Medicare Reimbursement for CPT 21210

This page covers CPT code 21210, a physician procedure code valued under the Medicare Physician Fee Schedule (PFS). It shows the estimated national Medicare allowed amount for this code, along with how that amount can vary by locality, and the difference between non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1793.63	$693.07
ALASKA* (AK)	$2052.84	$880.75
ALABAMA (AL)	$1603.19	$640.20
ARKANSAS (AR)	$1579.02	$633.64
ARIZONA (AZ)	$1744.77	$678.33
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2364.99	$813.20
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2413.23	$826.22
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2036.41	$735.55
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2044.56	$742.60
NAPA (CA)	$2230.65	$780.11
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2366.51	$814.72
VALLEJO (CA)	$2228.46	$777.92
BAKERSFIELD (CA)	$1914.70	$708.49
CHICO (CA)	$1910.67	$704.46
FRESNO (CA)	$1910.67	$704.46
HANFORD-CORCORAN (CA)	$1910.67	$704.46
MADERA (CA)	$1910.67	$704.46
MERCED (CA)	$1910.67	$704.46
MODESTO (CA)	$1910.67	$704.46
REDDING (CA)	$1910.67	$704.46
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1925.24	$719.03
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2009.57	$729.62
SALINAS (CA)	$2002.19	$726.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2419.45	$832.44
SANTA CRUZ-WATSONVILLE (CA)	$2075.00	$737.82
SANTA ROSA-PETALUMA (CA)	$2096.21	$744.72
STOCKTON (CA)	$1910.67	$704.46
VISALIA (CA)	$1910.67	$704.46
YUBA CITY (CA)	$1910.67	$704.46
EL CENTRO (CA)	$1910.90	$704.68
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2052.70	$736.43
SAN LUIS OBISPO-PASO ROBLES (CA)	$1969.50	$715.96
SANTA MARIA-SANTA BARBARA (CA)	$2010.63	$727.37
REST OF CALIFORNIA (CA)	$1910.67	$704.46
COLORADO (CO)	$1875.95	$704.96
CONNECTICUT (CT)	$1915.99	$730.68
DC + MD/VA SUBURBS (DC)	$2062.77	$766.31
DELAWARE (DE)	$1774.59	$687.24
FORT LAUDERDALE (FL)	$1847.58	$732.71
MIAMI (FL)	$1918.15	$772.47
REST OF FLORIDA (FL)	$1755.94	$703.81
ATLANTA (GA)	$1825.66	$707.49
REST OF GEORGIA (GA)	$1654.47	$672.77
HAWAII, GUAM (HI)	$1962.22	$710.88
IOWA (IA)	$1650.35	$643.34
IDAHO (ID)	$1660.59	$648.08
EAST ST. LOUIS (IL)	$1729.56	$717.05
SUBURBAN CHICAGO (IL)	$1867.79	$737.51
CHICAGO (IL)	$1861.09	$755.03
REST OF ILLINOIS (IL)	$1699.80	$694.99
INDIANA (IN)	$1670.75	$650.53
KANSAS (KS)	$1640.09	$645.19
KENTUCKY (KY)	$1637.96	$659.57
NEW ORLEANS (LA)	$1719.00	$683.37
REST OF LOUISIANA (LA)	$1634.42	$660.42
METROPOLITAN BOSTON (MA)	$2069.73	$755.66
REST OF MASSACHUSETTS (MA)	$1863.14	$704.25
BALTIMORE/SURR. CNTYS (MD)	$1910.20	$729.30
REST OF MARYLAND (MD)	$1810.18	$696.42
SOUTHERN MAINE (ME)	$1764.80	$674.15
REST OF MAINE (ME)	$1667.26	$654.75
DETROIT (MI)	$1776.45	$714.41
REST OF MICHIGAN (MI)	$1680.38	$675.57
MINNESOTA (MN)	$1801.79	$669.32
METROPOLITAN ST. LOUIS (MO)	$1728.05	$680.32
METROPOLITAN KANSAS CITY (MO)	$1709.14	$675.72
REST OF MISSOURI (MO)	$1603.67	$654.98
MISSISSIPPI (MS)	$1591.78	$644.20
MONTANA** (MT)	$1793.54	$692.98
NORTH CAROLINA (NC)	$1685.81	$658.99
NORTH DAKOTA** (ND)	$1767.04	$666.48
NEBRASKA (NE)	$1660.45	$644.63
NEW HAMPSHIRE (NH)	$1844.13	$698.44
NORTHERN NJ (NJ)	$2039.56	$762.91
REST OF NEW JERSEY (NJ)	$1939.07	$737.25
NEW MEXICO (NM)	$1689.07	$679.86
NEVADA** (NV)	$1787.52	$685.86
MANHATTAN (NY)	$2065.86	$787.01
NYC SUBURBS/LONG ISLAND (NY)	$2114.93	$806.36
POUGHKPSIE/N NYC SUBURBS (NY)	$1950.13	$745.02
QUEENS (NY)	$2086.77	$785.91
REST OF NEW YORK (NY)	$1711.93	$666.40
OHIO (OH)	$1674.96	$670.15
OKLAHOMA (OK)	$1637.26	$654.46
PORTLAND (OR)	$1940.12	$717.40
REST OF OREGON (OR)	$1774.86	$678.71
METROPOLITAN PHILADELPHIA (PA)	$1865.21	$719.53
REST OF PENNSYLVANIA (PA)	$1678.98	$668.67
PUERTO RICO (PR)	$1808.01	$695.34
RHODE ISLAND (RI)	$1841.18	$704.30
SOUTH CAROLINA (SC)	$1682.94	$666.02
SOUTH DAKOTA** (SD)	$1763.91	$663.35
TENNESSEE (TN)	$1648.41	$648.00
BRAZORIA (TX)	$1774.51	$683.86
DALLAS (TX)	$1785.23	$689.07
GALVESTON (TX)	$1779.40	$686.54
HOUSTON (TX)	$1803.93	$711.07
BEAUMONT (TX)	$1667.32	$665.81
FORT WORTH (TX)	$1772.13	$686.98
AUSTIN (TX)	$1868.64	$704.25
REST OF TEXAS (TX)	$1719.51	$675.08
UTAH (UT)	$1706.98	$672.45
VIRGINIA (VA)	$1757.21	$675.36
VIRGIN ISLANDS (VI)	$1808.01	$695.34
VERMONT (VT)	$1757.84	$668.28
SEATTLE (KING CNTY) (WA)	$2115.04	$764.65
REST OF WASHINGTON (WA)	$1860.39	$701.50
WISCONSIN (WI)	$1705.20	$650.86
WEST VIRGINIA (WV)	$1633.70	$677.31
WYOMING** (WY)	$1781.99	$681.43

