Medicare Reimbursement for CPT 21175

CPT 21175 is a surgical procedure code; CPT descriptors are licensed by the AMA and are not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for your locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1931.91	$1931.91
ALASKA* (AK)	$2428.50	$2428.50
ALABAMA (AL)	$1764.28	$1764.28
ARKANSAS (AR)	$1743.75	$1743.75
ARIZONA (AZ)	$1882.95	$1882.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2179.70	$2179.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2210.76	$2210.76
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2001.69	$2001.69
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2024.86	$2024.86
NAPA (CA)	$2103.08	$2103.08
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2186.61	$2186.61
VALLEJO (CA)	$2093.13	$2093.13
BAKERSFIELD (CA)	$1934.32	$1934.32
CHICO (CA)	$1917.31	$1917.31
FRESNO (CA)	$1917.31	$1917.31
HANFORD-CORCORAN (CA)	$1917.31	$1917.31
MADERA (CA)	$1917.31	$1917.31
MERCED (CA)	$1917.31	$1917.31
MODESTO (CA)	$1917.31	$1917.31
REDDING (CA)	$1917.31	$1917.31
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1982.78	$1982.78
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1980.68	$1980.68
SALINAS (CA)	$1972.68	$1972.68
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2238.99	$2238.99
SANTA CRUZ-WATSONVILLE (CA)	$1997.36	$1997.36
SANTA ROSA-PETALUMA (CA)	$2015.46	$2015.46
STOCKTON (CA)	$1917.31	$1917.31
VISALIA (CA)	$1917.31	$1917.31
YUBA CITY (CA)	$1917.31	$1917.31
EL CENTRO (CA)	$1918.33	$1918.33
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1996.33	$1996.33
SAN LUIS OBISPO-PASO ROBLES (CA)	$1944.66	$1944.66
SANTA MARIA-SANTA BARBARA (CA)	$1973.85	$1973.85
REST OF CALIFORNIA (CA)	$1917.31	$1917.31
COLORADO (CO)	$1941.25	$1941.25
CONNECTICUT (CT)	$2045.38	$2045.38
DC + MD/VA SUBURBS (DC)	$2127.07	$2127.07
DELAWARE (DE)	$1909.23	$1909.23
FORT LAUDERDALE (FL)	$2104.26	$2104.26
MIAMI (FL)	$2268.49	$2268.49
REST OF FLORIDA (FL)	$2006.07	$2006.07
ATLANTA (GA)	$1986.18	$1986.18
REST OF GEORGIA (GA)	$1902.22	$1902.22
HAWAII, GUAM (HI)	$1933.54	$1933.54
IOWA (IA)	$1755.40	$1755.40
IDAHO (ID)	$1774.01	$1774.01
EAST ST. LOUIS (IL)	$2086.95	$2086.95
SUBURBAN CHICAGO (IL)	$2113.50	$2113.50
CHICAGO (IL)	$2205.72	$2205.72
REST OF ILLINOIS (IL)	$1990.91	$1990.91
INDIANA (IN)	$1781.10	$1781.10
KANSAS (KS)	$1770.13	$1770.13
KENTUCKY (KY)	$1844.06	$1844.06
NEW ORLEANS (LA)	$1922.01	$1922.01
REST OF LOUISIANA (LA)	$1850.24	$1850.24
METROPOLITAN BOSTON (MA)	$2077.75	$2077.75
REST OF MASSACHUSETTS (MA)	$1941.87	$1941.87
BALTIMORE/SURR. CNTYS (MD)	$2043.95	$2043.95
REST OF MARYLAND (MD)	$1933.82	$1933.82
SOUTHERN MAINE (ME)	$1851.25	$1851.25
REST OF MAINE (ME)	$1804.27	$1804.27
DETROIT (MI)	$2048.96	$2048.96
REST OF MICHIGAN (MI)	$1902.78	$1902.78
MINNESOTA (MN)	$1807.38	$1807.38
METROPOLITAN ST. LOUIS (MO)	$1901.79	$1901.79
METROPOLITAN KANSAS CITY (MO)	$1888.44	$1888.44
REST OF MISSOURI (MO)	$1838.87	$1838.87
MISSISSIPPI (MS)	$1790.51	$1790.51
MONTANA** (MT)	$1931.50	$1931.50
NORTH CAROLINA (NC)	$1815.99	$1815.99
NORTH DAKOTA** (ND)	$1811.28	$1811.28
NEBRASKA (NE)	$1756.63	$1756.63
NEW HAMPSHIRE (NH)	$1932.60	$1932.60
NORTHERN NJ (NJ)	$2116.32	$2116.32
REST OF NEW JERSEY (NJ)	$2053.83	$2053.83
NEW MEXICO (NM)	$1919.94	$1919.94
NEVADA** (NV)	$1898.63	$1898.63
MANHATTAN (NY)	$2223.88	$2223.88
NYC SUBURBS/LONG ISLAND (NY)	$2296.08	$2296.08
POUGHKPSIE/N NYC SUBURBS (NY)	$2084.15	$2084.15
QUEENS (NY)	$2207.36	$2207.36
REST OF NEW YORK (NY)	$1839.80	$1839.80
OHIO (OH)	$1878.20	$1878.20
OKLAHOMA (OK)	$1818.57	$1818.57
PORTLAND (OR)	$1968.00	$1968.00
REST OF OREGON (OR)	$1869.05	$1869.05
METROPOLITAN PHILADELPHIA (PA)	$2016.85	$2016.85
REST OF PENNSYLVANIA (PA)	$1868.59	$1868.59
PUERTO RICO (PR)	$1935.86	$1935.86
RHODE ISLAND (RI)	$1951.73	$1951.73
SOUTH CAROLINA (SC)	$1853.11	$1853.11
SOUTH DAKOTA** (SD)	$1797.06	$1797.06
TENNESSEE (TN)	$1780.01	$1780.01
BRAZORIA (TX)	$1890.25	$1890.25
DALLAS (TX)	$1910.36	$1910.36
GALVESTON (TX)	$1901.27	$1901.27
HOUSTON (TX)	$2012.56	$2012.56
BEAUMONT (TX)	$1860.25	$1860.25
FORT WORTH (TX)	$1906.64	$1906.64
AUSTIN (TX)	$1947.83	$1947.83
REST OF TEXAS (TX)	$1879.78	$1879.78
UTAH (UT)	$1873.04	$1873.04
VIRGINIA (VA)	$1861.39	$1861.39
VIRGIN ISLANDS (VI)	$1935.86	$1935.86
VERMONT (VT)	$1825.23	$1825.23
SEATTLE (KING CNTY) (WA)	$2093.75	$2093.75
REST OF WASHINGTON (WA)	$1931.29	$1931.29
WISCONSIN (WI)	$1764.67	$1764.67
WEST VIRGINIA (WV)	$1936.12	$1936.12
WYOMING** (WY)	$1879.11	$1879.11

