Medicare Reimbursement for CPT 21181

This page covers Medicare Physician Fee Schedule (PFS) pricing for CPT code 21181, a procedure code whose official descriptor is not reproduced here due to AMA licensing. It shows the national Medicare allowed amount as well as how that amount can shift by locality, and compares the non-facility and facility payment settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$672.69	$672.69
ALASKA* (AK)	$830.07	$830.07
ALABAMA (AL)	$611.25	$611.25
ARKANSAS (AR)	$603.66	$603.66
ARIZONA (AZ)	$655.20	$655.20
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$781.88	$781.88
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$793.99	$793.99
OXNARD-THOUSAND OAKS-VENTURA (CA)	$708.86	$708.86
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$716.03	$716.03
NAPA (CA)	$750.95	$750.95
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$783.99	$783.99
VALLEJO (CA)	$747.90	$747.90
BAKERSFIELD (CA)	$681.25	$681.25
CHICO (CA)	$676.04	$676.04
FRESNO (CA)	$676.04	$676.04
HANFORD-CORCORAN (CA)	$676.04	$676.04
MADERA (CA)	$676.04	$676.04
MERCED (CA)	$676.04	$676.04
MODESTO (CA)	$676.04	$676.04
REDDING (CA)	$676.04	$676.04
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$696.07	$696.07
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$700.89	$700.89
SALINAS (CA)	$698.11	$698.11
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$802.63	$802.63
SANTA CRUZ-WATSONVILLE (CA)	$710.21	$710.21
SANTA ROSA-PETALUMA (CA)	$716.81	$716.81
STOCKTON (CA)	$676.04	$676.04
VISALIA (CA)	$676.04	$676.04
YUBA CITY (CA)	$676.04	$676.04
EL CENTRO (CA)	$676.35	$676.35
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$708.36	$708.36
SAN LUIS OBISPO-PASO ROBLES (CA)	$687.91	$687.91
SANTA MARIA-SANTA BARBARA (CA)	$699.04	$699.04
REST OF CALIFORNIA (CA)	$676.04	$676.04
COLORADO (CO)	$680.76	$680.76
CONNECTICUT (CT)	$713.68	$713.68
DC + MD/VA SUBURBS (DC)	$746.90	$746.90
DELAWARE (DE)	$664.78	$664.78
FORT LAUDERDALE (FL)	$726.48	$726.48
MIAMI (FL)	$779.00	$779.00
REST OF FLORIDA (FL)	$691.80	$691.80
ATLANTA (GA)	$690.60	$690.60
REST OF GEORGIA (GA)	$654.83	$654.83
HAWAII, GUAM (HI)	$684.34	$684.34
IOWA (IA)	$611.78	$611.78
IDAHO (ID)	$617.88	$617.88
EAST ST. LOUIS (IL)	$713.62	$713.62
SUBURBAN CHICAGO (IL)	$730.45	$730.45
CHICAGO (IL)	$756.87	$756.87
REST OF ILLINOIS (IL)	$683.67	$683.67
INDIANA (IN)	$620.62	$620.62
KANSAS (KS)	$615.39	$615.39
KENTUCKY (KY)	$636.79	$636.79
NEW ORLEANS (LA)	$664.87	$664.87
REST OF LOUISIANA (LA)	$638.36	$638.36
METROPOLITAN BOSTON (MA)	$733.10	$733.10
REST OF MASSACHUSETTS (MA)	$680.06	$680.06
BALTIMORE/SURR. CNTYS (MD)	$712.91	$712.91
REST OF MARYLAND (MD)	$674.26	$674.26
SOUTHERN MAINE (ME)	$647.29	$647.29
REST OF MAINE (ME)	$627.14	$627.14
DETROIT (MI)	$705.66	$705.66
REST OF MICHIGAN (MI)	$656.71	$656.71
MINNESOTA (MN)	$636.96	$636.96
METROPOLITAN ST. LOUIS (MO)	$659.58	$659.58
METROPOLITAN KANSAS CITY (MO)	$654.44	$654.44
REST OF MISSOURI (MO)	$633.01	$633.01
MISSISSIPPI (MS)	$618.13	$618.13
MONTANA** (MT)	$672.57	$672.57
NORTH CAROLINA (NC)	$631.78	$631.78
NORTH DAKOTA** (ND)	$635.79	$635.79
NEBRASKA (NE)	$612.81	$612.81
NEW HAMPSHIRE (NH)	$676.24	$676.24
NORTHERN NJ (NJ)	$742.15	$742.15
REST OF NEW JERSEY (NJ)	$717.49	$717.49
NEW MEXICO (NM)	$662.28	$662.28
NEVADA** (NV)	$662.60	$662.60
MANHATTAN (NY)	$775.21	$775.21
NYC SUBURBS/LONG ISLAND (NY)	$799.50	$799.50
POUGHKPSIE/N NYC SUBURBS (NY)	$727.01	$727.01
QUEENS (NY)	$771.79	$771.79
REST OF NEW YORK (NY)	$640.45	$640.45
OHIO (OH)	$649.19	$649.19
OKLAHOMA (OK)	$629.32	$629.32
PORTLAND (OR)	$692.77	$692.77
REST OF OREGON (OR)	$653.14	$653.14
METROPOLITAN PHILADELPHIA (PA)	$702.02	$702.02
REST OF PENNSYLVANIA (PA)	$646.65	$646.65
PUERTO RICO (PR)	$674.80	$674.80
RHODE ISLAND (RI)	$681.45	$681.45
SOUTH CAROLINA (SC)	$642.41	$642.41
SOUTH DAKOTA** (SD)	$631.44	$631.44
TENNESSEE (TN)	$618.82	$618.82
BRAZORIA (TX)	$659.22	$659.22
DALLAS (TX)	$665.78	$665.78
GALVESTON (TX)	$662.75	$662.75
HOUSTON (TX)	$696.80	$696.80
BEAUMONT (TX)	$643.45	$643.45
FORT WORTH (TX)	$663.83	$663.83
AUSTIN (TX)	$682.28	$682.28
REST OF TEXAS (TX)	$652.60	$652.60
UTAH (UT)	$649.80	$649.80
VIRGINIA (VA)	$649.74	$649.74
VIRGIN ISLANDS (VI)	$674.80	$674.80
VERMONT (VT)	$639.25	$639.25
SEATTLE (KING CNTY) (WA)	$740.69	$740.69
REST OF WASHINGTON (WA)	$676.82	$676.82
WISCONSIN (WI)	$618.12	$618.12
WEST VIRGINIA (WV)	$663.33	$663.33
WYOMING** (WY)	$656.54	$656.54

