Medicare Reimbursement for CPT 21195

CPT 21195 is a surgical procedure code; the full code descriptor is not shown here because CPT descriptors are licensed by the AMA. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted for locality, under non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1217.46	$1217.46
ALASKA* (AK)	$1521.48	$1521.48
ALABAMA (AL)	$1115.30	$1115.30
ARKANSAS (AR)	$1102.64	$1102.64
ARIZONA (AZ)	$1188.83	$1188.83
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1430.93	$1430.93
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1453.85	$1453.85
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1292.36	$1292.36
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1304.68	$1304.68
NAPA (CA)	$1372.20	$1372.20
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1434.00	$1434.00
VALLEJO (CA)	$1367.76	$1367.76
BAKERSFIELD (CA)	$1242.22	$1242.22
CHICO (CA)	$1234.36	$1234.36
FRESNO (CA)	$1234.36	$1234.36
HANFORD-CORCORAN (CA)	$1234.36	$1234.36
MADERA (CA)	$1234.36	$1234.36
MERCED (CA)	$1234.36	$1234.36
MODESTO (CA)	$1234.36	$1234.36
REDDING (CA)	$1234.36	$1234.36
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1263.68	$1263.68
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1279.92	$1279.92
SALINAS (CA)	$1274.78	$1274.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1466.43	$1466.43
SANTA CRUZ-WATSONVILLE (CA)	$1296.71	$1296.71
SANTA ROSA-PETALUMA (CA)	$1308.87	$1308.87
STOCKTON (CA)	$1234.36	$1234.36
VISALIA (CA)	$1234.36	$1234.36
YUBA CITY (CA)	$1234.36	$1234.36
EL CENTRO (CA)	$1234.81	$1234.81
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1293.32	$1293.32
SAN LUIS OBISPO-PASO ROBLES (CA)	$1255.99	$1255.99
SANTA MARIA-SANTA BARBARA (CA)	$1276.43	$1276.43
REST OF CALIFORNIA (CA)	$1234.36	$1234.36
COLORADO (CO)	$1237.32	$1237.32
CONNECTICUT (CT)	$1287.68	$1287.68
DC + MD/VA SUBURBS (DC)	$1350.92	$1350.92
DELAWARE (DE)	$1205.40	$1205.40
FORT LAUDERDALE (FL)	$1297.14	$1297.14
MIAMI (FL)	$1376.49	$1376.49
REST OF FLORIDA (FL)	$1240.86	$1240.86
ATLANTA (GA)	$1245.58	$1245.58
REST OF GEORGIA (GA)	$1180.52	$1180.52
HAWAII, GUAM (HI)	$1248.27	$1248.27
IOWA (IA)	$1120.12	$1120.12
IDAHO (ID)	$1129.52	$1129.52
EAST ST. LOUIS (IL)	$1269.01	$1269.01
SUBURBAN CHICAGO (IL)	$1305.29	$1305.29
CHICAGO (IL)	$1341.56	$1341.56
REST OF ILLINOIS (IL)	$1224.66	$1224.66
INDIANA (IN)	$1134.22	$1134.22
KANSAS (KS)	$1124.28	$1124.28
KENTUCKY (KY)	$1153.93	$1153.93
NEW ORLEANS (LA)	$1200.10	$1200.10
REST OF LOUISIANA (LA)	$1155.81	$1155.81
METROPOLITAN BOSTON (MA)	$1330.67	$1330.67
REST OF MASSACHUSETTS (MA)	$1235.73	$1235.73
BALTIMORE/SURR. CNTYS (MD)	$1285.62	$1285.62
REST OF MARYLAND (MD)	$1222.32	$1222.32
SOUTHERN MAINE (ME)	$1179.54	$1179.54
REST OF MAINE (ME)	$1143.01	$1143.01
DETROIT (MI)	$1261.95	$1261.95
REST OF MICHIGAN (MI)	$1185.38	$1185.38
MINNESOTA (MN)	$1168.33	$1168.33
METROPOLITAN ST. LOUIS (MO)	$1193.50	$1193.50
METROPOLITAN KANSAS CITY (MO)	$1184.70	$1184.70
REST OF MISSOURI (MO)	$1145.69	$1145.69
MISSISSIPPI (MS)	$1123.92	$1123.92
MONTANA** (MT)	$1217.28	$1217.28
NORTH CAROLINA (NC)	$1151.08	$1151.08
NORTH DAKOTA** (ND)	$1163.70	$1163.70
NEBRASKA (NE)	$1122.43	$1122.43
