Medicare Reimbursement for CPT 21179

CPT 21179 is a surgical procedure code reported to Medicare for physician and outpatient billing. 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 separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1343.05	$1343.05
ALASKA* (AK)	$1680.77	$1680.77
ALABAMA (AL)	$1225.04	$1225.04
ARKANSAS (AR)	$1210.56	$1210.56
ARIZONA (AZ)	$1308.80	$1308.80
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1526.50	$1526.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1548.72	$1548.72
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1397.36	$1397.36
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1413.03	$1413.03
NAPA (CA)	$1471.16	$1471.16
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1531.16	$1531.16
VALLEJO (CA)	$1464.45	$1464.45
BAKERSFIELD (CA)	$1348.50	$1348.50
CHICO (CA)	$1337.03	$1337.03
FRESNO (CA)	$1337.03	$1337.03
HANFORD-CORCORAN (CA)	$1337.03	$1337.03
MADERA (CA)	$1337.03	$1337.03
MERCED (CA)	$1337.03	$1337.03
MODESTO (CA)	$1337.03	$1337.03
REDDING (CA)	$1337.03	$1337.03
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1381.18	$1381.18
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1382.44	$1382.44
SALINAS (CA)	$1376.88	$1376.88
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1567.76	$1567.76
SANTA CRUZ-WATSONVILLE (CA)	$1395.75	$1395.75
SANTA ROSA-PETALUMA (CA)	$1408.48	$1408.48
STOCKTON (CA)	$1337.03	$1337.03
VISALIA (CA)	$1337.03	$1337.03
YUBA CITY (CA)	$1337.03	$1337.03
EL CENTRO (CA)	$1337.72	$1337.72
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1394.30	$1394.30
SAN LUIS OBISPO-PASO ROBLES (CA)	$1357.18	$1357.18
SANTA MARIA-SANTA BARBARA (CA)	$1377.95	$1377.95
REST OF CALIFORNIA (CA)	$1337.03	$1337.03
COLORADO (CO)	$1351.90	$1351.90
CONNECTICUT (CT)	$1422.64	$1422.64
DC + MD/VA SUBURBS (DC)	$1481.76	$1481.76
DELAWARE (DE)	$1327.28	$1327.28
FORT LAUDERDALE (FL)	$1459.79	$1459.79
MIAMI (FL)	$1571.65	$1571.65
REST OF FLORIDA (FL)	$1391.31	$1391.31
ATLANTA (GA)	$1380.29	$1380.29
REST OF GEORGIA (GA)	$1318.73	$1318.73
HAWAII, GUAM (HI)	$1349.60	$1349.60
IOWA (IA)	$1220.64	$1220.64
IDAHO (ID)	$1233.39	$1233.39
EAST ST. LOUIS (IL)	$1444.42	$1444.42
SUBURBAN CHICAGO (IL)	$1466.59	$1466.59
CHICAGO (IL)	$1527.90	$1527.90
REST OF ILLINOIS (IL)	$1379.38	$1379.38
INDIANA (IN)	$1238.45	$1238.45
KANSAS (KS)	$1230.14	$1230.14
KENTUCKY (KY)	$1279.39	$1279.39
NEW ORLEANS (LA)	$1334.03	$1334.03
REST OF LOUISIANA (LA)	$1283.41	$1283.41
METROPOLITAN BOSTON (MA)	$1449.13	$1449.13
REST OF MASSACHUSETTS (MA)	$1351.89	$1351.89
BALTIMORE/SURR. CNTYS (MD)	$1421.51	$1421.51
REST OF MARYLAND (MD)	$1344.82	$1344.82
SOUTHERN MAINE (ME)	$1288.30	$1288.30
REST OF MAINE (ME)	$1253.80	$1253.80
DETROIT (MI)	$1420.59	$1420.59
REST OF MICHIGAN (MI)	$1319.95	$1319.95
MINNESOTA (MN)	$1260.23	$1260.23
METROPOLITAN ST. LOUIS (MO)	$1320.83	$1320.83
METROPOLITAN KANSAS CITY (MO)	$1311.31	$1311.31
REST OF MISSOURI (MO)	$1274.82	$1274.82
MISSISSIPPI (MS)	$1242.17	$1242.17
MONTANA** (MT)	$1342.78	$1342.78
NORTH CAROLINA (NC)	$1262.22	$1262.22
NORTH DAKOTA** (ND)	$1261.71	$1261.71
NEBRASKA (NE)	$1221.79	$1221.79
NEW HAMPSHIRE (NH)	$1345.15	$1345.15
NORTHERN NJ (NJ)	$1473.80	$1473.80
REST OF NEW JERSEY (NJ)	$1428.95	$1428.95
