROPOLITAN BOSTON (MA)	$1575.24	$1575.24
REST OF MASSACHUSETTS (MA)	$1469.96	$1469.96
BALTIMORE/SURR. CNTYS (MD)	$1532.06	$1532.06
REST OF MARYLAND (MD)	$1457.73	$1457.73
SOUTHERN MAINE (ME)	$1404.95	$1404.95
REST OF MAINE (ME)	$1366.57	$1366.57
DETROIT (MI)	$1514.96	$1514.96
REST OF MICHIGAN (MI)	$1422.32	$1422.32
MINNESOTA (MN)	$1385.65	$1385.65
METROPOLITAN ST. LOUIS (MO)	$1427.94	$1427.94
METROPOLITAN KANSAS CITY (MO)	$1418.17	$1418.17
REST OF MISSOURI (MO)	$1377.34	$1377.34
MISSISSIPPI (MS)	$1349.26	$1349.26
MONTANA** (MT)	$1452.70	$1452.70
NORTH CAROLINA (NC)	$1375.39	$1375.39
NORTH DAKOTA** (ND)	$1383.30	$1383.30
NEBRASKA (NE)	$1339.54	$1339.54
NEW HAMPSHIRE (NH)	$1459.84	$1459.84
NORTHERN NJ (NJ)	$1596.06	$1596.06
REST OF NEW JERSEY (NJ)	$1545.08	$1545.08
NEW MEXICO (NM)	$1432.87	$1432.87
NEVADA** (NV)	$1433.89	$1433.89
MANHATTAN (NY)	$1658.65	$1658.65
NYC SUBURBS/LONG ISLAND (NY)	$1704.61	$1704.61
POUGHKPSIE/N NYC SUBURBS (NY)	$1563.95	$1563.95
QUEENS (NY)	$1652.28	$1652.28
REST OF NEW YORK (NY)	$1391.83	$1391.83
OHIO (OH)	$1408.14	$1408.14
OKLAHOMA (OK)	$1370.54	$1370.54
PORTLAND (OR)	$1494.24	$1494.24
REST OF OREGON (OR)	$1416.02	$1416.02
METROPOLITAN PHILADELPHIA (PA)	$1511.70	$1511.70
REST OF PENNSYLVANIA (PA)	$1403.38	$1403.38
PUERTO RICO (PR)	$1456.96	$1456.96
RHODE ISLAND (RI)	$1473.02	$1473.02
SOUTH CAROLINA (SC)	$1395.40	$1395.40
SOUTH DAKOTA** (SD)	$1375.09	$1375.09
TENNESSEE (TN)	$1350.82	$1350.82
BRAZORIA (TX)	$1428.90	$1428.90
DALLAS (TX)	$1441.48	$1441.48
GALVESTON (TX)	$1435.57	$1435.57
HOUSTON (TX)	$1499.82	$1499.82
BEAUMONT (TX)	$1397.30	$1397.30
FORT WORTH (TX)	$1437.75	$1437.75
AUSTIN (TX)	$1471.69	$1471.69
REST OF TEXAS (TX)	$1414.75	$1414.75
UTAH (UT)	$1409.44	$1409.44
VIRGINIA (VA)	$1409.53	$1409.53
VIRGIN ISLANDS (VI)	$1456.96	$1456.96
VERMONT (VT)	$1389.77	$1389.77
SEATTLE (KING CNTY) (WA)	$1591.32	$1591.32
REST OF WASHINGTON (WA)	$1463.31	$1463.31
WISCONSIN (WI)	$1349.73	$1349.73
WEST VIRGINIA (WV)	$1434.60	$1434.60
WYOMING** (WY)	$1422.46	$1422.46

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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 pricing for this procedure code starts with three RVU components — physician work, practice expense (PE), and malpractice (MP) — which reflect the relative resources involved in furnishing the service. Each RVU component is adjusted by geographic practice cost indices (GPCIs) specific to a given locality to account for local cost differences, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates can differ because the practice-expense RVU is typically higher in non-facility settings (e.g., office) where the practicing clinician bears more overhead, versus facility settings (e.g., hospital) where the facility absorbs certain costs. For this code, the non-facility and facility PE RVUs are the same, so the resulting allowed amounts align in both settings nationally, though locality-level results may still vary due to GPCI differences.

RVUs — work 24.25, practice expense 15.74 (non-facility) / 15.74 (facility), malpractice 3.51 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national/locality PFS inputs — 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 responsible for the remainder.
Actual payment can be affected by modifiers, place-of-service rules, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Rates vary by locality due to GPCI differences; always confirm exact allowed amounts with your Medicare Administrative Contractor (MAC).

Frequently asked

Why do non-facility and facility amounts sometimes differ for the same code?

They differ when the practice-expense RVU assigned to non-facility settings is higher than the facility RVU, reflecting that the billing provider incurs more overhead in an office setting versus a hospital or ambulatory surgical center.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare Physician Fee Schedule allowed amount before the 20% coinsurance, deductible, and any applicable adjustments like sequestration or modifiers are applied.

Why does the amount change from year to year?

The conversion factor, RVUs, and GPCIs are updated annually (and sometimes mid-year) by CMS, which can increase or decrease the allowed amount even if the code's relative value stays the same.

Where can I find the locality-specific amount for my practice?

Use the locality selector on this page, or consult your MAC's fee schedule lookup tool, since GPCIs vary by geographic area and affect the final allowed amount.

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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.