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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's fee for this procedure is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is billed. The GPCI-adjusted RVUs are summed and then multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility settings can use different practice-expense RVUs, reflecting whether the physician's office or a facility absorbs overhead and equipment costs. Because GPCIs vary by region, the same code can have different allowed amounts in different parts of the country even though the RVUs and conversion factor are the same.

RVUs — work 10.02, practice expense 8.26 (non-facility) / 8.26 (facility), malpractice 1.86 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment; actual claims processing may differ.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary insurer is generally responsible for the rest.
Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Figures shown are based on the national conversion factor and may not reflect your specific Medicare Administrative Contractor (MAC) locality adjustment.
Always verify current rates and coverage policy with your MAC before billing or appealing a denial.

Frequently asked

Why does the amount for this code differ between my locality and the national figure?

Local wage, rent, and malpractice cost differences are captured in the GPCIs, which adjust the RVUs before the conversion factor is applied, so the same code can price differently by region.

Why are the non-facility and facility amounts sometimes the same or different?

The practice-expense RVU component differs depending on whether the service is performed in a physician office (non-facility) or a hospital/ASC setting (facility), since overhead responsibility shifts in facility settings.

Does this amount include what the patient owes?

No — the figure shown is the total Medicare-allowed amount; Medicare generally pays 80% after the deductible, with the remainder being patient or secondary-payer responsibility.

Will this amount change next year?

Yes — RVUs, GPCIs, and the conversion factor are updated annually and can also be affected by mid-year budget-neutrality adjustments or legislative changes.

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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.