Medicare Reimbursement for CPT 21194

CPT code 21194 is a procedure code defined by the American Medical Association; its specific clinical description is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) 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)	$1279.59	$1279.59
ALASKA* (AK)	$1619.10	$1619.10
ALABAMA (AL)	$1176.76	$1176.76
ARKANSAS (AR)	$1164.06	$1164.06
ARIZONA (AZ)	$1250.36	$1250.36
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1479.43	$1479.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1502.15	$1502.15
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1345.75	$1345.75
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1359.65	$1359.65
NAPA (CA)	$1422.28	$1422.28
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1482.92	$1482.92
VALLEJO (CA)	$1417.25	$1417.25
BAKERSFIELD (CA)	$1297.79	$1297.79
CHICO (CA)	$1288.88	$1288.88
FRESNO (CA)	$1288.88	$1288.88
HANFORD-CORCORAN (CA)	$1288.88	$1288.88
MADERA (CA)	$1288.88	$1288.88
MERCED (CA)	$1288.88	$1288.88
MODESTO (CA)	$1288.88	$1288.88
REDDING (CA)	$1288.88	$1288.88
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1322.10	$1322.10
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1333.64	$1333.64
SALINAS (CA)	$1328.22	$1328.22
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1516.40	$1516.40
SANTA CRUZ-WATSONVILLE (CA)	$1347.25	$1347.25
SANTA ROSA-PETALUMA (CA)	$1359.71	$1359.71
STOCKTON (CA)	$1288.88	$1288.88
VISALIA (CA)	$1288.88	$1288.88
YUBA CITY (CA)	$1288.88	$1288.88
EL CENTRO (CA)	$1289.39	$1289.39
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1345.39	$1345.39
SAN LUIS OBISPO-PASO ROBLES (CA)	$1308.95	$1308.95
SANTA MARIA-SANTA BARBARA (CA)	$1329.36	$1329.36
REST OF CALIFORNIA (CA)	$1288.88	$1288.88
COLORADO (CO)	$1295.52	$1295.52
CONNECTICUT (CT)	$1351.26	$1351.26
DC + MD/VA SUBURBS (DC)	$1412.60	$1412.60
DELAWARE (DE)	$1267.18	$1267.18
FORT LAUDERDALE (FL)	$1368.51	$1368.51
MIAMI (FL)	$1455.50	$1455.50
REST OF FLORIDA (FL)	$1310.64	$1310.64
ATLANTA (GA)	$1309.80	$1309.80
REST OF GEORGIA (GA)	$1248.88	$1248.88
HAWAII, GUAM (HI)	$1300.34	$1300.34
IOWA (IA)	$1178.09	$1178.09
IDAHO (ID)	$1188.22	$1188.22
EAST ST. LOUIS (IL)	$1346.24	$1346.24
SUBURBAN CHICAGO (IL)	$1376.32	$1376.32
CHICAGO (IL)	$1419.68	$1419.68
REST OF ILLINOIS (IL)	$1296.72	$1296.72
INDIANA (IN)	$1192.82	$1192.82
KANSAS (KS)	$1183.93	$1183.93
KENTUCKY (KY)	$1219.08	$1219.08
NEW ORLEANS (LA)	$1266.00	$1266.00
REST OF LOUISIANA (LA)	$1221.62	$1221.62
METROPOLITAN BOSTON (MA)	$1387.96	$1387.96
REST OF MASSACHUSETTS (MA)	$1294.87	$1294.87
BALTIMORE/SURR. CNTYS (MD)	$1349.32	$1349.32
REST OF MARYLAND (MD)	$1283.88	$1283.88
SOUTHERN MAINE (ME)	$1237.55	$1237.55
REST OF MAINE (ME)	$1203.50	$1203.50
DETROIT (MI)	$1333.60	$1333.60
REST OF MICHIGAN (MI)	$1252.22	$1252.22
MINNESOTA (MN)	$1220.93	$1220.93
METROPOLITAN ST. LOUIS (MO)	$1257.40	$1257.40
METROPOLITAN KANSAS CITY (MO)	$1248.77	$1248.77
REST OF MISSOURI (MO)	$1212.53	$1212.53
MISSISSIPPI (MS)	$1187.97	$1187.97
MONTANA** (MT)	$1279.38	$1279.38
NORTH CAROLINA (NC)	$1211.31	$1211.31