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units 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 pricing for this code starts with 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, reflecting local cost-of-living and practice cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility allowed amounts differ primarily because the practice-expense RVU is higher in non-facility settings (where the practicing physician bears more overhead) and lower in facility settings (where the facility itself is paid separately for overhead).

RVUs — work 11.4, practice expense 40.96 (non-facility) / 8.01 (facility), malpractice 1.34 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment depends on claim-specific factors.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Amounts shown are national and locality-adjusted PFS estimates, not a guarantee of payment — always verify with your Medicare Administrative Contractor (MAC).

Frequently asked

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

In facility settings, the facility (e.g., hospital) is separately reimbursed for overhead costs, so the practice-expense RVU assigned to the physician's payment is lower than when the same service is performed in a non-facility setting like an office.

Why does the Medicare payment for this code differ by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust the work, practice expense, and malpractice RVUs based on regional cost differences, so the same code can have different allowed amounts in different localities.

Does this page show what Medicare will actually pay?

No — it shows the estimated PFS allowed amount. Actual payment depends on the beneficiary's deductible status, applicable modifiers, secondary payers, and any claim-specific adjustments.

Where can I confirm the exact amount for my locality and claim?

Your Medicare Administrative Contractor (MAC) publishes the official locality-specific fee schedule and can confirm final payment amounts for a submitted claim.

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.