Medicare Reimbursement for CPT 21188

CPT 21188 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated 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)	$1428.89	$1428.89
ALASKA* (AK)	$1793.56	$1793.56
ALABAMA (AL)	$1310.76	$1310.76
ARKANSAS (AR)	$1296.14	$1296.14
ARIZONA (AZ)	$1395.62	$1395.62
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1669.69	$1669.69
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1696.04	$1696.04
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1511.80	$1511.80
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1526.64	$1526.64
NAPA (CA)	$1602.57	$1602.57
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1673.40	$1673.40
VALLEJO (CA)	$1597.22	$1597.22
BAKERSFIELD (CA)	$1454.83	$1454.83
CHICO (CA)	$1445.35	$1445.35
FRESNO (CA)	$1445.35	$1445.35
HANFORD-CORCORAN (CA)	$1445.35	$1445.35
MADERA (CA)	$1445.35	$1445.35
MERCED (CA)	$1445.35	$1445.35
MODESTO (CA)	$1445.35	$1445.35
REDDING (CA)	$1445.35	$1445.35
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1480.72	$1480.72
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1497.58	$1497.58
SALINAS (CA)	$1491.55	$1491.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1711.22	$1711.22
SANTA CRUZ-WATSONVILLE (CA)	$1515.69	$1515.69
SANTA ROSA-PETALUMA (CA)	$1529.83	$1529.83
STOCKTON (CA)	$1445.35	$1445.35
VISALIA (CA)	$1445.35	$1445.35
YUBA CITY (CA)	$1445.35	$1445.35
EL CENTRO (CA)	$1445.89	$1445.89
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1512.38	$1512.38
SAN LUIS OBISPO-PASO ROBLES (CA)	$1469.68	$1469.68
SANTA MARIA-SANTA BARBARA (CA)	$1493.24	$1493.24
REST OF CALIFORNIA (CA)	$1445.35	$1445.35
COLORADO (CO)	$1450.23	$1450.23
CONNECTICUT (CT)	$1510.47	$1510.47
DC + MD/VA SUBURBS (DC)	$1582.66	$1582.66
DELAWARE (DE)	$1414.84	$1414.84
FORT LAUDERDALE (FL)	$1524.50	$1524.50
MIAMI (FL)	$1619.09	$1619.09
REST OF FLORIDA (FL)	$1458.93	$1458.93
ATLANTA (GA)	$1462.16	$1462.16
REST OF GEORGIA (GA)	$1388.75	$1388.75
HAWAII, GUAM (HI)	$1460.42	$1460.42
IOWA (IA)	$1314.94	$1314.94
IDAHO (ID)	$1326.07	$1326.07
EAST ST. LOUIS (IL)	$1494.38	$1494.38
SUBURBAN CHICAGO (IL)	$1533.76	$1533.76
CHICAGO (IL)	$1578.44	$1578.44
REST OF ILLINOIS (IL)	$1441.16	$1441.16
INDIANA (IN)	$1331.45	$1331.45
KANSAS (KS)	$1320.40	$1320.40
KENTUCKY (KY)	$1356.80	$1356.80
NEW ORLEANS (LA)	$1410.36	$1410.36
REST OF LOUISIANA (LA)	$1359.23	$1359.23
METROPOLITAN BOSTON (MA)	$1557.55	$1557.55
REST OF MASSACHUSETTS (MA)	$1448.77	$1448.77
BALTIMORE/SURR. CNTYS (MD)	$1508.14	$1508.14
REST OF MARYLAND (MD)	$1434.26	$1434.26
SOUTHERN MAINE (ME)	$1383.50	$1383.50
REST OF MAINE (ME)	$1342.34	$1342.34
DETROIT (MI)	$1484.01	$1484.01
REST OF MICHIGAN (MI)	$1393.75	$1393.75
MINNESOTA (MN)	$1368.41	$1368.41
METROPOLITAN ST. LOUIS (MO)	$1401.95	$1401.95
METROPOLITAN KANSAS CITY (MO)	$1391.86	$1391.86
REST OF MISSOURI (MO)	$1347.97	$1347.97
MISSISSIPPI (MS)	$1321.74	$1321.74
MONTANA** (MT)	$1428.67	$1428.67
NORTH CAROLINA (NC)	$1351.55	$1351.55
NORTH DAKOTA** (ND)	$1364.01	$1364.01
NEBRASKA (NE)	$1317.39	$1317.39
NEW HAMPSHIRE (NH)	$1438.44	$1438.44