NORTH DAKOTA** (ND)	$1218.68	$1218.68
NEBRASKA (NE)	$1179.88	$1179.88
NEW HAMPSHIRE (NH)	$1285.90	$1285.90
NORTHERN NJ (NJ)	$1405.98	$1405.98
REST OF NEW JERSEY (NJ)	$1360.88	$1360.88
NEW MEXICO (NM)	$1261.47	$1261.47
NEVADA** (NV)	$1262.93	$1262.93
MANHATTAN (NY)	$1460.74	$1460.74
NYC SUBURBS/LONG ISLAND (NY)	$1501.12	$1501.12
POUGHKPSIE/N NYC SUBURBS (NY)	$1377.42	$1377.42
QUEENS (NY)	$1455.30	$1455.30
REST OF NEW YORK (NY)	$1225.80	$1225.80
OHIO (OH)	$1239.81	$1239.81
OKLAHOMA (OK)	$1206.79	$1206.79
PORTLAND (OR)	$1316.50	$1316.50
REST OF OREGON (OR)	$1247.27	$1247.27
METROPOLITAN PHILADELPHIA (PA)	$1331.30	$1331.30
REST OF PENNSYLVANIA (PA)	$1235.69	$1235.69
PUERTO RICO (PR)	$1283.18	$1283.18
RHODE ISLAND (RI)	$1297.41	$1297.41
SOUTH CAROLINA (SC)	$1228.74	$1228.74
SOUTH DAKOTA** (SD)	$1211.50	$1211.50
TENNESSEE (TN)	$1189.65	$1189.65
BRAZORIA (TX)	$1258.51	$1258.51
DALLAS (TX)	$1269.56	$1269.56
GALVESTON (TX)	$1264.37	$1264.37
HOUSTON (TX)	$1320.56	$1320.56
BEAUMONT (TX)	$1230.31	$1230.31
FORT WORTH (TX)	$1266.22	$1266.22
AUSTIN (TX)	$1296.38	$1296.38
REST OF TEXAS (TX)	$1245.84	$1245.84
UTAH (UT)	$1241.13	$1241.13
VIRGINIA (VA)	$1241.51	$1241.51
VIRGIN ISLANDS (VI)	$1283.18	$1283.18
VERMONT (VT)	$1224.27	$1224.27
SEATTLE (KING CNTY) (WA)	$1402.27	$1402.27
REST OF WASHINGTON (WA)	$1289.05	$1289.05
WISCONSIN (WI)	$1189.03	$1189.03
WEST VIRGINIA (WV)	$1262.66	$1262.66
WYOMING** (WY)	$1252.93	$1252.93

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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, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why two separate allowed amounts may be shown.

RVUs — work 21.27, practice expense 13.97 (non-facility) / 13.97 (facility), malpractice 3.07 — × 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's deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs and the conversion factor are updated periodically and may differ from the figures used here.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility and non-facility rate differ for this code?

The practice-expense RVU component is typically lower in a facility setting because the facility (e.g., hospital) absorbs certain overhead costs, whereas in a non-facility setting the billing provider bears those costs directly.

Why might my actual payment differ from the amount shown?

Actual payment depends on your specific Medicare Administrative Contractor's locality GPCIs, any applicable modifiers, secondary payer coordination, sequestration reductions, and yearly fee schedule updates.

Does this amount include the patient's share?

No. The figure shown is the total Medicare-allowed amount. Medicare generally pays 80% of this after the deductible, with the remaining 20% being the patient's or secondary insurer's responsibility.

Where can I find the official description for CPT 21194?

CPT code descriptors are copyrighted by the American Medical Association. Refer to your licensed CPT codebook or AMA resources for the official language.

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.