Medicare Reimbursement for CPT 21208

CPT 21208 is a surgical procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated national Medicare allowed amount for this code, along with how that amount can vary by locality and by place of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1657.02	$670.69
ALASKA* (AK)	$1903.95	$853.51
ALABAMA (AL)	$1482.84	$619.80
ARKANSAS (AR)	$1460.74	$613.49
ARIZONA (AZ)	$1612.23	$656.48
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2176.20	$785.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2220.28	$797.99
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1876.89	$711.05
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1884.76	$717.93
NAPA (CA)	$2053.71	$753.73
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2177.68	$786.96
VALLEJO (CA)	$2051.57	$751.59
BAKERSFIELD (CA)	$1766.16	$685.14
CHICO (CA)	$1762.22	$681.21
FRESNO (CA)	$1762.22	$681.21
HANFORD-CORCORAN (CA)	$1762.22	$681.21
MADERA (CA)	$1762.22	$681.21
MERCED (CA)	$1762.22	$681.21
MODESTO (CA)	$1762.22	$681.21
REDDING (CA)	$1762.22	$681.21
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1776.46	$695.45
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1852.47	$705.37
SALINAS (CA)	$1845.64	$702.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2226.36	$804.07
SANTA CRUZ-WATSONVILLE (CA)	$1911.45	$713.06
SANTA ROSA-PETALUMA (CA)	$1930.93	$719.72
STOCKTON (CA)	$1762.22	$681.21
VISALIA (CA)	$1762.22	$681.21
YUBA CITY (CA)	$1762.22	$681.21
EL CENTRO (CA)	$1762.44	$681.42
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1891.47	$711.82
SAN LUIS OBISPO-PASO ROBLES (CA)	$1815.61	$692.18
SANTA MARIA-SANTA BARBARA (CA)	$1853.22	$703.16
REST OF CALIFORNIA (CA)	$1762.22	$681.21
COLORADO (CO)	$1731.35	$681.90
CONNECTICUT (CT)	$1769.24	$706.96
DC + MD/VA SUBURBS (DC)	$1903.03	$741.13
DELAWARE (DE)	$1639.56	$665.07
FORT LAUDERDALE (FL)	$1708.51	$709.36
MIAMI (FL)	$1774.82	$748.05
REST OF FLORIDA (FL)	$1624.40	$681.47
ATLANTA (GA)	$1686.79	$684.68
REST OF GEORGIA (GA)	$1531.34	$651.53
HAWAII, GUAM (HI)	$1808.68	$687.23
IOWA (IA)	$1525.11	$622.62
IDAHO (ID)	$1534.64	$627.22
EAST ST. LOUIS (IL)	$1602.07	$694.64
SUBURBAN CHICAGO (IL)	$1726.92	$713.96
CHICAGO (IL)	$1722.49	$731.23
REST OF ILLINOIS (IL)	$1573.64	$673.12
INDIANA (IN)	$1543.90	$629.57
KANSAS (KS)	$1516.13	$624.49
KENTUCKY (KY)	$1515.49	$638.65
NEW ORLEANS (LA)	$1589.72	$661.58
REST OF LOUISIANA (LA)	$1512.41	$639.51
METROPOLITAN BOSTON (MA)	$1908.30	$730.62
REST OF MASSACHUSETTS (MA)	$1719.88	$681.28
BALTIMORE/SURR. CNTYS (MD)	$1763.97	$705.64
REST OF MARYLAND (MD)	$1672.05	$673.88
SOUTHERN MAINE (ME)	$1629.70	$652.25
REST OF MAINE (ME)	$1541.16	$633.74
DETROIT (MI)	$1643.58	$691.77
REST OF MICHIGAN (MI)	$1554.65	$654.13
MINNESOTA (MN)	$1662.22	$647.29
METROPOLITAN ST. LOUIS (MO)	$1597.51	$658.53
METROPOLITAN KANSAS CITY (MO)	$1580.28	$654.12
REST OF MISSOURI (MO)	$1484.55	$634.34
MISSISSIPPI (MS)	$1473.03	$623.80
MONTANA** (MT)	$1656.93	$670.60
NORTH CAROLINA (NC)	$1558.04	$637.80
NORTH DAKOTA** (ND)	$1631.03	$644.70
NEBRASKA (NE)	$1534.21	$623.83
NEW HAMPSHIRE (NH)	$1702.45	$675.68
NORTHERN NJ (NJ)	$1882.06	$737.92
REST OF NEW JERSEY (NJ)	$1790.35	$713.28
NEW MEXICO (NM)	$1562.77	$658.30
