Medicare Reimbursement for CPT 21180

CPT 21180 is a procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1495.69	$1495.69
ALASKA* (AK)	$1875.79	$1875.79
ALABAMA (AL)	$1365.07	$1365.07
ARKANSAS (AR)	$1349.06	$1349.06
ARIZONA (AZ)	$1457.67	$1457.67
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1694.20	$1694.20
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1718.62	$1718.62
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1553.18	$1553.18
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1570.85	$1570.85
NAPA (CA)	$1633.64	$1633.64
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1699.46	$1699.46
VALLEJO (CA)	$1626.06	$1626.06
BAKERSFIELD (CA)	$1499.82	$1499.82
CHICO (CA)	$1486.87	$1486.87
FRESNO (CA)	$1486.87	$1486.87
HANFORD-CORCORAN (CA)	$1486.87	$1486.87
MADERA (CA)	$1486.87	$1486.87
MERCED (CA)	$1486.87	$1486.87
MODESTO (CA)	$1486.87	$1486.87
REDDING (CA)	$1486.87	$1486.87
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1536.72	$1536.72
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1536.73	$1536.73
SALINAS (CA)	$1530.54	$1530.54
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1740.12	$1740.12
SANTA CRUZ-WATSONVILLE (CA)	$1550.66	$1550.66
SANTA ROSA-PETALUMA (CA)	$1564.76	$1564.76
STOCKTON (CA)	$1486.87	$1486.87
VISALIA (CA)	$1486.87	$1486.87
YUBA CITY (CA)	$1486.87	$1486.87
EL CENTRO (CA)	$1487.64	$1487.64
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1549.43	$1549.43
SAN LUIS OBISPO-PASO ROBLES (CA)	$1508.71	$1508.71
SANTA MARIA-SANTA BARBARA (CA)	$1531.59	$1531.59
REST OF CALIFORNIA (CA)	$1486.87	$1486.87
COLORADO (CO)	$1504.33	$1504.33
CONNECTICUT (CT)	$1583.95	$1583.95
DC + MD/VA SUBURBS (DC)	$1648.58	$1648.58
DELAWARE (DE)	$1478.14	$1478.14
FORT LAUDERDALE (FL)	$1627.25	$1627.25
MIAMI (FL)	$1752.98	$1752.98
REST OF FLORIDA (FL)	$1551.13	$1551.13
ATLANTA (GA)	$1537.40	$1537.40
REST OF GEORGIA (GA)	$1470.52	$1470.52
HAWAII, GUAM (HI)	$1500.19	$1500.19
IOWA (IA)	$1359.26	$1359.26
IDAHO (ID)	$1373.55	$1373.55
EAST ST. LOUIS (IL)	$1611.86	$1611.86
SUBURBAN CHICAGO (IL)	$1634.63	$1634.63
CHICAGO (IL)	$1704.33	$1704.33
REST OF ILLINOIS (IL)	$1538.56	$1538.56
INDIANA (IN)	$1379.12	$1379.12
KANSAS (KS)	$1370.22	$1370.22
KENTUCKY (KY)	$1426.16	$1426.16
NEW ORLEANS (LA)	$1486.75	$1486.75
REST OF LOUISIANA (LA)	$1430.77	$1430.77
METROPOLITAN BOSTON (MA)	$1611.39	$1611.39
REST OF MASSACHUSETTS (MA)	$1504.55	$1504.55
BALTIMORE/SURR. CNTYS (MD)	$1582.76	$1582.76
REST OF MARYLAND (MD)	$1497.44	$1497.44
SOUTHERN MAINE (ME)	$1434.06	$1434.06
REST OF MAINE (ME)	$1396.59	$1396.59
DETROIT (MI)	$1584.00	$1584.00
REST OF MICHIGAN (MI)	$1471.44	$1471.44
MINNESOTA (MN)	$1401.55	$1401.55
METROPOLITAN ST. LOUIS (MO)	$1471.62	$1471.62
METROPOLITAN KANSAS CITY (MO)	$1461.15	$1461.15
REST OF MISSOURI (MO)	$1421.56	$1421.56
MISSISSIPPI (MS)	$1384.71	$1384.71
MONTANA** (MT)	$1495.38	$1495.38
NORTH CAROLINA (NC)	$1405.83	$1405.83
NORTH DAKOTA** (ND)	$1403.83	$1403.83
NEBRASKA (NE)	$1360.38	$1360.38
NEW HAMPSHIRE (NH)	$1497.19	$1497.19
NORTHERN NJ (NJ)	$1639.97	$1639.97
