Medicare Reimbursement for CPT 21155

CPT 21155 is a surgical procedure code; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1851.41	$1851.41
ALASKA* (AK)	$2384.68	$2384.68
ALABAMA (AL)	$1711.65	$1711.65
ARKANSAS (AR)	$1694.52	$1694.52
ARIZONA (AZ)	$1810.67	$1810.67
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2084.36	$2084.36
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2114.07	$2114.07
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1918.19	$1918.19
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1940.50	$1940.50
NAPA (CA)	$2012.14	$2012.14
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2090.05	$2090.05
VALLEJO (CA)	$2003.94	$2003.94
BAKERSFIELD (CA)	$1859.34	$1859.34
CHICO (CA)	$1844.83	$1844.83
FRESNO (CA)	$1844.83	$1844.83
HANFORD-CORCORAN (CA)	$1844.83	$1844.83
MADERA (CA)	$1844.83	$1844.83
MERCED (CA)	$1844.83	$1844.83
MODESTO (CA)	$1844.83	$1844.83
REDDING (CA)	$1844.83	$1844.83
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1899.02	$1899.02
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1902.60	$1902.60
SALINAS (CA)	$1894.72	$1894.72
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2137.33	$2137.33
SANTA CRUZ-WATSONVILLE (CA)	$1913.33	$1913.33
SANTA ROSA-PETALUMA (CA)	$1930.63	$1930.63
STOCKTON (CA)	$1844.83	$1844.83
VISALIA (CA)	$1844.83	$1844.83
YUBA CITY (CA)	$1844.83	$1844.83
EL CENTRO (CA)	$1845.66	$1845.66
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1914.45	$1914.45
SAN LUIS OBISPO-PASO ROBLES (CA)	$1867.92	$1867.92
SANTA MARIA-SANTA BARBARA (CA)	$1895.04	$1895.04
REST OF CALIFORNIA (CA)	$1844.83	$1844.83
COLORADO (CO)	$1862.90	$1862.90
CONNECTICUT (CT)	$1950.85	$1950.85
DC + MD/VA SUBURBS (DC)	$2027.86	$2027.86
DELAWARE (DE)	$1833.80	$1833.80
FORT LAUDERDALE (FL)	$1993.60	$1993.60
MIAMI (FL)	$2129.29	$2129.29
REST OF FLORIDA (FL)	$1911.95	$1911.95
ATLANTA (GA)	$1897.08	$1897.08
REST OF GEORGIA (GA)	$1825.54	$1825.54
HAWAII, GUAM (HI)	$1854.54	$1854.54
IOWA (IA)	$1704.85	$1704.85
IDAHO (ID)	$1720.26	$1720.26
EAST ST. LOUIS (IL)	$1978.13	$1978.13
SUBURBAN CHICAGO (IL)	$2003.13	$2003.13
CHICAGO (IL)	$2078.83	$2078.83
REST OF ILLINOIS (IL)	$1898.90	$1898.90
INDIANA (IN)	$1726.19	$1726.19
KANSAS (KS)	$1716.85	$1716.85
KENTUCKY (KY)	$1777.57	$1777.57
NEW ORLEANS (LA)	$1842.48	$1842.48
REST OF LOUISIANA (LA)	$1782.62	$1782.62
METROPOLITAN BOSTON (MA)	$1984.23	$1984.23
REST OF MASSACHUSETTS (MA)	$1864.26	$1864.26
BALTIMORE/SURR. CNTYS (MD)	$1948.63	$1948.63
REST OF MARYLAND (MD)	$1855.61	$1855.61
SOUTHERN MAINE (ME)	$1784.83	$1784.83
REST OF MAINE (ME)	$1745.19	$1745.19
DETROIT (MI)	$1947.41	$1947.41
REST OF MICHIGAN (MI)	$1826.27	$1826.27
MINNESOTA (MN)	$1749.18	$1749.18
METROPOLITAN ST. LOUIS (MO)	$1825.97	$1825.97
METROPOLITAN KANSAS CITY (MO)	$1814.80	$1814.80
REST OF MISSOURI (MO)	$1772.94	$1772.94
MISSISSIPPI (MS)	$1733.08	$1733.08
MONTANA** (MT)	$1851.08	$1851.08
NORTH CAROLINA (NC)	$1755.02	$1755.02
NORTH DAKOTA** (ND)	$1752.01	$1752.01
NEBRASKA (NE)	$1705.97	$1705.97
NEW HAMPSHIRE (NH)	$1852.52	$1852.52
NORTHERN NJ (NJ)	$2020.98	$2020.98
REST OF NEW JERSEY (NJ)	$1962.94	$1962.94
NEW MEXICO (NM)	$1840.47	$1840.47
NEVADA** (NV)	$1824.00	$1824.00
MANHATTAN (NY)	$2109.89	$2109.89
NYC SUBURBS/LONG ISLAND (NY)	$2169.74	$2169.74
POUGHKPSIE/N NYC SUBURBS (NY)	$1989.19	$1989.19
QUEENS (NY)	$2096.53	$2096.53
REST OF NEW YORK (NY)	$1774.86	$1774.86
OHIO (OH)	$1806.02	$1806.02
OKLAHOMA (OK)	$1756.63	$1756.63
PORTLAND (OR)	$1886.54	$1886.54
REST OF OREGON (OR)	$1799.56	$1799.56
METROPOLITAN PHILADELPHIA (PA)	$1926.37	$1926.37
REST OF PENNSYLVANIA (PA)	$1798.17	$1798.17
PUERTO RICO (PR)	$1854.81	$1854.81
RHODE ISLAND (RI)	$1872.86	$1872.86
SOUTH CAROLINA (SC)	$1785.49	$1785.49
SOUTH DAKOTA** (SD)	$1740.30	$1740.30
TENNESSEE (TN)	$1725.06	$1725.06
BRAZORIA (TX)	$1818.94	$1818.94
DALLAS (TX)	$1835.82	$1835.82
GALVESTON (TX)	$1828.05	$1828.05
HOUSTON (TX)	$1919.75	$1919.75
BEAUMONT (TX)	$1791.19	$1791.19
FORT WORTH (TX)	$1832.63	$1832.63
AUSTIN (TX)	$1865.78	$1865.78
REST OF TEXAS (TX)	$1807.79	$1807.79
UTAH (UT)	$1802.12	$1802.12
VIRGINIA (VA)	$1793.08	$1793.08
VIRGIN ISLANDS (VI)	$1854.81	$1854.81
VERMONT (VT)	$1763.38	$1763.38
SEATTLE (KING CNTY) (WA)	$2000.06	$2000.06
REST OF WASHINGTON (WA)	$1854.79	$1854.79
WISCONSIN (WI)	$1713.06	$1713.06
WEST VIRGINIA (WV)	$1853.18	$1853.18
WYOMING** (WY)	$1807.90	$1807.90

