Medicare Reimbursement for CPT 21159

CPT 21159 is a surgical procedure code; the exact service it represents is defined by the American Medical Association's CPT descriptor, which is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted by locality, with non-facility and facility settings shown separately when they differ.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2210.14	$2210.14
ALASKA* (AK)	$2859.32	$2859.32
ALABAMA (AL)	$2046.00	$2046.00
ARKANSAS (AR)	$2025.93	$2025.93
ARIZONA (AZ)	$2161.96	$2161.96
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2471.43	$2471.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2505.95	$2505.95
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2281.21	$2281.21
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2308.49	$2308.49
NAPA (CA)	$2388.34	$2388.34
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2478.42	$2478.42
VALLEJO (CA)	$2378.27	$2378.27
BAKERSFIELD (CA)	$2214.10	$2214.10
CHICO (CA)	$2196.30	$2196.30
FRESNO (CA)	$2196.30	$2196.30
HANFORD-CORCORAN (CA)	$2196.30	$2196.30
MADERA (CA)	$2196.30	$2196.30
MERCED (CA)	$2196.30	$2196.30
MODESTO (CA)	$2196.30	$2196.30
REDDING (CA)	$2196.30	$2196.30
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2262.82	$2262.82
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2263.18	$2263.18
SALINAS (CA)	$2253.76	$2253.76
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2534.50	$2534.50
SANTA CRUZ-WATSONVILLE (CA)	$2273.30	$2273.30
SANTA ROSA-PETALUMA (CA)	$2293.74	$2293.74
STOCKTON (CA)	$2196.30	$2196.30
VISALIA (CA)	$2196.30	$2196.30
YUBA CITY (CA)	$2196.30	$2196.30
EL CENTRO (CA)	$2197.32	$2197.32
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2275.78	$2275.78
SAN LUIS OBISPO-PASO ROBLES (CA)	$2222.09	$2222.09
SANTA MARIA-SANTA BARBARA (CA)	$2253.74	$2253.74
REST OF CALIFORNIA (CA)	$2196.30	$2196.30
COLORADO (CO)	$2220.40	$2220.40
CONNECTICUT (CT)	$2327.56	$2327.56
DC + MD/VA SUBURBS (DC)	$2415.99	$2415.99
DELAWARE (DE)	$2189.22	$2189.22
FORT LAUDERDALE (FL)	$2383.91	$2383.91
MIAMI (FL)	$2548.81	$2548.81
REST OF FLORIDA (FL)	$2287.07	$2287.07
ATLANTA (GA)	$2265.24	$2265.24
REST OF GEORGIA (GA)	$2184.79	$2184.79
HAWAII, GUAM (HI)	$2205.84	$2205.84
IOWA (IA)	$2035.28	$2035.28
IDAHO (ID)	$2053.89	$2053.89
EAST ST. LOUIS (IL)	$2370.44	$2370.44
SUBURBAN CHICAGO (IL)	$2394.75	$2394.75
CHICAGO (IL)	$2488.98	$2488.98
REST OF ILLINOIS (IL)	$2273.60	$2273.60
INDIANA (IN)	$2060.76	$2060.76
KANSAS (KS)	$2050.66	$2050.66
KENTUCKY (KY)	$2126.09	$2126.09
NEW ORLEANS (LA)	$2202.68	$2202.68
REST OF LOUISIANA (LA)	$2132.52	$2132.52
METROPOLITAN BOSTON (MA)	$2361.52	$2361.52
REST OF MASSACHUSETTS (MA)	$2222.71	$2222.71
BALTIMORE/SURR. CNTYS (MD)	$2325.09	$2325.09
REST OF MARYLAND (MD)	$2214.54	$2214.54
SOUTHERN MAINE (ME)	$2128.94	$2128.94
REST OF MAINE (ME)	$2084.50	$2084.50
DETROIT (MI)	$2330.06	$2330.06
REST OF MICHIGAN (MI)	$2184.45	$2184.45
MINNESOTA (MN)	$2082.92	$2082.92
METROPOLITAN ST. LOUIS (MO)	$2181.75	$2181.75
METROPOLITAN KANSAS CITY (MO)	$2168.82	$2168.82
REST OF MISSOURI (MO)	$2122.01	$2122.01
MISSISSIPPI (MS)	$2073.14	$2073.14
MONTANA** (MT)	$2209.73	$2209.73
NORTH CAROLINA (NC)	$2095.79	$2095.79
NORTH DAKOTA** (ND)	$2088.12	$2088.12
NEBRASKA (NE)	$2036.18	$2036.18
NEW HAMPSHIRE (NH)	$2209.06	$2209.06
NORTHERN NJ (NJ)	$2408.59	$2408.59
REST OF NEW JERSEY (NJ)	$2341.45	$2341.45
NEW MEXICO (NM)	$2201.64	$2201.64
NEVADA** (NV)	$2176.43	$2176.43
MANHATTAN (NY)	$2517.60	$2517.60
NYC SUBURBS/LONG ISLAND (NY)	$2589.47	$2589.47
POUGHKPSIE/N NYC SUBURBS (NY)	$2373.48	$2373.48
QUEENS (NY)	$2500.02	$2500.02
REST OF NEW YORK (NY)	$2119.14	$2119.14
OHIO (OH)	$2159.59	$2159.59
OKLAHOMA (OK)	$2100.14	$2100.14
PORTLAND (OR)	$2246.62	$2246.62
REST OF OREGON (OR)	$2146.73	$2146.73
METROPOLITAN PHILADELPHIA (PA)	$2299.66	$2299.66
REST OF PENNSYLVANIA (PA)	$2149.65	$2149.65
PUERTO RICO (PR)	$2213.66	$2213.66
RHODE ISLAND (RI)	$2234.44	$2234.44
SOUTH CAROLINA (SC)	$2133.73	$2133.73
SOUTH DAKOTA** (SD)	$2073.74	$2073.74
TENNESSEE (TN)	$2060.44	$2060.44
BRAZORIA (TX)	$2170.79	$2170.79
DALLAS (TX)	$2191.21	$2191.21
GALVESTON (TX)	$2181.85	$2181.85
HOUSTON (TX)	$2294.41	$2294.41
BEAUMONT (TX)	$2141.56	$2141.56
FORT WORTH (TX)	$2187.88	$2187.88
AUSTIN (TX)	$2224.32	$2224.32
REST OF TEXAS (TX)	$2159.62	$2159.62
UTAH (UT)	$2153.19	$2153.19
VIRGINIA (VA)	$2139.55	$2139.55
VIRGIN ISLANDS (VI)	$2213.66	$2213.66
VERMONT (VT)	$2102.66	$2102.66
SEATTLE (KING CNTY) (WA)	$2378.96	$2378.96
REST OF WASHINGTON (WA)	$2211.10	$2211.10
WISCONSIN (WI)	$2042.80	$2042.80
WEST VIRGINIA (WV)	$2220.09	$2220.09
WYOMING** (WY)	$2156.73	$2156.73

