Medicare Reimbursement for CPT 21154

CPT 21154 is a surgical procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1673.72	$1673.72
ALASKA* (AK)	$2149.23	$2149.23
ALABAMA (AL)	$1545.86	$1545.86
ARKANSAS (AR)	$1530.17	$1530.17
ARIZONA (AZ)	$1636.59	$1636.59
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1892.21	$1892.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1919.50	$1919.50
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1738.13	$1738.13
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1757.99	$1757.99
NAPA (CA)	$1825.44	$1825.44
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1897.27	$1897.27
VALLEJO (CA)	$1818.14	$1818.14
BAKERSFIELD (CA)	$1683.38	$1683.38
CHICO (CA)	$1670.47	$1670.47
FRESNO (CA)	$1670.47	$1670.47
HANFORD-CORCORAN (CA)	$1670.47	$1670.47
MADERA (CA)	$1670.47	$1670.47
MERCED (CA)	$1670.47	$1670.47
MODESTO (CA)	$1670.47	$1670.47
REDDING (CA)	$1670.47	$1670.47
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1718.71	$1718.71
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1723.71	$1723.71
SALINAS (CA)	$1716.59	$1716.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1940.21	$1940.21
SANTA CRUZ-WATSONVILLE (CA)	$1734.72	$1734.72
SANTA ROSA-PETALUMA (CA)	$1750.47	$1750.47
STOCKTON (CA)	$1670.47	$1670.47
VISALIA (CA)	$1670.47	$1670.47
YUBA CITY (CA)	$1670.47	$1670.47
EL CENTRO (CA)	$1671.21	$1671.21
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1735.18	$1735.18
SAN LUIS OBISPO-PASO ROBLES (CA)	$1692.21	$1692.21
SANTA MARIA-SANTA BARBARA (CA)	$1717.08	$1717.08
REST OF CALIFORNIA (CA)	$1670.47	$1670.47
COLORADO (CO)	$1685.69	$1685.69
CONNECTICUT (CT)	$1764.32	$1764.32
DC + MD/VA SUBURBS (DC)	$1835.59	$1835.59
DELAWARE (DE)	$1657.70	$1657.70
FORT LAUDERDALE (FL)	$1800.66	$1800.66
MIAMI (FL)	$1922.22	$1922.22
REST OF FLORIDA (FL)	$1726.40	$1726.40
ATLANTA (GA)	$1714.81	$1714.81
REST OF GEORGIA (GA)	$1647.71	$1647.71
HAWAII, GUAM (HI)	$1680.28	$1680.28
IOWA (IA)	$1540.91	$1540.91
IDAHO (ID)	$1554.76	$1554.76
EAST ST. LOUIS (IL)	$1784.32	$1784.32
SUBURBAN CHICAGO (IL)	$1809.51	$1809.51
CHICAGO (IL)	$1876.29	$1876.29
REST OF ILLINOIS (IL)	$1713.59	$1713.59
INDIANA (IN)	$1560.23	$1560.23
KANSAS (KS)	$1551.28	$1551.28
KENTUCKY (KY)	$1604.93	$1604.93
NEW ORLEANS (LA)	$1664.14	$1664.14
REST OF LOUISIANA (LA)	$1609.31	$1609.31
METROPOLITAN BOSTON (MA)	$1797.22	$1797.22
REST OF MASSACHUSETTS (MA)	$1686.59	$1686.59
BALTIMORE/SURR. CNTYS (MD)	$1762.24	$1762.24
REST OF MARYLAND (MD)	$1677.76	$1677.76
SOUTHERN MAINE (ME)	$1614.20	$1614.20
REST OF MAINE (ME)	$1576.95	$1576.95
DETROIT (MI)	$1758.21	$1758.21
REST OF MICHIGAN (MI)	$1648.94	$1648.94
MINNESOTA (MN)	$1583.51	$1583.51
METROPOLITAN ST. LOUIS (MO)	$1649.74	$1649.74
METROPOLITAN KANSAS CITY (MO)	$1639.45	$1639.45
REST OF MISSOURI (MO)	$1600.06	$1600.06
MISSISSIPPI (MS)	$1564.55	$1564.55
MONTANA** (MT)	$1673.42	$1673.42
NORTH CAROLINA (NC)	$1586.06	$1586.06
NORTH DAKOTA** (ND)	$1585.23	$1585.23
NEBRASKA (NE)	$1542.12	$1542.12
NEW HAMPSHIRE (NH)	$1675.83	$1675.83
NORTHERN NJ (NJ)	$1828.96	$1828.96
REST OF NEW JERSEY (NJ)	$1775.45	$1775.45
NEW MEXICO (NM)	$1661.69	$1661.69
NEVADA** (NV)	$1649.35	$1649.35
MANHATTAN (NY)	$1908.16	$1908.16
NYC SUBURBS/LONG ISLAND (NY)	$1962.18	$1962.18
POUGHKPSIE/N NYC SUBURBS (NY)	$1798.90	$1798.90
QUEENS (NY)	$1896.82	$1896.82
REST OF NEW YORK (NY)	$1604.19	$1604.19
OHIO (OH)	$1630.92	$1630.92
OKLAHOMA (OK)	$1586.39	$1586.39
PORTLAND (OR)	$1708.02	$1708.02
REST OF OREGON (OR)	$1627.45	$1627.45
METROPOLITAN PHILADELPHIA (PA)	$1741.55	$1741.55
REST OF PENNSYLVANIA (PA)	$1624.06	$1624.06
PUERTO RICO (PR)	$1677.05	$1677.05
RHODE ISLAND (RI)	$1693.68	$1693.68
SOUTH CAROLINA (SC)	$1612.94	$1612.94
SOUTH DAKOTA** (SD)	$1574.80	$1574.80
TENNESSEE (TN)	$1558.73	$1558.73
BRAZORIA (TX)	$1644.55	$1644.55
DALLAS (TX)	$1659.71	$1659.71
GALVESTON (TX)	$1652.71	$1652.71
HOUSTON (TX)	$1734.34	$1734.34
BEAUMONT (TX)	$1617.63	$1617.63
FORT WORTH (TX)	$1656.59	$1656.59
AUSTIN (TX)	$1688.10	$1688.10
REST OF TEXAS (TX)	$1633.48	$1633.48
UTAH (UT)	$1628.18	$1628.18
VIRGINIA (VA)	$1621.33	$1621.33
VIRGIN ISLANDS (VI)	$1677.05	$1677.05
VERMONT (VT)	$1595.07	$1595.07
SEATTLE (KING CNTY) (WA)	$1812.20	$1812.20
REST OF WASHINGTON (WA)	$1678.17	$1678.17
WISCONSIN (WI)	$1549.39	$1549.39
WEST VIRGINIA (WV)	$1671.68	$1671.68
WYOMING** (WY)	$1634.99	$1634.99