REST OF NEW JERSEY (NJ)	$1590.75	$1590.75
NEW MEXICO (NM)	$1484.61	$1484.61
NEVADA** (NV)	$1470.37	$1470.37
MANHATTAN (NY)	$1721.93	$1721.93
NYC SUBURBS/LONG ISLAND (NY)	$1777.55	$1777.55
POUGHKPSIE/N NYC SUBURBS (NY)	$1613.92	$1613.92
QUEENS (NY)	$1709.82	$1709.82
REST OF NEW YORK (NY)	$1424.36	$1424.36
OHIO (OH)	$1452.73	$1452.73
OKLAHOMA (OK)	$1406.85	$1406.85
PORTLAND (OR)	$1525.82	$1525.82
REST OF OREGON (OR)	$1447.73	$1447.73
METROPOLITAN PHILADELPHIA (PA)	$1561.36	$1561.36
REST OF PENNSYLVANIA (PA)	$1445.53	$1445.53
PUERTO RICO (PR)	$1498.96	$1498.96
RHODE ISLAND (RI)	$1511.58	$1511.58
SOUTH CAROLINA (SC)	$1433.89	$1433.89
SOUTH DAKOTA** (SD)	$1393.01	$1393.01
TENNESSEE (TN)	$1377.86	$1377.86
BRAZORIA (TX)	$1463.76	$1463.76
DALLAS (TX)	$1479.20	$1479.20
GALVESTON (TX)	$1472.20	$1472.20
HOUSTON (TX)	$1556.95	$1556.95
BEAUMONT (TX)	$1438.99	$1438.99
FORT WORTH (TX)	$1476.13	$1476.13
AUSTIN (TX)	$1509.19	$1509.19
REST OF TEXAS (TX)	$1454.78	$1454.78
UTAH (UT)	$1449.44	$1449.44
VIRGINIA (VA)	$1441.59	$1441.59
VIRGIN ISLANDS (VI)	$1498.96	$1498.96
VERMONT (VT)	$1414.22	$1414.22
SEATTLE (KING CNTY) (WA)	$1624.37	$1624.37
REST OF WASHINGTON (WA)	$1496.49	$1496.49
WISCONSIN (WI)	$1367.34	$1367.34
WEST VIRGINIA (WV)	$1495.79	$1495.79
WYOMING** (WY)	$1455.48	$1455.48

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. The adjusted RVUs are summed and multiplied by the annual Conversion Factor (CF) to produce a dollar amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which can change the final allowed amount even when work and malpractice RVUs stay the same. The national figures shown use national GPCI averages, while locality-specific figures reflect local cost adjustments.

RVUs — work 24.94, practice expense 15.21 (non-facility) / 15.21 (facility), malpractice 4.63 — × 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 payer is responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts change year to year.
Always verify final payment with your Medicare Administrative Contractor (MAC), as local policies may apply.

Frequently asked

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

Practice-expense RVUs account for overhead costs like staff and supplies. In a facility setting, Medicare assumes the facility absorbs some of those costs separately, so the physician's practice-expense RVU — and therefore the allowed amount — may differ from the non-facility setting.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-allowed amount before the standard 80/20 split, deductible, and any applicable modifiers or adjustments are applied.

Why does the amount vary by locality?

Geographic Practice Cost Indices (GPCIs) adjust the work, practice-expense, and malpractice RVUs to reflect regional differences in wages, rent, and other costs, which changes the final calculation for each locality.

Will this amount stay the same next year?

No. The conversion factor and RVUs are updated annually by CMS, and budget-neutrality adjustments can shift amounts even if RVUs stay similar.

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.