Medicare Reimbursement for CPT 21215

CPT 21215 is a physician procedure code reported under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$4120.00	$720.46
ALASKA* (AK)	$4536.78	$916.27
ALABAMA (AL)	$3640.22	$665.62
ARKANSAS (AR)	$3579.02	$658.81
ARIZONA (AZ)	$3999.30	$705.14
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$5637.40	$844.04
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$5759.64	$857.50
OXNARD-THOUSAND OAKS-VENTURA (CA)	$4782.20	$763.94
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$4792.98	$771.32
NAPA (CA)	$5290.49	$809.89
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$5639.00	$845.64
VALLEJO (CA)	$5288.18	$807.58
BAKERSFIELD (CA)	$4461.93	$736.03
CHICO (CA)	$4457.69	$731.80
FRESNO (CA)	$4457.69	$731.80
HANFORD-CORCORAN (CA)	$4457.69	$731.80
MADERA (CA)	$4457.69	$731.80
MERCED (CA)	$4457.69	$731.80
MODESTO (CA)	$4457.69	$731.80
REDDING (CA)	$4457.69	$731.80
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$4473.02	$747.12
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$4711.47	$757.80
SALINAS (CA)	$4694.78	$754.71
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$5766.19	$864.05
SANTA CRUZ-WATSONVILLE (CA)	$4896.58	$766.14
SANTA ROSA-PETALUMA (CA)	$4947.94	$773.30
STOCKTON (CA)	$4457.69	$731.80
VISALIA (CA)	$4457.69	$731.80
YUBA CITY (CA)	$4457.69	$731.80
EL CENTRO (CA)	$4457.93	$732.03
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$4830.63	$764.78
SAN LUIS OBISPO-PASO ROBLES (CA)	$4615.71	$743.63
SANTA MARIA-SANTA BARBARA (CA)	$4719.31	$755.44
REST OF CALIFORNIA (CA)	$4457.69	$731.80
COLORADO (CO)	$4349.65	$732.54
CONNECTICUT (CT)	$4420.81	$759.50
DC + MD/VA SUBURBS (DC)	$4800.93	$796.27
DELAWARE (DE)	$4073.14	$714.39
FORT LAUDERDALE (FL)	$4205.83	$762.09
MIAMI (FL)	$4342.68	$803.75
REST OF FLORIDA (FL)	$3982.00	$732.04
ATLANTA (GA)	$4189.46	$735.52
REST OF GEORGIA (GA)	$3732.17	$699.78
HAWAII, GUAM (HI)	$4603.62	$738.34
IOWA (IA)	$3779.25	$668.66
IDAHO (ID)	$3801.20	$673.62
EAST ST. LOUIS (IL)	$3873.77	$746.19
SUBURBAN CHICAGO (IL)	$4258.36	$767.03
CHICAGO (IL)	$4202.15	$785.61
REST OF ILLINOIS (IL)	$3826.81	$723.03
INDIANA (IN)	$3827.54	$676.16
KANSAS (KS)	$3743.86	$670.68
KENTUCKY (KY)	$3708.10	$685.90
NEW ORLEANS (LA)	$3909.59	$710.62
REST OF LOUISIANA (LA)	$3695.42	$686.83
METROPOLITAN BOSTON (MA)	$4844.05	$784.99
REST OF MASSACHUSETTS (MA)	$4311.57	$731.85
BALTIMORE/SURR. CNTYS (MD)	$4405.79	$758.08
REST OF MARYLAND (MD)	$4164.22	$723.88
SOUTHERN MAINE (ME)	$4069.55	$700.60
REST OF MAINE (ME)	$3808.22	$680.64
DETROIT (MI)	$4023.69	$743.13
REST OF MICHIGAN (MI)	$3806.37	$702.59
MINNESOTA (MN)	$4193.41	$695.28
METROPOLITAN ST. LOUIS (MO)	$3943.71	$707.34
METROPOLITAN KANSAS CITY (MO)	$3894.76	$702.59
REST OF MISSOURI (MO)	$3611.66	$681.25
MISSISSIPPI (MS)	$3596.92	$669.91
MONTANA** (MT)	$4119.91	$720.36
NORTH CAROLINA (NC)	$3856.79	$685.02
NORTH DAKOTA** (ND)	$4092.03	$692.48
NEBRASKA (NE)	$3807.75	$669.97
NEW HAMPSHIRE (NH)	$4264.78	$725.85
