Medicare Reimbursement for CPT 21193
CPT 21193 is a surgical procedure code reported to Medicare and other payers; the specific clinical description is maintained by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $1108.58 | $1108.58 |
| ALASKA* (AK) | $1402.40 | $1402.40 |
| ALABAMA (AL) | $1019.29 | $1019.29 |
| ARKANSAS (AR) | $1008.27 | $1008.27 |
| ARIZONA (AZ) | $1083.18 | $1083.18 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1281.01 | $1281.01 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1300.65 | $1300.65 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1165.50 | $1165.50 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1177.58 | $1177.58 |
| NAPA (CA) | $1231.62 | $1231.62 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1284.06 | $1284.06 |
| VALLEJO (CA) | $1227.24 | $1227.24 |
| BAKERSFIELD (CA) | $1124.01 | $1124.01 |
| CHICO (CA) | $1116.24 | $1116.24 |
| FRESNO (CA) | $1116.24 | $1116.24 |
| HANFORD-CORCORAN (CA) | $1116.24 | $1116.24 |
| MADERA (CA) | $1116.24 | $1116.24 |
| MERCED (CA) | $1116.24 | $1116.24 |
| MODESTO (CA) | $1116.24 | $1116.24 |
| REDDING (CA) | $1116.24 | $1116.24 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $1145.23 | $1145.23 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1154.97 | $1154.97 |
| SALINAS (CA) | $1150.28 | $1150.28 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1313.09 | $1313.09 |
| SANTA CRUZ-WATSONVILLE (CA) | $1166.72 | $1166.72 |
| SANTA ROSA-PETALUMA (CA) | $1177.50 | $1177.50 |
| STOCKTON (CA) | $1116.24 | $1116.24 |
| VISALIA (CA) | $1116.24 | $1116.24 |
| YUBA CITY (CA) | $1116.24 | $1116.24 |
| EL CENTRO (CA) | $1116.69 | $1116.69 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1165.13 | $1165.13 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $1133.59 | $1133.59 |
| SANTA MARIA-SANTA BARBARA (CA) | $1151.26 | $1151.26 |
| REST OF CALIFORNIA (CA) | $1116.24 | $1116.24 |
| COLORADO (CO) | $1122.18 | $1122.18 |
| CONNECTICUT (CT) | $1170.75 | $1170.75 |
| DC + MD/VA SUBURBS (DC) | $1223.75 | $1223.75 |
| DELAWARE (DE) | $1097.77 | $1097.77 |
| FORT LAUDERDALE (FL) | $1186.15 | $1186.15 |
| MIAMI (FL) | $1261.99 | $1261.99 |
| REST OF FLORIDA (FL) | $1135.85 | $1135.85 |
| ATLANTA (GA) | $1134.87 | $1134.87 |
| REST OF GEORGIA (GA) | $1082.19 | $1082.19 |
| HAWAII, GUAM (HI) | $1126.17 | $1126.17 |
| IOWA (IA) | $1020.30 | $1020.30 |
| IDAHO (ID) | $1029.12 | $1029.12 |
| EAST ST. LOUIS (IL) | $1167.06 | $1167.06 |
| SUBURBAN CHICAGO (IL) | $1192.88 | $1192.88 |
| CHICAGO (IL) | $1230.82 | $1230.82 |
| REST OF ILLINOIS (IL) | $1123.87 | $1123.87 |
| INDIANA (IN) | $1033.11 | $1033.11 |
| KANSAS (KS) | $1025.44 | $1025.44 |
| KENTUCKY (KY) | $1056.18 | $1056.18 |
| NEW ORLEANS (LA) | $1096.94 | $1096.94 |
| REST OF LOUISIANA (LA) | $1058.42 | $1058.42 |
| METROPOLITAN BOSTON (MA) | $1202.24 | $1202.24 |
| REST OF MASSACHUSETTS (MA) | $1121.64 | $1121.64 |
| BALTIMORE/SURR. CNTYS (MD) | $1169.09 | $1169.09 |
| REST OF MARYLAND (MD) | $1112.23 | $1112.23 |
| SOUTHERN MAINE (ME) | $1071.91 | $1071.91 |
| REST OF MAINE (ME) | $1042.46 | $1042.46 |
| DETROIT (MI) | $1155.86 | $1155.86 |
| REST OF MICHIGAN (MI) | $1085.02 | $1085.02 |
| MINNESOTA (MN) | $1057.26 | $1057.26 |
| METROPOLITAN ST. LOUIS (MO) | $1089.39 | $1089.39 |
| METROPOLITAN KANSAS CITY (MO) | $1081.90 | $1081.90 |
| REST OF MISSOURI (MO) | $1050.57 | $1050.57 |
| MISSISSIPPI (MS) | $1029.13 | $1029.13 |
| MONTANA** (MT) | $1108.40 | $1108.40 |
| NORTH CAROLINA (NC) | $1049.23 | $1049.23 |
| NORTH DAKOTA** (ND) | $1055.40 | $1055.40 |
