Medicare Reimbursement for CPT 21199

CPT 21199 is a physician procedure code; because CPT descriptors are proprietary to the AMA, this page refers to it generically. The figures below show the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and adjusted for a chosen locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$906.17	$906.17
ALASKA* (AK)	$1161.35	$1161.35
ALABAMA (AL)	$836.53	$836.53
ARKANSAS (AR)	$827.98	$827.98
ARIZONA (AZ)	$886.02	$886.02
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1028.12	$1028.12
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1043.11	$1043.11
OXNARD-THOUSAND OAKS-VENTURA (CA)	$942.94	$942.94
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$953.55	$953.55
NAPA (CA)	$991.29	$991.29
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1030.81	$1030.81
VALLEJO (CA)	$987.41	$987.41
BAKERSFIELD (CA)	$912.66	$912.66
CHICO (CA)	$905.79	$905.79
FRESNO (CA)	$905.79	$905.79
HANFORD-CORCORAN (CA)	$905.79	$905.79
MADERA (CA)	$905.79	$905.79
MERCED (CA)	$905.79	$905.79
MODESTO (CA)	$905.79	$905.79
REDDING (CA)	$905.79	$905.79
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$931.43	$931.43
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$935.05	$935.05
SALINAS (CA)	$931.20	$931.20
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1054.11	$1054.11
SANTA CRUZ-WATSONVILLE (CA)	$941.56	$941.56
SANTA ROSA-PETALUMA (CA)	$950.13	$950.13
STOCKTON (CA)	$905.79	$905.79
VISALIA (CA)	$905.79	$905.79
YUBA CITY (CA)	$905.79	$905.79
EL CENTRO (CA)	$906.19	$906.19
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$941.57	$941.57
SAN LUIS OBISPO-PASO ROBLES (CA)	$917.93	$917.93
SANTA MARIA-SANTA BARBARA (CA)	$931.54	$931.54
REST OF CALIFORNIA (CA)	$905.79	$905.79
COLORADO (CO)	$913.43	$913.43
CONNECTICUT (CT)	$955.42	$955.42
DC + MD/VA SUBURBS (DC)	$994.77	$994.77
DELAWARE (DE)	$897.51	$897.51
FORT LAUDERDALE (FL)	$973.80	$973.80
MIAMI (FL)	$1038.77	$1038.77
REST OF FLORIDA (FL)	$933.57	$933.57
ATLANTA (GA)	$928.23	$928.23
REST OF GEORGIA (GA)	$890.88	$890.88
HAWAII, GUAM (HI)	$911.51	$911.51
IOWA (IA)	$834.44	$834.44
IDAHO (ID)	$841.87	$841.87
EAST ST. LOUIS (IL)	$963.86	$963.86
SUBURBAN CHICAGO (IL)	$978.71	$978.71
CHICAGO (IL)	$1013.90	$1013.90
REST OF ILLINOIS (IL)	$926.18	$926.18
INDIANA (IN)	$844.87	$844.87
KANSAS (KS)	$839.81	$839.81
KENTUCKY (KY)	$868.11	$868.11
NEW ORLEANS (LA)	$900.28	$900.28
REST OF LOUISIANA (LA)	$870.38	$870.38
METROPOLITAN BOSTON (MA)	$974.55	$974.55
REST OF MASSACHUSETTS (MA)	$913.77	$913.77
BALTIMORE/SURR. CNTYS (MD)	$954.25	$954.25
REST OF MARYLAND (MD)	$908.51	$908.51
SOUTHERN MAINE (ME)	$874.42	$874.42
REST OF MAINE (ME)	$853.66	$853.66
DETROIT (MI)	$950.59	$950.59
REST OF MICHIGAN (MI)	$891.82	$891.82
MINNESOTA (MN)	$858.62	$858.62
METROPOLITAN ST. LOUIS (MO)	$892.78	$892.78
METROPOLITAN KANSAS CITY (MO)	$887.13	$887.13
REST OF MISSOURI (MO)	$865.16	$865.16
MISSISSIPPI (MS)	$846.27	$846.27
MONTANA** (MT)	$906.01	$906.01
NORTH CAROLINA (NC)	$858.68	$858.68
NORTH DAKOTA** (ND)	$859.15	$859.15
NEBRASKA (NE)	$835.20	$835.20
NEW HAMPSHIRE (NH)	$907.84	$907.84
NORTHERN NJ (NJ)	$991.03	$991.03
REST OF NEW JERSEY (NJ)	$961.60	$961.60
NEW MEXICO (NM)	$898.65	$898.65
NEVADA** (NV)	$893.23	$893.23
MANHATTAN (NY)	$1033.14	$1033.14
NYC SUBURBS/LONG ISLAND (NY)	$1062.21	$1062.21
POUGHKPSIE/N NYC SUBURBS (NY)	$974.12	$974.12
QUEENS (NY)	$1027.39	$1027.39
REST OF NEW YORK (NY)	$868.54	$868.54
OHIO (OH)	$882.25	$882.25
OKLAHOMA (OK)	$858.31	$858.31
PORTLAND (OR)	$925.95	$925.95
REST OF OREGON (OR)	$881.53	$881.53
METROPOLITAN PHILADELPHIA (PA)	$942.82	$942.82
REST OF PENNSYLVANIA (PA)	$878.67	$878.67
PUERTO RICO (PR)	$908.08	$908.08
RHODE ISLAND (RI)	$917.28	$917.28
SOUTH CAROLINA (SC)	$872.84	$872.84
SOUTH DAKOTA** (SD)	$853.60	$853.60
TENNESSEE (TN)	$843.83	$843.83
BRAZORIA (TX)	$890.57	$890.57
DALLAS (TX)	$898.70	$898.70
GALVESTON (TX)	$894.93	$894.93
HOUSTON (TX)	$938.31	$938.31
BEAUMONT (TX)	$875.14	$875.14
FORT WORTH (TX)	$896.91	$896.91
AUSTIN (TX)	$914.60	$914.60
REST OF TEXAS (TX)	$884.09	$884.09
UTAH (UT)	$881.16	$881.16
VIRGINIA (VA)	$878.10	$878.10
VIRGIN ISLANDS (VI)	$908.08	$908.08
VERMONT (VT)	$864.24	$864.24
SEATTLE (KING CNTY) (WA)	$982.99	$982.99
REST OF WASHINGTON (WA)	$909.29	$909.29
WISCONSIN (WI)	$839.53	$839.53
WEST VIRGINIA (WV)	$903.31	$903.31
WYOMING** (WY)	$885.58	$885.58