NORTHERN NJ (NJ)	$4736.25	$792.78
REST OF NEW JERSEY (NJ)	$4478.57	$766.27
NEW MEXICO (NM)	$3824.46	$707.08
NEVADA** (NV)	$4115.81	$712.87
MANHATTAN (NY)	$4768.39	$818.12
NYC SUBURBS/LONG ISLAND (NY)	$4880.37	$838.32
POUGHKPSIE/N NYC SUBURBS (NY)	$4496.91	$774.41
QUEENS (NY)	$4835.11	$816.85
REST OF NEW YORK (NY)	$3922.28	$692.71
OHIO (OH)	$3800.67	$696.89
OKLAHOMA (OK)	$3716.30	$680.51
PORTLAND (OR)	$4522.21	$745.32
REST OF OREGON (OR)	$4091.31	$705.37
METROPOLITAN PHILADELPHIA (PA)	$4286.92	$748.00
REST OF PENNSYLVANIA (PA)	$3816.08	$695.30
PUERTO RICO (PR)	$4159.72	$722.78
RHODE ISLAND (RI)	$4243.75	$732.02
SOUTH CAROLINA (SC)	$3833.65	$692.48
SOUTH DAKOTA** (SD)	$4088.73	$689.19
TENNESSEE (TN)	$3763.79	$673.61
BRAZORIA (TX)	$4079.75	$710.80
DALLAS (TX)	$4102.20	$716.25
GALVESTON (TX)	$4089.36	$713.62
HOUSTON (TX)	$4115.17	$739.42
BEAUMONT (TX)	$3785.93	$692.34
FORT WORTH (TX)	$4066.06	$714.11
AUSTIN (TX)	$4328.56	$731.85
REST OF TEXAS (TX)	$3928.02	$701.85
UTAH (UT)	$3894.71	$699.14
VIRGINIA (VA)	$4043.68	$701.93
VIRGIN ISLANDS (VI)	$4159.72	$722.78
VERMONT (VT)	$4059.99	$694.44
SEATTLE (KING CNTY) (WA)	$4965.46	$794.22
REST OF WASHINGTON (WA)	$4308.68	$728.96
WISCONSIN (WI)	$3933.07	$676.31
WEST VIRGINIA (WV)	$3658.90	$704.70
WYOMING** (WY)	$4107.76	$708.21

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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 payment for a 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, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility settings use different practice-expense RVUs, since facility settings assume certain overhead costs are borne by the facility rather than the billing physician.

RVUs — work 11.92, practice expense 110.02 (non-facility) / 8.24 (facility), malpractice 1.41 — × 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 meets their Part B deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary based on modifiers, place of service, sequestration, and annual budget-neutrality adjustments.
Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount different from the non-facility amount?

The facility rate uses lower practice-expense RVUs because the hospital or facility, not the billing physician, is assumed to cover certain overhead costs like equipment and supplies.

Does this amount reflect what Medicare actually pays?

It reflects the Medicare allowed amount before the standard 20% coinsurance and deductible are applied, and before any modifier or sequestration adjustments.

Why do amounts vary by locality?

Medicare adjusts practice expense, work, and malpractice RVUs using locality-specific Geographic Practice Cost Indices (GPCIs) to account for differences in regional costs of practicing medicine.

Where can I verify the exact amount for my claim?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules and can confirm the exact allowed amount for a given date of service.

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.