| NEBRASKA (NE) | $1021.83 | $1021.83 |
| NEW HAMPSHIRE (NH) | $1113.93 | $1113.93 |
| NORTHERN NJ (NJ) | $1218.00 | $1218.00 |
| REST OF NEW JERSEY (NJ) | $1179.00 | $1179.00 |
| NEW MEXICO (NM) | $1093.08 | $1093.08 |
| NEVADA** (NV) | $1094.03 | $1094.03 |
| MANHATTAN (NY) | $1265.79 | $1265.79 |
| NYC SUBURBS/LONG ISLAND (NY) | $1300.95 | $1300.95 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1193.41 | $1193.41 |
| QUEENS (NY) | $1260.97 | $1260.97 |
| REST OF NEW YORK (NY) | $1061.82 | $1061.82 |
| OHIO (OH) | $1074.19 | $1074.19 |
| OKLAHOMA (OK) | $1045.44 | $1045.44 |
| PORTLAND (OR) | $1140.30 | $1140.30 |
| REST OF OREGON (OR) | $1080.38 | $1080.38 |
| METROPOLITAN PHILADELPHIA (PA) | $1153.48 | $1153.48 |
| REST OF PENNSYLVANIA (PA) | $1070.57 | $1070.57 |
| PUERTO RICO (PR) | $1111.67 | $1111.67 |
| RHODE ISLAND (RI) | $1123.92 | $1123.92 |
| SOUTH CAROLINA (SC) | $1064.48 | $1064.48 |
| SOUTH DAKOTA** (SD) | $1049.14 | $1049.14 |
| TENNESSEE (TN) | $1030.41 | $1030.41 |
| BRAZORIA (TX) | $1090.18 | $1090.18 |
| DALLAS (TX) | $1099.79 | $1099.79 |
| GALVESTON (TX) | $1095.28 | $1095.28 |
| HOUSTON (TX) | $1144.33 | $1144.33 |
| BEAUMONT (TX) | $1065.91 | $1065.91 |
| FORT WORTH (TX) | $1096.92 | $1096.92 |
| AUSTIN (TX) | $1123.00 | $1123.00 |
| REST OF TEXAS (TX) | $1079.32 | $1079.32 |
| UTAH (UT) | $1075.24 | $1075.24 |
| VIRGINIA (VA) | $1075.40 | $1075.40 |
| VIRGIN ISLANDS (VI) | $1111.67 | $1111.67 |
| VERMONT (VT) | $1060.32 | $1060.32 |
| SEATTLE (KING CNTY) (WA) | $1214.56 | $1214.56 |
| REST OF WASHINGTON (WA) | $1116.57 | $1116.57 |
| WISCONSIN (WI) | $1029.69 | $1029.69 |
| WEST VIRGINIA (WV) | $1094.30 | $1094.30 |
| WYOMING** (WY) | $1085.30 | $1085.30 |
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 — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which is why this code may show the same or different amounts across those settings. These RVU, GPCI, and conversion factor values are updated annually by CMS.
RVUs — work 18.43, practice expense 12.08 (non-facility) / 12.08 (facility), malpractice 2.68 — × 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 insurer is responsible for the remainder.
- Actual payment can vary by locality, applicable modifiers, site of service, sequestration, and annual budget-neutrality adjustments.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the amount differ between non-facility and facility settings?
Practice-expense RVUs account for overhead costs like staff and supplies, which are typically higher in non-facility settings (e.g., a physician's office) than in facility settings (e.g., a hospital), where the facility separately bills its own costs.
Does this amount include the patient's deductible and coinsurance?
No. The figure shown is the Medicare-allowed amount before cost-sharing; Medicare generally pays 80% after the deductible, with the patient or secondary payer covering the rest.
Why might my local Medicare payment differ from the national amount shown here?
Local payment amounts reflect locality-specific GPCIs that adjust for regional differences in labor, practice costs, and malpractice insurance, so actual payment can be higher or lower than the national average.
Can modifiers change this amount?
Yes. Modifiers such as those for bilateral procedures, multiple procedures, or professional/technical component splits can increase or decrease the final paid amount relative to the base PFS rate shown here.
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.
Bill accurately, get paid faster
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free