Medicare Reimbursement for CPT 21147

This page covers CPT code 21147, a physician procedure code valued under the Medicare Physician Fee Schedule (PFS). It shows the estimated national PFS allowed amount for both non-facility and facility settings, along with the RVU and GPCI inputs used to derive it. Actual payment in a specific locality may differ from the national figure shown here.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1525.42	$1525.42
ALASKA* (AK)	$1935.19	$1935.19
ALABAMA (AL)	$1403.80	$1403.80
ARKANSAS (AR)	$1388.80	$1388.80
ARIZONA (AZ)	$1490.70	$1490.70
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1755.91	$1755.91
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1782.55	$1782.55
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1600.27	$1600.27
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1617.15	$1617.15
NAPA (CA)	$1689.22	$1689.22
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1760.17	$1760.17
VALLEJO (CA)	$1683.08	$1683.08
BAKERSFIELD (CA)	$1544.48	$1544.48
CHICO (CA)	$1533.61	$1533.61
FRESNO (CA)	$1533.61	$1533.61
HANFORD-CORCORAN (CA)	$1533.61	$1533.61
MADERA (CA)	$1533.61	$1533.61
MERCED (CA)	$1533.61	$1533.61
MODESTO (CA)	$1533.61	$1533.61
REDDING (CA)	$1533.61	$1533.61
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1574.18	$1574.18
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1586.04	$1586.04
SALINAS (CA)	$1579.58	$1579.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1799.97	$1799.97
SANTA CRUZ-WATSONVILLE (CA)	$1601.09	$1601.09
SANTA ROSA-PETALUMA (CA)	$1615.85	$1615.85
STOCKTON (CA)	$1533.61	$1533.61
VISALIA (CA)	$1533.61	$1533.61
YUBA CITY (CA)	$1533.61	$1533.61
EL CENTRO (CA)	$1534.24	$1534.24
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1599.38	$1599.38
SAN LUIS OBISPO-PASO ROBLES (CA)	$1556.75	$1556.75
SANTA MARIA-SANTA BARBARA (CA)	$1580.76	$1580.76
REST OF CALIFORNIA (CA)	$1533.61	$1533.61
COLORADO (CO)	$1542.77	$1542.77
CONNECTICUT (CT)	$1610.40	$1610.40
DC + MD/VA SUBURBS (DC)	$1681.90	$1681.90
DELAWARE (DE)	$1510.62	$1510.62
FORT LAUDERDALE (FL)	$1633.62	$1633.62
MIAMI (FL)	$1738.99	$1738.99
REST OF FLORIDA (FL)	$1564.75	$1564.75
ATLANTA (GA)	$1561.79	$1561.79
REST OF GEORGIA (GA)	$1491.35	$1491.35
HAWAII, GUAM (HI)	$1546.41	$1546.41
IOWA (IA)	$1404.15	$1404.15
IDAHO (ID)	$1416.36	$1416.36
EAST ST. LOUIS (IL)	$1609.38	$1609.38
SUBURBAN CHICAGO (IL)	$1642.68	$1642.68
CHICAGO (IL)	$1696.35	$1696.35
REST OF ILLINOIS (IL)	$1549.12	$1549.12
INDIANA (IN)	$1421.76	$1421.76
KANSAS (KS)	$1411.64	$1411.64
KENTUCKY (KY)	$1455.04	$1455.04
NEW ORLEANS (LA)	$1510.71	$1510.71
REST OF LOUISIANA (LA)	$1458.28	$1458.28
METROPOLITAN BOSTON (MA)	$1651.38	$1651.38
REST OF MASSACHUSETTS (MA)	$1542.30	$1542.30
BALTIMORE/SURR. CNTYS (MD)	$1608.18	$1608.18
REST OF MARYLAND (MD)	$1530.23	$1530.23
SOUTHERN MAINE (ME)	$1474.36	$1474.36
REST OF MAINE (ME)	$1435.03	$1435.03
DETROIT (MI)	$1592.51	$1592.51
REST OF MICHIGAN (MI)	$1494.76	$1494.76
MINNESOTA (MN)	$1452.85	$1452.85
METROPOLITAN ST. LOUIS (MO)	$1499.84	$1499.84
METROPOLITAN KANSAS CITY (MO)	$1489.71	$1489.71
REST OF MISSOURI (MO)	$1447.91	$1447.91
MISSISSIPPI (MS)	$1417.93	$1417.93
MONTANA** (MT)	$1525.17	$1525.17
NORTH CAROLINA (NC)	$1444.15	$1444.15
NORTH DAKOTA** (ND)	$1451.02	$1451.02
NEBRASKA (NE)	$1406.08	$1406.08
NEW HAMPSHIRE (NH)	$1531.82	$1531.82
NORTHERN NJ (NJ)	$1674.34	$1674.34
REST OF NEW JERSEY (NJ)	$1621.56	$1621.56
NEW MEXICO (NM)	$1505.93	$1505.93
NEVADA** (NV)	$1505.04	$1505.04
MANHATTAN (NY)	$1741.16	$1741.16
NYC SUBURBS/LONG ISLAND (NY)	$1789.63	$1789.63
POUGHKPSIE/N NYC SUBURBS (NY)	$1641.63	$1641.63
QUEENS (NY)	$1733.89	$1733.89
REST OF NEW YORK (NY)	$1461.31	$1461.31
OHIO (OH)	$1479.61	$1479.61
OKLAHOMA (OK)	$1439.91	$1439.91
PORTLAND (OR)	$1566.88	$1566.88
REST OF OREGON (OR)	$1486.07	$1486.07
METROPOLITAN PHILADELPHIA (PA)	$1587.17	$1587.17
REST OF PENNSYLVANIA (PA)	$1474.41	$1474.41
PUERTO RICO (PR)	$1529.46	$1529.46
RHODE ISLAND (RI)	$1546.03	$1546.03
SOUTH CAROLINA (SC)	$1465.74	$1465.74
SOUTH DAKOTA** (SD)	$1442.25	$1442.25
TENNESSEE (TN)	$1418.46	$1418.46
BRAZORIA (TX)	$1499.92	$1499.92
DALLAS (TX)	$1513.24	$1513.24
GALVESTON (TX)	$1507.01	$1507.01
HOUSTON (TX)	$1575.64	$1575.64
BEAUMONT (TX)	$1468.10	$1468.10
FORT WORTH (TX)	$1509.49	$1509.49
AUSTIN (TX)	$1544.07	$1544.07
REST OF TEXAS (TX)	$1485.83	$1485.83
UTAH (UT)	$1480.36	$1480.36
VIRGINIA (VA)	$1479.45	$1479.45
VIRGIN ISLANDS (VI)	$1529.46	$1529.46
VERMONT (VT)	$1458.16	$1458.16
SEATTLE (KING CNTY) (WA)	$1667.75	$1667.75
REST OF WASHINGTON (WA)	$1535.21	$1535.21
WISCONSIN (WI)	$1416.14	$1416.14
WEST VIRGINIA (WV)	$1508.91	$1508.91
WYOMING** (WY)	$1492.85	$1492.85