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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 Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The GPCI-adjusted RVUs are summed and multiplied by the annual conversion factor (a fixed dollar figure set by CMS) to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs, reflecting whether overhead costs (like clinical staff and supplies) are borne by the physician's office or by a facility such as a hospital. For this code, work, practice expense, and malpractice RVUs are published separately, and the final price varies when GPCIs differ across localities.

RVUs — work 34.34, practice expense 16.08 (non-facility) / 16.08 (facility), malpractice 5.01 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national RVUs and the conversion factor; actual payment depends on the specific locality's GPCIs.
Medicare typically pays 80% of the approved amount after the annual Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify current rates with your Medicare Administrative Contractor (MAC) or the CMS PFS lookup tool before billing or appealing a denial.

Frequently asked

Why does the facility and non-facility amount look the same for this code?

When the practice-expense RVUs are identical for both settings, the resulting PFS amounts will match; this can happen when the procedure's overhead costs are treated the same regardless of site of service.

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

Not necessarily. The national figure uses a GPCI of 1.0 for all components; your actual locality may have higher or lower GPCIs, which will raise or lower the final allowed amount.

Does this amount reflect what Medicare will actually pay?

No. The PFS amount is the allowed amount before patient responsibility; Medicare generally reimburses 80% of this figure after the deductible, with the remaining 20% owed by the patient or secondary payer.

Can this amount change during the year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and mid-year adjustments (such as sequestration) can also affect the net payment.

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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.