Look up another code or locality →

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 performed. These locality-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Because practice expense costs differ between settings, the practice-expense RVU (and resulting payment) can differ between non-facility (e.g., office) and facility (e.g., hospital) settings for some codes. The conversion factor and GPCIs are updated annually and can change the final amount even if RVUs stay the same.

RVUs — work 42.06, practice expense 17.96 (non-facility) / 17.96 (facility), malpractice 6.15 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the approved amount after the patient's deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment varies by locality, applicable modifiers, place of service, and claim-specific adjustments.
Sequestration and annual budget-neutrality adjustments can reduce or otherwise change the final paid amount.
Always confirm the current allowed amount and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why do non-facility and facility amounts differ for some codes?

Practice expense RVUs can differ by setting because the costs a provider incurs (staff, supplies, equipment) differ between an office and a facility like a hospital, where the facility itself bears some of those costs.

Does this amount reflect what my practice will actually be paid?

No. This is a PFS-based estimate. Actual reimbursement depends on your specific Medicare Administrative Contractor, your locality, any modifiers applied, and other claim-specific factors.

Why might this amount change year to year?

The conversion factor, RVUs, and GPICs are all subject to annual updates by CMS, which can increase or decrease the calculated amount even if the code itself is unchanged.

Where can I find the official CPT descriptor for this code?

CPT descriptors are copyrighted by the American Medical Association. You can look up the official description through a licensed CPT code reference or your practice management/coding software.

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.