Medicare Reimbursement for CPT 21172

CPT 21172 is a physician procedure code reported to Medicare for payment under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility and facility settings. Actual payment depends on where the service is performed and the GPCIs that apply to that locality.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2089.23	$2089.23
ALASKA* (AK)	$2424.92	$2424.92
ALABAMA (AL)	$1822.86	$1822.86
ARKANSAS (AR)	$1790.53	$1790.53
ARIZONA (AZ)	$2009.04	$2009.04
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2273.85	$2273.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2301.78	$2301.78
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2110.87	$2110.87
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2139.52	$2139.52
NAPA (CA)	$2204.73	$2204.73
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2287.06	$2287.06
VALLEJO (CA)	$2185.70	$2185.70
BAKERSFIELD (CA)	$2029.89	$2029.89
CHICO (CA)	$1999.70	$1999.70
FRESNO (CA)	$1999.70	$1999.70
HANFORD-CORCORAN (CA)	$1999.70	$1999.70
MADERA (CA)	$1999.70	$1999.70
MERCED (CA)	$1999.70	$1999.70
MODESTO (CA)	$1999.70	$1999.70
REDDING (CA)	$1999.70	$1999.70
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2123.75	$2123.75
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2069.56	$2069.56
SALINAS (CA)	$2061.84	$2061.84
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2355.78	$2355.78
SANTA CRUZ-WATSONVILLE (CA)	$2096.46	$2096.46
SANTA ROSA-PETALUMA (CA)	$2114.89	$2114.89
STOCKTON (CA)	$1999.70	$1999.70
VISALIA (CA)	$1999.70	$1999.70
YUBA CITY (CA)	$1999.70	$1999.70
EL CENTRO (CA)	$2001.64	$2001.64
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2092.19	$2092.19
SAN LUIS OBISPO-PASO ROBLES (CA)	$2033.33	$2033.33
SANTA MARIA-SANTA BARBARA (CA)	$2064.56	$2064.56
REST OF CALIFORNIA (CA)	$1999.70	$1999.70
COLORADO (CO)	$2065.24	$2065.24
CONNECTICUT (CT)	$2249.40	$2249.40
DC + MD/VA SUBURBS (DC)	$2321.96	$2321.96
DELAWARE (DE)	$2045.20	$2045.20
FORT LAUDERDALE (FL)	$2413.27	$2413.27
MIAMI (FL)	$2715.24	$2715.24
REST OF FLORIDA (FL)	$2250.20	$2250.20
ATLANTA (GA)	$2182.58	$2182.58
REST OF GEORGIA (GA)	$2079.33	$2079.33
HAWAII, GUAM (HI)	$2032.86	$2032.86
IOWA (IA)	$1788.50	$1788.50
IDAHO (ID)	$1821.93	$1821.93
EAST ST. LOUIS (IL)	$2420.54	$2420.54
SUBURBAN CHICAGO (IL)	$2416.66	$2416.66
CHICAGO (IL)	$2602.61	$2602.61
REST OF ILLINOIS (IL)	$2239.87	$2239.87
INDIANA (IN)	$1832.46	$1832.46
KANSAS (KS)	$1821.46	$1821.46
KENTUCKY (KY)	$1969.38	$1969.38
NEW ORLEANS (LA)	$2095.90	$2095.90
REST OF LOUISIANA (LA)	$1982.95	$1982.95
METROPOLITAN BOSTON (MA)	$2235.91	$2235.91
REST OF MASSACHUSETTS (MA)	$2066.53	$2066.53
BALTIMORE/SURR. CNTYS (MD)	$2253.09	$2253.09
REST OF MARYLAND (MD)	$2075.95	$2075.95
SOUTHERN MAINE (ME)	$1938.85	$1938.85
REST OF MAINE (ME)	$1879.81	$1879.81
DETROIT (MI)	$2328.33	$2328.33
REST OF MICHIGAN (MI)	$2071.28	$2071.28
MINNESOTA (MN)	$1838.44	$1838.44
METROPOLITAN ST. LOUIS (MO)	$2052.46	$2052.46
METROPOLITAN KANSAS CITY (MO)	$2032.57	$2032.57
REST OF MISSOURI (MO)	$1971.18	$1971.18
MISSISSIPPI (MS)	$1879.11	$1879.11
MONTANA** (MT)	$2088.45	$2088.45
NORTH CAROLINA (NC)	$1896.58	$1896.58
NORTH DAKOTA** (ND)	$1858.49	$1858.49
NEBRASKA (NE)	$1787.38	$1787.38
NEW HAMPSHIRE (NH)	$2072.74	$2072.74
NORTHERN NJ (NJ)	$2298.67	$2298.67
REST OF NEW JERSEY (NJ)	$2235.61	$2235.61
NEW MEXICO (NM)	$2102.38	$2102.38
NEVADA** (NV)	$2025.14	$2025.14
MANHATTAN (NY)	$2502.37	$2502.37
NYC SUBURBS/LONG ISLAND (NY)	$2628.76	$2628.76
POUGHKPSIE/N NYC SUBURBS (NY)	$2286.45	$2286.45
QUEENS (NY)	$2462.08	$2462.08
REST OF NEW YORK (NY)	$1934.74	$1934.74
OHIO (OH)	$2024.28	$2024.28
OKLAHOMA (OK)	$1918.90	$1918.90
PORTLAND (OR)	$2091.31	$2091.31
REST OF OREGON (OR)	$1970.73	$1970.73
METROPOLITAN PHILADELPHIA (PA)	$2212.80	$2212.80
REST OF PENNSYLVANIA (PA)	$2003.72	$2003.72
PUERTO RICO (PR)	$2092.00	$2092.00
RHODE ISLAND (RI)	$2090.54	$2090.54
SOUTH CAROLINA (SC)	$1971.51	$1971.51
SOUTH DAKOTA** (SD)	$1831.29	$1831.29
TENNESSEE (TN)	$1838.19	$1838.19
BRAZORIA (TX)	$2004.07	$2004.07
DALLAS (TX)	$2039.20	$2039.20
GALVESTON (TX)	$2024.28	$2024.28
HOUSTON (TX)	$2237.16	$2237.16
BEAUMONT (TX)	$1991.24	$1991.24
FORT WORTH (TX)	$2036.43	$2036.43
AUSTIN (TX)	$2092.15	$2092.15
REST OF TEXAS (TX)	$2011.65	$2011.65
UTAH (UT)	$2002.67	$2002.67
VIRGINIA (VA)	$1961.72	$1961.72
VIRGIN ISLANDS (VI)	$2092.00	$2092.00
VERMONT (VT)	$1889.51	$1889.51
SEATTLE (KING CNTY) (WA)	$2241.64	$2241.64
REST OF WASHINGTON (WA)	$2049.79	$2049.79
WISCONSIN (WI)	$1787.56	$1787.56
WEST VIRGINIA (WV)	$2154.17	$2154.17
WYOMING** (WY)	$1988.23	$1988.23

