Medicare Reimbursement for CPT 21150

CPT 21150 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount for this code nationally and by locality, along with the non-facility and facility rate distinction.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1415.20	$1415.20
ALASKA* (AK)	$1811.57	$1811.57
ALABAMA (AL)	$1305.88	$1305.88
ARKANSAS (AR)	$1292.45	$1292.45
ARIZONA (AZ)	$1383.60	$1383.60
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1607.73	$1607.73
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1631.25	$1631.25
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1473.68	$1473.68
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1490.17	$1490.17
NAPA (CA)	$1549.83	$1549.83
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1611.92	$1611.92
VALLEJO (CA)	$1543.79	$1543.79
BAKERSFIELD (CA)	$1425.94	$1425.94
CHICO (CA)	$1415.25	$1415.25
FRESNO (CA)	$1415.25	$1415.25
HANFORD-CORCORAN (CA)	$1415.25	$1415.25
MADERA (CA)	$1415.25	$1415.25
MERCED (CA)	$1415.25	$1415.25
MODESTO (CA)	$1415.25	$1415.25
REDDING (CA)	$1415.25	$1415.25
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1455.17	$1455.17
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1461.23	$1461.23
SALINAS (CA)	$1455.22	$1455.22
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1648.38	$1648.38
SANTA CRUZ-WATSONVILLE (CA)	$1471.77	$1471.77
SANTA ROSA-PETALUMA (CA)	$1485.19	$1485.19
STOCKTON (CA)	$1415.25	$1415.25
VISALIA (CA)	$1415.25	$1415.25
YUBA CITY (CA)	$1415.25	$1415.25
EL CENTRO (CA)	$1415.87	$1415.87
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1471.64	$1471.64
SAN LUIS OBISPO-PASO ROBLES (CA)	$1434.45	$1434.45
SANTA MARIA-SANTA BARBARA (CA)	$1455.81	$1455.81
REST OF CALIFORNIA (CA)	$1415.25	$1415.25
COLORADO (CO)	$1426.93	$1426.93
CONNECTICUT (CT)	$1492.37	$1492.37
DC + MD/VA SUBURBS (DC)	$1554.26	$1554.26
DELAWARE (DE)	$1401.62	$1401.62
FORT LAUDERDALE (FL)	$1520.59	$1520.59
MIAMI (FL)	$1621.95	$1621.95
REST OF FLORIDA (FL)	$1457.54	$1457.54
ATLANTA (GA)	$1449.65	$1449.65
REST OF GEORGIA (GA)	$1390.63	$1390.63
HAWAII, GUAM (HI)	$1424.49	$1424.49
IOWA (IA)	$1302.92	$1302.92
IDAHO (ID)	$1314.52	$1314.52
EAST ST. LOUIS (IL)	$1504.45	$1504.45
SUBURBAN CHICAGO (IL)	$1528.32	$1528.32
CHICAGO (IL)	$1582.95	$1582.95
REST OF ILLINOIS (IL)	$1445.73	$1445.73
INDIANA (IN)	$1319.25	$1319.25
KANSAS (KS)	$1311.19	$1311.19
KENTUCKY (KY)	$1355.15	$1355.15
NEW ORLEANS (LA)	$1405.61	$1405.61
REST OF LOUISIANA (LA)	$1358.66	$1358.66
METROPOLITAN BOSTON (MA)	$1522.93	$1522.93
REST OF MASSACHUSETTS (MA)	$1427.37	$1427.37
BALTIMORE/SURR. CNTYS (MD)	$1490.53	$1490.53
REST OF MARYLAND (MD)	$1418.90	$1418.90
SOUTHERN MAINE (ME)	$1365.70	$1365.70
REST OF MAINE (ME)	$1332.88	$1332.88
DETROIT (MI)	$1484.12	$1484.12
REST OF MICHIGAN (MI)	$1392.24	$1392.24
MINNESOTA (MN)	$1341.38	$1341.38
METROPOLITAN ST. LOUIS (MO)	$1394.01	$1394.01
METROPOLITAN KANSAS CITY (MO)	$1385.12	$1385.12
REST OF MISSOURI (MO)	$1350.36	$1350.36
MISSISSIPPI (MS)	$1320.95	$1320.95
MONTANA** (MT)	$1414.95	$1414.95
NORTH CAROLINA (NC)	$1340.78	$1340.78
NORTH DAKOTA** (ND)	$1341.99	$1341.99
NEBRASKA (NE)	$1304.15	$1304.15
NEW HAMPSHIRE (NH)	$1418.10	$1418.10
NORTHERN NJ (NJ)	$1548.29	$1548.29
REST OF NEW JERSEY (NJ)	$1502.05	$1502.05
NEW MEXICO (NM)	$1402.90	$1402.90
NEVADA** (NV)	$1395.06	$1395.06
MANHATTAN (NY)	$1613.87	$1613.87
NYC SUBURBS/LONG ISLAND (NY)	$1659.33	$1659.33
POUGHKPSIE/N NYC SUBURBS (NY)	$1521.54	$1521.54
QUEENS (NY)	$1605.05	$1605.05
REST OF NEW YORK (NY)	$1356.26	$1356.26
OHIO (OH)	$1377.33	$1377.33
OKLAHOMA (OK)	$1339.93	$1339.93
PORTLAND (OR)	$1446.74	$1446.74
REST OF OREGON (OR)	$1376.80	$1376.80
METROPOLITAN PHILADELPHIA (PA)	$1472.51	$1472.51
REST OF PENNSYLVANIA (PA)	$1371.80	$1371.80
PUERTO RICO (PR)	$1418.26	$1418.26
RHODE ISLAND (RI)	$1432.68	$1432.68
SOUTH CAROLINA (SC)	$1362.77	$1362.77
SOUTH DAKOTA** (SD)	$1333.36	$1333.36
TENNESSEE (TN)	$1317.49	$1317.49
BRAZORIA (TX)	$1390.83	$1390.83
DALLAS (TX)	$1403.52	$1403.52
GALVESTON (TX)	$1397.63	$1397.63
HOUSTON (TX)	$1465.17	$1465.17
BEAUMONT (TX)	$1366.25	$1366.25
FORT WORTH (TX)	$1400.65	$1400.65
AUSTIN (TX)	$1428.74	$1428.74
REST OF TEXAS (TX)	$1380.47	$1380.47
UTAH (UT)	$1375.83	$1375.83
VIRGINIA (VA)	$1371.37	$1371.37
VIRGIN ISLANDS (VI)	$1418.26	$1418.26
VERMONT (VT)	$1349.85	$1349.85
SEATTLE (KING CNTY) (WA)	$1536.28	$1536.28
REST OF WASHINGTON (WA)	$1420.40	$1420.40
WISCONSIN (WI)	$1311.15	$1311.15
WEST VIRGINIA (WV)	$1409.82	$1409.82
WYOMING** (WY)	$1383.15	$1383.15

