Medicare Reimbursement for CPT 21160

CPT 21160 is a procedure code reported under the Medicare Physician Fee Schedule (PFS); the specific service it describes is defined by AMA CPT and not reproduced here. This page shows the estimated Medicare PFS allowed amount for 2026, both at the national level and adjustable by locality, and compares non-facility and facility settings. Amounts shown are estimates derived from published RVUs and conversion factor data.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2392.84	$2392.84
ALASKA* (AK)	$3101.67	$3101.67
ALABAMA (AL)	$2216.58	$2216.58
ARKANSAS (AR)	$2195.04	$2195.04
ARIZONA (AZ)	$2340.98	$2340.98
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2669.06	$2669.06
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2706.06	$2706.06
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2466.39	$2466.39
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2496.19	$2496.19
NAPA (CA)	$2580.35	$2580.35
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2676.68	$2676.68
VALLEJO (CA)	$2569.37	$2569.37
BAKERSFIELD (CA)	$2395.07	$2395.07
CHICO (CA)	$2375.64	$2375.64
FRESNO (CA)	$2375.64	$2375.64
HANFORD-CORCORAN (CA)	$2375.64	$2375.64
MADERA (CA)	$2375.64	$2375.64
MERCED (CA)	$2375.64	$2375.64
MODESTO (CA)	$2375.64	$2375.64
REDDING (CA)	$2375.64	$2375.64
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2448.22	$2448.22
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2447.18	$2447.18
SALINAS (CA)	$2436.97	$2436.97
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2737.21	$2737.21
SANTA CRUZ-WATSONVILLE (CA)	$2456.99	$2456.99
SANTA ROSA-PETALUMA (CA)	$2479.04	$2479.04
STOCKTON (CA)	$2375.64	$2375.64
VISALIA (CA)	$2375.64	$2375.64
YUBA CITY (CA)	$2375.64	$2375.64
EL CENTRO (CA)	$2376.76	$2376.76
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2460.16	$2460.16
SAN LUIS OBISPO-PASO ROBLES (CA)	$2402.81	$2402.81
SANTA MARIA-SANTA BARBARA (CA)	$2436.78	$2436.78
REST OF CALIFORNIA (CA)	$2375.64	$2375.64
COLORADO (CO)	$2402.64	$2402.64
CONNECTICUT (CT)	$2519.30	$2519.30
DC + MD/VA SUBURBS (DC)	$2613.64	$2613.64
DELAWARE (DE)	$2370.30	$2370.30
FORT LAUDERDALE (FL)	$2582.14	$2582.14
MIAMI (FL)	$2761.43	$2761.43
REST OF FLORIDA (FL)	$2477.77	$2477.77
ATLANTA (GA)	$2452.61	$2452.61
REST OF GEORGIA (GA)	$2367.62	$2367.62
HAWAII, GUAM (HI)	$2385.06	$2385.06
IOWA (IA)	$2203.98	$2203.98
IDAHO (ID)	$2224.17	$2224.17
EAST ST. LOUIS (IL)	$2569.54	$2569.54
SUBURBAN CHICAGO (IL)	$2593.68	$2593.68
CHICAGO (IL)	$2696.99	$2696.99
REST OF ILLINOIS (IL)	$2464.04	$2464.04
INDIANA (IN)	$2231.51	$2231.51
KANSAS (KS)	$2221.01	$2221.01
KENTUCKY (KY)	$2303.64	$2303.64
NEW ORLEANS (LA)	$2386.04	$2386.04
REST OF LOUISIANA (LA)	$2310.75	$2310.75
METROPOLITAN BOSTON (MA)	$2553.79	$2553.79
REST OF MASSACHUSETTS (MA)	$2405.43	$2405.43
BALTIMORE/SURR. CNTYS (MD)	$2516.68	$2516.68
REST OF MARYLAND (MD)	$2397.41	$2397.41
SOUTHERN MAINE (ME)	$2304.45	$2304.45
REST OF MAINE (ME)	$2257.57	$2257.57
DETROIT (MI)	$2524.47	$2524.47
REST OF MICHIGAN (MI)	$2366.77	$2366.77
MINNESOTA (MN)	$2253.39	$2253.39
METROPOLITAN ST. LOUIS (MO)	$2362.96	$2362.96
METROPOLITAN KANSAS CITY (MO)	$2349.14	$2349.14
REST OF MISSOURI (MO)	$2299.80	$2299.80
MISSISSIPPI (MS)	$2246.50	$2246.50
MONTANA** (MT)	$2392.39	$2392.39
NORTH CAROLINA (NC)	$2269.59	$2269.59
NORTH DAKOTA** (ND)	$2259.71	$2259.71
NEBRASKA (NE)	$2204.78	$2204.78
NEW HAMPSHIRE (NH)	$2390.74	$2390.74
NORTHERN NJ (NJ)	$2606.01	$2606.01
REST OF NEW JERSEY (NJ)	$2534.19	$2534.19
NEW MEXICO (NM)	$2385.44	$2385.44
NEVADA** (NV)	$2356.04	$2356.04
MANHATTAN (NY)	$2724.90	$2724.90
NYC SUBURBS/LONG ISLAND (NY)	$2802.70	$2802.70
POUGHKPSIE/N NYC SUBURBS (NY)	$2569.10	$2569.10
QUEENS (NY)	$2705.27	$2705.27
REST OF NEW YORK (NY)	$2294.68	$2294.68
OHIO (OH)	$2339.65	$2339.65
OKLAHOMA (OK)	$2275.24	$2275.24
PORTLAND (OR)	$2430.20	$2430.20
REST OF OREGON (OR)	$2323.75	$2323.75
METROPOLITAN PHILADELPHIA (PA)	$2489.67	$2489.67
REST OF PENNSYLVANIA (PA)	$2328.69	$2328.69
PUERTO RICO (PR)	$2396.43	$2396.43
RHODE ISLAND (RI)	$2418.69	$2418.69
SOUTH CAROLINA (SC)	$2311.19	$2311.19
SOUTH DAKOTA** (SD)	$2244.02	$2244.02
TENNESSEE (TN)	$2231.57	$2231.57
BRAZORIA (TX)	$2350.14	$2350.14
DALLAS (TX)	$2372.32	$2372.32
GALVESTON (TX)	$2362.16	$2362.16
HOUSTON (TX)	$2484.98	$2484.98
BEAUMONT (TX)	$2320.05	$2320.05
FORT WORTH (TX)	$2368.91	$2368.91
AUSTIN (TX)	$2407.02	$2407.02
REST OF TEXAS (TX)	$2338.87	$2338.87
UTAH (UT)	$2332.06	$2332.06
VIRGINIA (VA)	$2316.21	$2316.21
VIRGIN ISLANDS (VI)	$2396.43	$2396.43
VERMONT (VT)	$2275.81	$2275.81
SEATTLE (KING CNTY) (WA)	$2572.12	$2572.12
REST OF WASHINGTON (WA)	$2392.75	$2392.75
WISCONSIN (WI)	$2211.21	$2211.21
WEST VIRGINIA (WV)	$2406.65	$2406.65
WYOMING** (WY)	$2334.57	$2334.57