NEW MEXICO (NM)	$1331.68	$1331.68
NEVADA** (NV)	$1320.65	$1320.65
MANHATTAN (NY)	$1546.41	$1546.41
NYC SUBURBS/LONG ISLAND (NY)	$1596.18	$1596.18
POUGHKPSIE/N NYC SUBURBS (NY)	$1449.51	$1449.51
QUEENS (NY)	$1536.07	$1536.07
REST OF NEW YORK (NY)	$1278.95	$1278.95
OHIO (OH)	$1303.38	$1303.38
OKLAHOMA (OK)	$1262.37	$1262.37
PORTLAND (OR)	$1371.81	$1371.81
REST OF OREGON (OR)	$1300.50	$1300.50
METROPOLITAN PHILADELPHIA (PA)	$1401.97	$1401.97
REST OF PENNSYLVANIA (PA)	$1297.09	$1297.09
PUERTO RICO (PR)	$1346.15	$1346.15
RHODE ISLAND (RI)	$1357.74	$1357.74
SOUTH CAROLINA (SC)	$1286.89	$1286.89
SOUTH DAKOTA** (SD)	$1252.12	$1252.12
TENNESSEE (TN)	$1237.00	$1237.00
BRAZORIA (TX)	$1314.60	$1314.60
DALLAS (TX)	$1328.37	$1328.37
GALVESTON (TX)	$1322.12	$1322.12
HOUSTON (TX)	$1397.16	$1397.16
BEAUMONT (TX)	$1291.15	$1291.15
FORT WORTH (TX)	$1325.46	$1325.46
AUSTIN (TX)	$1356.09	$1356.09
REST OF TEXAS (TX)	$1305.87	$1305.87
UTAH (UT)	$1300.97	$1300.97
VIRGINIA (VA)	$1294.82	$1294.82
VIRGIN ISLANDS (VI)	$1346.15	$1346.15
VERMONT (VT)	$1270.71	$1270.71
SEATTLE (KING CNTY) (WA)	$1461.24	$1461.24
REST OF WASHINGTON (WA)	$1344.74	$1344.74
WISCONSIN (WI)	$1228.60	$1228.60
WEST VIRGINIA (WV)	$1340.68	$1340.68
WYOMING** (WY)	$1307.44	$1307.44

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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 — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs often differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings because overhead costs differ, which is why the two amounts can diverge. The conversion factor is updated annually by CMS and applies uniformly across all codes before locality adjustments.

RVUs — work 22.08, practice expense 14.03 (non-facility) / 14.03 (facility), malpractice 4.1 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can change the actual payment.
Annual budget-neutrality adjustments and conversion factor updates can shift amounts year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why do the non-facility and facility amounts differ for CPT 21179?

The practice-expense RVU component differs between settings because the resources and overhead a physician practice bears are different when a procedure is done in an office versus a hospital or ambulatory surgical center. In this case the PE RVU is the same across both, so the national amounts are equal, but this is code-specific and not guaranteed to be the case for other codes.

Is this the amount Medicare will actually pay?

No. This is the PFS allowed amount before adjustments. Medicare generally pays 80% of this allowed amount after the deductible, and the final payment can be affected by locality GPCIs, modifiers, and sequestration.

Why does the amount change from year to year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, which can raise or lower the allowed amount even if the code itself doesn't change.

Can I use this amount for claims in my state?

The national amount is a baseline; actual reimbursement depends on your specific locality's GPCI values. Check the locality-adjusted figure on this page or confirm with your MAC for the exact rate in your area.

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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.