Medicare Reimbursement for CPT 21151

CPT 21151 is a surgical procedure code; this page does not reproduce the AMA descriptor but shows the Medicare Physician Fee Schedule (PFS) allowed amount for it. Amounts are shown nationally and can vary by locality, as well as by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1553.81	$1553.81
ALASKA* (AK)	$1994.94	$1994.94
ALABAMA (AL)	$1435.07	$1435.07
ARKANSAS (AR)	$1420.50	$1420.50
ARIZONA (AZ)	$1519.35	$1519.35
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1757.35	$1757.35
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1782.73	$1782.73
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1613.98	$1613.98
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1632.39	$1632.39
NAPA (CA)	$1695.23	$1695.23
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1762.04	$1762.04
VALLEJO (CA)	$1688.47	$1688.47
BAKERSFIELD (CA)	$1563.04	$1563.04
CHICO (CA)	$1551.08	$1551.08
FRESNO (CA)	$1551.08	$1551.08
HANFORD-CORCORAN (CA)	$1551.08	$1551.08
MADERA (CA)	$1551.08	$1551.08
MERCED (CA)	$1551.08	$1551.08
MODESTO (CA)	$1551.08	$1551.08
REDDING (CA)	$1551.08	$1551.08
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1595.75	$1595.75
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1600.59	$1600.59
SALINAS (CA)	$1593.98	$1593.98
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1801.90	$1801.90
SANTA CRUZ-WATSONVILLE (CA)	$1610.90	$1610.90
SANTA ROSA-PETALUMA (CA)	$1625.53	$1625.53
STOCKTON (CA)	$1551.08	$1551.08
VISALIA (CA)	$1551.08	$1551.08
YUBA CITY (CA)	$1551.08	$1551.08
EL CENTRO (CA)	$1551.77	$1551.77
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1611.28	$1611.28
SAN LUIS OBISPO-PASO ROBLES (CA)	$1571.33	$1571.33
SANTA MARIA-SANTA BARBARA (CA)	$1594.44	$1594.44
REST OF CALIFORNIA (CA)	$1551.08	$1551.08
COLORADO (CO)	$1565.08	$1565.08
CONNECTICUT (CT)	$1637.94	$1637.94
DC + MD/VA SUBURBS (DC)	$1704.25	$1704.25
DELAWARE (DE)	$1538.95	$1538.95
FORT LAUDERDALE (FL)	$1671.39	$1671.39
MIAMI (FL)	$1784.04	$1784.04
REST OF FLORIDA (FL)	$1602.47	$1602.47
ATLANTA (GA)	$1591.91	$1591.91
REST OF GEORGIA (GA)	$1529.43	$1529.43
HAWAII, GUAM (HI)	$1560.26	$1560.26
IOWA (IA)	$1430.60	$1430.60
IDAHO (ID)	$1443.44	$1443.44
EAST ST. LOUIS (IL)	$1656.01	$1656.01
SUBURBAN CHICAGO (IL)	$1679.63	$1679.63
CHICAGO (IL)	$1741.42	$1741.42
REST OF ILLINOIS (IL)	$1590.50	$1590.50
INDIANA (IN)	$1448.53	$1448.53
KANSAS (KS)	$1440.18	$1440.18
KENTUCKY (KY)	$1489.81	$1489.81
NEW ORLEANS (LA)	$1544.78	$1544.78
REST OF LOUISIANA (LA)	$1493.86	$1493.86
METROPOLITAN BOSTON (MA)	$1668.74	$1668.74
REST OF MASSACHUSETTS (MA)	$1565.89	$1565.89
BALTIMORE/SURR. CNTYS (MD)	$1636.00	$1636.00
REST OF MARYLAND (MD)	$1557.60	$1557.60
SOUTHERN MAINE (ME)	$1498.67	$1498.67
REST OF MAINE (ME)	$1463.99	$1463.99
DETROIT (MI)	$1631.96	$1631.96
REST OF MICHIGAN (MI)	$1530.63	$1530.63
MINNESOTA (MN)	$1470.35	$1470.35
METROPOLITAN ST. LOUIS (MO)	$1531.48	$1531.48
METROPOLITAN KANSAS CITY (MO)	$1521.91	$1521.91
REST OF MISSOURI (MO)	$1485.23	$1485.23
MISSISSIPPI (MS)	$1452.34	$1452.34
MONTANA** (MT)	$1553.53	$1553.53
NORTH CAROLINA (NC)	$1472.46	$1472.46
NORTH DAKOTA** (ND)	$1471.87	$1471.87
NEBRASKA (NE)	$1431.74	$1431.74
NEW HAMPSHIRE (NH)	$1555.88	$1555.88
NORTHERN NJ (NJ)	$1698.07	$1698.07
REST OF NEW JERSEY (NJ)	$1648.31	$1648.31
NEW MEXICO (NM)	$1542.45	$1542.45
NEVADA** (NV)	$1531.24	$1531.24
MANHATTAN (NY)	$1771.41	$1771.41
NYC SUBURBS/LONG ISLAND (NY)	$1821.51	$1821.51
POUGHKPSIE/N NYC SUBURBS (NY)	$1670.04	$1670.04
QUEENS (NY)	$1760.97	$1760.97
REST OF NEW YORK (NY)	$1489.29	$1489.29
OHIO (OH)	$1513.94	$1513.94
OKLAHOMA (OK)	$1472.66	$1472.66
PORTLAND (OR)	$1585.89	$1585.89
REST OF OREGON (OR)	$1510.96	$1510.96
METROPOLITAN PHILADELPHIA (PA)	$1616.75	$1616.75
REST OF PENNSYLVANIA (PA)	$1507.60	$1507.60
PUERTO RICO (PR)	$1556.92	$1556.92
RHODE ISLAND (RI)	$1572.41	$1572.41
SOUTH CAROLINA (SC)	$1497.33	$1497.33
SOUTH DAKOTA** (SD)	$1462.21	$1462.21
TENNESSEE (TN)	$1447.08	$1447.08
BRAZORIA (TX)	$1526.78	$1526.78
DALLAS (TX)	$1540.84	$1540.84
GALVESTON (TX)	$1534.35	$1534.35
HOUSTON (TX)	$1609.94	$1609.94
BEAUMONT (TX)	$1501.63	$1501.63
FORT WORTH (TX)	$1537.93	$1537.93
AUSTIN (TX)	$1567.29	$1567.29
REST OF TEXAS (TX)	$1516.41	$1516.41
UTAH (UT)	$1511.48	$1511.48
VIRGINIA (VA)	$1505.25	$1505.25
VIRGIN ISLANDS (VI)	$1556.92	$1556.92
VERMONT (VT)	$1480.96	$1480.96
SEATTLE (KING CNTY) (WA)	$1682.72	$1682.72
REST OF WASHINGTON (WA)	$1558.09	$1558.09
WISCONSIN (WI)	$1438.57	$1438.57
WEST VIRGINIA (WV)	$1551.57	$1551.57
WYOMING** (WY)	$1517.94	$1517.94