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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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — that are each adjusted by the Geographic Practice Cost Indices (GPCIs) for the selected locality, summed, and then multiplied by the annual Medicare conversion factor. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, but for this code the practice-expense RVU is the same in both settings, so the national amounts shown match; locality GPCIs can still cause non-facility and facility amounts to diverge once adjusted. The conversion factor is updated annually and applies uniformly across codes before locality adjustment.

RVUs — work 16.31, practice expense 8.45 (non-facility) / 8.45 (facility), malpractice 2.37 — × 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 payer is generally responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual budget-neutrality adjustments and conversion factor updates can shift amounts from one year to the next.
Always confirm current rates and locality-specific adjustments with your Medicare Administrative Contractor (MAC).

Frequently asked

Why isn't a plain-English description shown for this code?

CPT code descriptors are copyrighted by the American Medical Association, so this page cannot display or paraphrase the official descriptor. Only the code number and its Medicare pricing inputs are shown.

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

The national amounts match because the practice-expense RVU used in this code's calculation is identical for non-facility and facility settings. Locality-adjusted amounts could still differ slightly depending on GPCI values.

Does this amount reflect what Medicare will actually pay?

No. It reflects the PFS allowed amount before the patient's deductible and coinsurance are applied, and before any modifier, sequestration, or local contractor adjustments.

How often do these figures change?

RVUs, GPCIs, and the conversion factor are reviewed and typically updated annually, and can also be revised mid-year through rulemaking.

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.