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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: Clinical. 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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is furnished, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Because practice-expense RVUs differ when a procedure is done in a non-facility (e.g., office) versus a facility (e.g., hospital) setting, the resulting allowed amount can differ between the two settings, even though work and malpractice RVUs stay the same.

RVUs — work 27.5, practice expense 23.42 (non-facility) / 23.42 (facility), malpractice 11.63 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Rates vary by Medicare Administrative Contractor (MAC) locality; confirm the exact locality-adjusted amount with your MAC before billing.
CPT code descriptors are proprietary to the AMA and are not reproduced here; consult your CPT codebook for the full description.

Frequently asked

Why does the allowed amount differ between non-facility and facility settings?

The practice-expense RVU component differs by setting because overhead costs (supplies, staff, equipment) are treated differently when a procedure is performed in a physician's office versus a hospital or ambulatory surgical center.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare Physician Fee Schedule allowed amount before adjustments for deductible, coinsurance, modifiers, sequestration, and locality-specific factors, so actual payment may differ.

Why do amounts change year to year?

The conversion factor, RVUs, and GPCIs are updated annually by CMS, which can raise or lower the allowed amount even if the code itself is unchanged.

Where can I find the exact amount for my locality?

Check your Medicare Administrative Contractor's published fee schedule, which applies the current year's locality-specific GPCIs to the national RVUs.

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.