NEW HAMPSHIRE (NH)	$1226.77	$1226.77
NORTHERN NJ (NJ)	$1343.41	$1343.41
REST OF NEW JERSEY (NJ)	$1297.48	$1297.48
NEW MEXICO (NM)	$1193.91	$1193.91
NEVADA** (NV)	$1202.85	$1202.85
MANHATTAN (NY)	$1391.93	$1391.93
NYC SUBURBS/LONG ISLAND (NY)	$1430.04	$1430.04
POUGHKPSIE/N NYC SUBURBS (NY)	$1312.33	$1312.33
QUEENS (NY)	$1388.95	$1388.95
REST OF NEW YORK (NY)	$1165.43	$1165.43
OHIO (OH)	$1174.42	$1174.42
OKLAHOMA (OK)	$1143.45	$1143.45
PORTLAND (OR)	$1260.11	$1260.11
REST OF OREGON (OR)	$1188.57	$1188.57
METROPOLITAN PHILADELPHIA (PA)	$1266.79	$1266.79
REST OF PENNSYLVANIA (PA)	$1171.24	$1171.24
PUERTO RICO (PR)	$1221.64	$1221.64
RHODE ISLAND (RI)	$1236.14	$1236.14
SOUTH CAROLINA (SC)	$1165.66	$1165.66
SOUTH DAKOTA** (SD)	$1157.36	$1157.36
TENNESSEE (TN)	$1129.78	$1129.78
BRAZORIA (TX)	$1198.01	$1198.01
DALLAS (TX)	$1208.21	$1208.21
GALVESTON (TX)	$1203.36	$1203.36
HOUSTON (TX)	$1252.97	$1252.97
BEAUMONT (TX)	$1165.76	$1165.76
FORT WORTH (TX)	$1204.36	$1204.36
AUSTIN (TX)	$1237.57	$1237.57
REST OF TEXAS (TX)	$1183.03	$1183.03
UTAH (UT)	$1178.05	$1178.05
VIRGINIA (VA)	$1182.30	$1182.30
VIRGIN ISLANDS (VI)	$1221.64	$1221.64
VERMONT (VT)	$1167.72	$1167.72
SEATTLE (KING CNTY) (WA)	$1346.28	$1346.28
REST OF WASHINGTON (WA)	$1230.60	$1230.60
WISCONSIN (WI)	$1133.70	$1133.70
WEST VIRGINIA (WV)	$1190.58	$1190.58
WYOMING** (WY)	$1193.93	$1193.93

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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

The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed. The locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs, reflecting whether overhead costs (like supplies and staff) are borne by the physician's office or by a facility such as a hospital. For this code, the practice-expense RVU is the same in both settings, so the non-facility and facility national amounts shown are equal.

RVUs — work 18.68, practice expense 15.06 (non-facility) / 15.06 (facility), malpractice 2.71 — × 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 beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-specific circumstances, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why don't the non-facility and facility amounts differ for this code?

The practice-expense RVU is the same in both settings for this code, which results in the same national allowed amount for non-facility and facility.

Why might my local Medicare payment differ from the national amount shown?

The national amount uses standard RVUs before locality adjustment; actual payments are adjusted by the GPCI values specific to your geographic locality, which can raise or lower the amount.

Does this amount reflect what the patient will owe?

No. Medicare generally pays 80% of the allowed amount after the deductible; the patient or secondary payer is typically responsible for the remaining 20%, plus any unmet deductible.

Can modifiers change the payment amount?

Yes. Certain modifiers (e.g., for bilateral procedures, reduced services, or multiple procedures) can increase or decrease the final payment relative to the base PFS amount.

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.