Medicare Reimbursement for CPT 21230

CPT 21230 is a surgical procedure code; the full descriptor is not shown here because CPT codes are licensed by the AMA. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both nationally and adjustable by locality, with non-facility and facility rates shown separately.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$659.67	$659.67
ALASKA* (AK)	$830.73	$830.73
ALABAMA (AL)	$604.61	$604.61
ARKANSAS (AR)	$597.83	$597.83
ARIZONA (AZ)	$643.89	$643.89
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$757.98	$757.98
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$769.40	$769.40
OXNARD-THOUSAND OAKS-VENTURA (CA)	$691.04	$691.04
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$698.40	$698.40
NAPA (CA)	$729.34	$729.34
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$759.97	$759.97
VALLEJO (CA)	$726.48	$726.48
BAKERSFIELD (CA)	$666.52	$666.52
CHICO (CA)	$661.53	$661.53
FRESNO (CA)	$661.53	$661.53
HANFORD-CORCORAN (CA)	$661.53	$661.53
MADERA (CA)	$661.53	$661.53
MERCED (CA)	$661.53	$661.53
MODESTO (CA)	$661.53	$661.53
REDDING (CA)	$661.53	$661.53
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$680.42	$680.42
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$684.35	$684.35
SALINAS (CA)	$681.58	$681.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$777.52	$777.52
SANTA CRUZ-WATSONVILLE (CA)	$691.24	$691.24
SANTA ROSA-PETALUMA (CA)	$697.60	$697.60
STOCKTON (CA)	$661.53	$661.53
VISALIA (CA)	$661.53	$661.53
YUBA CITY (CA)	$661.53	$661.53
EL CENTRO (CA)	$661.82	$661.82
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$690.36	$690.36
SAN LUIS OBISPO-PASO ROBLES (CA)	$671.74	$671.74
SANTA MARIA-SANTA BARBARA (CA)	$682.15	$682.15
REST OF CALIFORNIA (CA)	$661.53	$661.53
COLORADO (CO)	$666.43	$666.43
CONNECTICUT (CT)	$697.50	$697.50
DC + MD/VA SUBURBS (DC)	$728.19	$728.19
DELAWARE (DE)	$652.73	$652.73
FORT LAUDERDALE (FL)	$709.98	$709.98
MIAMI (FL)	$758.78	$758.78
REST OF FLORIDA (FL)	$678.62	$678.62
ATLANTA (GA)	$676.31	$676.31
REST OF GEORGIA (GA)	$645.24	$645.24
HAWAII, GUAM (HI)	$667.59	$667.59
IOWA (IA)	$604.24	$604.24
IDAHO (ID)	$609.87	$609.87
EAST ST. LOUIS (IL)	$699.94	$699.94
SUBURBAN CHICAGO (IL)	$713.75	$713.75
CHICAGO (IL)	$739.10	$739.10
REST OF ILLINOIS (IL)	$671.92	$671.92
INDIANA (IN)	$612.29	$612.29
KANSAS (KS)	$607.88	$607.88
KENTUCKY (KY)	$628.34	$628.34
NEW ORLEANS (LA)	$653.61	$653.61
REST OF LOUISIANA (LA)	$629.90	$629.90
METROPOLITAN BOSTON (MA)	$714.22	$714.22
REST OF MASSACHUSETTS (MA)	$666.21	$666.21
BALTIMORE/SURR. CNTYS (MD)	$696.68	$696.68
REST OF MARYLAND (MD)	$661.36	$661.36
SOUTHERN MAINE (ME)	$635.96	$635.96
REST OF MAINE (ME)	$618.57	$618.57
DETROIT (MI)	$691.45	$691.45
REST OF MICHIGAN (MI)	$646.55	$646.55
MINNESOTA (MN)	$625.40	$625.40
METROPOLITAN ST. LOUIS (MO)	$648.39	$648.39
METROPOLITAN KANSAS CITY (MO)	$643.84	$643.84
REST OF MISSOURI (MO)	$625.38	$625.38
MISSISSIPPI (MS)	$611.40	$611.40
MONTANA** (MT)	$659.55	$659.55
NORTH CAROLINA (NC)	$622.66	$622.66
NORTH DAKOTA** (ND)	$624.95	$624.95
NEBRASKA (NE)	$605.02	$605.02
NEW HAMPSHIRE (NH)	$662.10	$662.10
NORTHERN NJ (NJ)	$724.55	$724.55
REST OF NEW JERSEY (NJ)	$701.74	$701.74
NEW MEXICO (NM)	$651.71	$651.71
NEVADA** (NV)	$650.14	$650.14
MANHATTAN (NY)	$755.67	$755.67
NYC SUBURBS/LONG ISLAND (NY)	$777.92	$777.92
POUGHKPSIE/N NYC SUBURBS (NY)	$710.87	$710.87
QUEENS (NY)	$752.00	$752.00
REST OF NEW YORK (NY)	$630.43	$630.43
OHIO (OH)	$639.47	$639.47
OKLAHOMA (OK)	$621.22	$621.22
PORTLAND (OR)	$676.88	$676.88
REST OF OREGON (OR)	$641.36	$641.36
METROPOLITAN PHILADELPHIA (PA)	$687.23	$687.23
REST OF PENNSYLVANIA (PA)	$636.98	$636.98
PUERTO RICO (PR)	$661.40	$661.40
RHODE ISLAND (RI)	$668.10	$668.10
SOUTH CAROLINA (SC)	$632.85	$632.85
SOUTH DAKOTA** (SD)	$620.86	$620.86
TENNESSEE (TN)	$610.99	$610.99
BRAZORIA (TX)	$647.58	$647.58
DALLAS (TX)	$653.69	$653.69
GALVESTON (TX)	$650.86	$650.86
HOUSTON (TX)	$682.89	$682.89
BEAUMONT (TX)	$634.14	$634.14
FORT WORTH (TX)	$652.08	$652.08
AUSTIN (TX)	$667.51	$667.51
REST OF TEXAS (TX)	$641.89	$641.89
UTAH (UT)	$639.46	$639.46
VIRGINIA (VA)	$638.45	$638.45
VIRGIN ISLANDS (VI)	$661.40	$661.40
VERMONT (VT)	$628.42	$628.42
SEATTLE (KING CNTY) (WA)	$721.07	$721.07
REST OF WASHINGTON (WA)	$663.01	$663.01
WISCONSIN (WI)	$609.25	$609.25
WEST VIRGINIA (WV)	$653.75	$653.75
WYOMING** (WY)	$644.47	$644.47