NORTHERN NJ (NJ)	$1574.34	$1574.34
REST OF NEW JERSEY (NJ)	$1521.69	$1521.69
NEW MEXICO (NM)	$1403.88	$1403.88
NEVADA** (NV)	$1411.22	$1411.22
MANHATTAN (NY)	$1632.80	$1632.80
NYC SUBURBS/LONG ISLAND (NY)	$1677.68	$1677.68
POUGHKPSIE/N NYC SUBURBS (NY)	$1539.50	$1539.50
QUEENS (NY)	$1628.39	$1628.39
REST OF NEW YORK (NY)	$1368.16	$1368.16
OHIO (OH)	$1380.54	$1380.54
OKLAHOMA (OK)	$1343.99	$1343.99
PORTLAND (OR)	$1475.80	$1475.80
REST OF OREGON (OR)	$1394.19	$1394.19
METROPOLITAN PHILADELPHIA (PA)	$1486.74	$1486.74
REST OF PENNSYLVANIA (PA)	$1376.49	$1376.49
PUERTO RICO (PR)	$1433.48	$1433.48
RHODE ISLAND (RI)	$1450.09	$1450.09
SOUTH CAROLINA (SC)	$1369.51	$1369.51
SOUTH DAKOTA** (SD)	$1356.37	$1356.37
TENNESSEE (TN)	$1326.83	$1326.83
BRAZORIA (TX)	$1405.80	$1405.80
DALLAS (TX)	$1417.90	$1417.90
GALVESTON (TX)	$1412.17	$1412.17
HOUSTON (TX)	$1472.03	$1472.03
BEAUMONT (TX)	$1370.21	$1370.21
FORT WORTH (TX)	$1413.66	$1413.66
AUSTIN (TX)	$1450.76	$1450.76
REST OF TEXAS (TX)	$1389.44	$1389.44
UTAH (UT)	$1383.80	$1383.80
VIRGINIA (VA)	$1387.16	$1387.16
VIRGIN ISLANDS (VI)	$1433.48	$1433.48
VERMONT (VT)	$1369.28	$1369.28
SEATTLE (KING CNTY) (WA)	$1575.04	$1575.04
REST OF WASHINGTON (WA)	$1442.57	$1442.57
WISCONSIN (WI)	$1329.55	$1329.55
WEST VIRGINIA (WV)	$1401.84	$1401.84
WYOMING** (WY)	$1400.49	$1400.49

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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 — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The geographically adjusted RVUs are summed and multiplied by the annual conversion factor to produce the allowed amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why two allowed amounts may be shown. For this code, the non-facility and facility PE RVUs are listed separately above.

RVUs — work 22.57, practice expense 16.94 (non-facility) / 16.94 (facility), malpractice 3.27 — × 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 patient meets their deductible; the beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the allowed amount change by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to the work, practice expense, and malpractice RVUs to reflect regional cost differences, so the same code can have different allowed amounts in different areas.

Why are the non-facility and facility amounts the same for this code?

When the practice expense RVUs are identical for non-facility and facility settings, as shown above, the resulting allowed amounts will also match.

Does this amount reflect what the practice will actually collect?

No. Medicare generally pays 80% of the allowed amount after the deductible is met, and the final payment may be further adjusted by modifiers, sequestration, or other policy factors.

Why isn't the CPT descriptor shown on this page?

CPT code descriptors are copyrighted by the American Medical Association and cannot be reproduced here; refer to your CPT codebook or AMA resources for the official description.

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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.