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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 Physician Fee Schedule assigns each code three Relative Value Units (RVUs) — for physician work, practice expense, and malpractice risk. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two amounts can vary; for this code, that difference may be minimal or nonexistent depending on how CMS has set the practice-expense inputs.

RVUs — work 30.51, practice expense 15.14 (non-facility) / 15.14 (facility), malpractice 4.46 — × 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 payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Local Medicare Administrative Contractor (MAC) policies and locality-specific GPCI values may cause variation from national figures.
CPT code descriptors are copyrighted by the AMA and are not reproduced here; confirm the exact procedure description in your coding reference.

Frequently asked

Why is the facility amount the same as the non-facility amount for this code?

When CMS sets identical practice-expense RVUs for both settings, the calculated allowed amounts come out the same. This can happen for certain procedure types where site-of-service cost differences are not reflected in the PE RVU inputs.

Will my locality's payment match the national amount shown?

Not necessarily. The national figure uses a GPCI value of 1.0 for all components, while actual locality payments apply the specific GPCI adjustments for where the service was rendered, which can raise or lower the amount.

Does this amount include the patient's coinsurance?

No. The figure shown is the total Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible is met, with the remaining 20% owed by the patient or a secondary payer.

Why might the amount I'm actually paid differ from this estimate?

Differences can arise from modifiers, multiple-procedure payment reductions, sequestration cuts, and annual budget-neutrality adjustments CMS applies to the conversion factor or RVUs.

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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.