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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 payment for this procedure code is based on three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — which are each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility and facility rates can differ because the practice-expense RVU component reflects the overhead costs of performing the service in an office setting versus a hospital or other facility setting. For this code, the non-facility and facility practice-expense RVUs shown are the same, so the national allowed amounts align across both settings, though locality-adjusted figures may still vary.

RVUs — work 25.31, practice expense 13.37 (non-facility) / 13.37 (facility), malpractice 3.69 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual Medicare payment may differ.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final payment.
Allowed amounts vary by locality due to differing GPCIs; always confirm current rates with your Medicare Administrative Contractor (MAC).
Figures are based on the stated fee schedule year and are subject to CMS updates.

Frequently asked

Why does the allowed amount differ by locality?

Medicare adjusts the work, practice expense, and malpractice RVUs using locality-specific GPICs to account for regional cost-of-living and practice cost differences before applying the conversion factor.

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

When the practice-expense RVU is identical for both settings, as shown here, the resulting allowed amounts are the same; this typically happens when CMS determines overhead costs don't meaningfully differ between settings for this service.

Does this figure represent what the biller should expect to collect?

No — it's the Medicare allowed amount before deductible and coinsurance are applied. Actual collections depend on patient deductible status, secondary coverage, and any applicable modifiers or adjustments.

Where can I verify the exact rate for my location?

Check the CMS Physician Fee Schedule Look-Up Tool or contact your MAC, since locality-specific GPCIs and any local adjustments are applied there.

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.