NEVADA** (NV)	$1650.95	$663.64
MANHATTAN (NY)	$1907.58	$761.46
NYC SUBURBS/LONG ISLAND (NY)	$1952.95	$780.21
POUGHKPSIE/N NYC SUBURBS (NY)	$1800.88	$720.85
QUEENS (NY)	$1926.11	$760.27
REST OF NEW YORK (NY)	$1581.95	$644.94
OHIO (OH)	$1549.36	$648.84
OKLAHOMA (OK)	$1514.42	$633.63
PORTLAND (OR)	$1789.57	$693.76
REST OF OREGON (OR)	$1639.06	$656.67
METROPOLITAN PHILADELPHIA (PA)	$1723.06	$696.29
REST OF PENNSYLVANIA (PA)	$1552.81	$647.36
PUERTO RICO (PR)	$1670.02	$672.84
RHODE ISLAND (RI)	$1700.33	$681.45
SOUTH CAROLINA (SC)	$1556.10	$644.73
SOUTH DAKOTA** (SD)	$1627.97	$641.64
TENNESSEE (TN)	$1523.78	$627.21
BRAZORIA (TX)	$1639.19	$661.74
DALLAS (TX)	$1649.19	$666.80
GALVESTON (TX)	$1643.78	$664.35
HOUSTON (TX)	$1667.75	$688.33
BEAUMONT (TX)	$1542.18	$644.62
FORT WORTH (TX)	$1637.34	$664.82
AUSTIN (TX)	$1724.78	$681.25
REST OF TEXAS (TX)	$1589.46	$653.43
UTAH (UT)	$1578.06	$650.92
VIRGINIA (VA)	$1623.05	$653.49
VIRGIN ISLANDS (VI)	$1670.02	$672.84
VERMONT (VT)	$1622.99	$646.52
SEATTLE (KING CNTY) (WA)	$1949.42	$739.20
REST OF WASHINGTON (WA)	$1717.19	$678.59
WISCONSIN (WI)	$1574.60	$629.69
WEST VIRGINIA (WV)	$1513.24	$656.12
WYOMING** (WY)	$1645.64	$659.31

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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: Clinical. 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 payment for this procedure code is based on three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, and the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the same code can have two different national amounts. Locality-specific GPCIs mean the final payment amount will differ from the national figure depending on where the service is rendered.

RVUs — work 11.13, practice expense 37.17 (non-facility) / 7.64 (facility), malpractice 1.31 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, based on the national or locality-adjusted Medicare Physician Fee Schedule; actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the remaining 20% is patient or secondary-payer responsibility.
Modifiers, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments can all change the final paid amount.
Always verify the current allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

The facility rate uses a lower practice-expense RVU because the facility (e.g., hospital) absorbs certain overhead costs instead of the physician's practice.

Why does the Medicare payment for this code vary by state or ZIP code?

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust the work, practice-expense, and malpractice RVUs for local cost-of-living and labor differences before applying the conversion factor.

Is this the amount my practice will actually receive?

No. This is an estimated PFS allowed amount. Actual reimbursement depends on your specific locality, any applicable modifiers, deductible status, sequestration, and payer-specific adjustments.

Does this figure represent the full description of CPT 21208?

No. The CPT code descriptor itself is licensed by the AMA and is not reproduced here; this page addresses only the Medicare fee calculation for the code.

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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.