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 PFS amounts are calculated by combining three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed. These geographically adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs, reflecting the different overhead costs borne by the billing provider in each setting. For this code, work and malpractice RVUs stay constant across settings, while the practice-expense RVU component may shift the final allowed amount.

RVUs — work 46.01, practice expense 18.92 (non-facility) / 18.92 (facility), malpractice 6.71 — × 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 allowed amount after the patient's deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality GPCI, applied modifiers, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to the conversion factor.
Always verify the final payable amount with your Medicare Administrative Contractor (MAC) or official CMS fee schedule lookup tool.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The two settings can have different practice-expense RVUs, since the overhead costs are allocated differently depending on whether the service is performed in a physician office versus a hospital or facility setting.

Why might my local Medicare payment differ from the national amount shown here?

Local Geographic Practice Cost Indices (GPCIs) adjust the RVUs based on the cost of practicing medicine in a specific geographic area, so the final allowed amount can be higher or lower than the national average.

Does this amount reflect what the patient or secondary payer will pay?

No. The amount shown is the total Medicare-allowed amount; Medicare generally pays 80% after the deductible is met, with the remaining portion owed by the patient or a secondary payer.

Can modifiers change this reimbursement amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple procedures can increase or decrease the final payment relative to the base PFS amount shown here.

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.