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 the Geographic Practice Cost Indices (GPCIs) for a specific locality to reflect local cost differences. The 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 use different practice-expense RVUs because overhead costs differ depending on where the service is performed. For this code, the practice-expense RVU is the same in both settings, so the national non-facility and facility amounts shown are identical before locality adjustment.

RVUs — work 32.72, practice expense 19.04 (non-facility) / 19.04 (facility), malpractice 6.08 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the beneficiary or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral surgery rules, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-adjusted amounts can differ meaningfully from the national figures shown here.
Always verify current rates and edits with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why do I see the same amount for non-facility and facility settings?

For this code, the practice-expense RVU used in the Medicare formula is identical for non-facility and facility settings, so the calculated national amounts match. Locality adjustments are still applied separately.

Will my practice actually receive this amount?

Not necessarily. The figure shown is a pre-adjustment estimate. Your actual payment depends on your locality's GPCIs, any applicable modifiers, sequestration, and other PFS adjustments in effect at the time of service.

What's included in the RVUs used to calculate this fee?

The fee is derived from three RVU components — physician work, practice expense, and malpractice — each weighted by locality-specific GPCIs before being converted to a dollar amount using the annual conversion factor.

Where can I find the official CPT code description?

CPT code descriptors are copyrighted by the American Medical Association. You can look up the official description in your licensed CPT codebook or through the AMA's CPT code search tool.

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.