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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) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility and facility settings can have different practice-expense RVUs, reflecting whether overhead costs (like staff and supplies) are borne by the physician's office or by a facility such as a hospital. For this code, the non-facility and facility PE RVUs are the same, so the national allowed amounts shown are identical for both settings, though locality adjustments may still cause variation. The result is an estimate of what Medicare would pay before patient cost-sharing is applied.

RVUs — work 28.29, practice expense 14.1 (non-facility) / 14.1 (facility), malpractice 4.13 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimated allowed amount only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary insurer is generally responsible for the remainder.
Actual payment can be affected by modifiers, place-of-service coding, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Rates vary by locality due to GPCI adjustments; the national figure is a reference point, not a locality-specific guarantee.
Always verify the current allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the amount shown here differ from what my MAC paid?

The MAC applies locality-specific GPCIs, and may also factor in modifiers, multiple-procedure payment reductions, sequestration, or other claim-specific adjustments not reflected in this national estimate.

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

When the practice-expense RVUs are identical for both settings, the calculated allowed amount does not differ between non-facility and facility place-of-service, though locality adjustments can still cause variation.

Does this amount reflect what the patient will pay?

No. This is the Medicare-allowed amount before cost-sharing. Patients are typically responsible for 20% coinsurance after meeting the deductible, unless they have supplemental coverage.

Will this amount change during the year?

The conversion factor and RVUs are typically set annually, but mid-year adjustments, correction notices, or legislative changes can occur, so it's worth confirming current rates with CMS or your MAC.

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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.