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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) — work, practice expense (PE), and malpractice (MP) — that reflect the physician effort, overhead, and liability costs associated with a service. Each RVU component is adjusted by a locality-specific Geographic Practice Cost Index (GPCI) to account for regional cost differences, then the adjusted RVUs are summed and multiplied by the annual Conversion Factor (CF) to produce a dollar amount. Non-facility and facility PE RVUs can differ because non-facility pricing assumes the practice bears overhead costs (e.g., office-based services), while facility pricing assumes a hospital or ASC absorbs most overhead. For this code, the work and malpractice RVUs stay constant across settings, but the PE RVU may be the only component that changes between non-facility and facility totals. The final allowed amount therefore varies by locality and by where the service is performed.

RVUs — work 25.81, practice expense 16.11 (non-facility) / 16.11 (facility), malpractice 3.75 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their annual deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Locality-specific GPCIs mean the actual allowed amount in your area may differ from the national figure shown.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount different from the non-facility amount?

Facility and non-facility rates can differ because the Practice Expense RVU component accounts for who bears the overhead cost — the physician's office (non-facility) or the hospital/ASC (facility). If PE RVUs are equal for both settings, the allowed amounts will match; otherwise they'll diverge.

Does this figure reflect what my Medicare Administrative Contractor (MAC) will actually pay?

Not exactly. The MAC applies the locality-specific GPCIs to these RVUs, so the final allowed amount can be higher or lower than the national average shown here.

Why might the conversion factor change year to year?

The Conversion Factor is updated annually by CMS based on statutory formulas, budget-neutrality adjustments, and legislative changes, so the same RVUs can produce a different dollar amount from one year to the next.

Can modifiers affect this amount?

Yes. Modifiers such as bilateral, multiple-procedure, or assistant-at-surgery indicators can increase or reduce the base allowed amount shown here.

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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.