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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 pricing starts with three Relative Value Units (RVUs) assigned to the code — work, practice expense (PE), and malpractice (MP) — which reflect physician effort, overhead costs, and liability risk. Each RVU component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. The non-facility rate applies when the service is furnished in a physician's office or other non-facility setting, while the facility rate applies in a hospital or ambulatory surgical center; the difference typically lies in the practice-expense RVU, since the facility absorbs certain overhead costs. For this code, the practice-expense RVU is the same in both settings, so the computed national amounts are identical for non-facility and facility use.

RVUs — work 10.89, practice expense 7.11 (non-facility) / 7.11 (facility), malpractice 1.75 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on the national conversion factor and standard GPCIs — actual payment varies by Medicare Administrative Contractor (MAC) and locality.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the beneficiary or secondary insurance is responsible for the remainder.
Modifiers (e.g., bilateral, multiple procedure, assistant-at-surgery), sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always confirm current rates and locality-specific adjustments with your MAC before billing or appealing a claim.

Frequently asked

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

When the practice-expense RVU is identical for both settings, the resulting non-facility and facility PFS amounts will compute to the same dollar figure, since no overhead differential is reflected in the formula.

Does this amount reflect what Medicare will actually pay?

No — it's an estimate of the allowed amount before the patient's coinsurance and deductible are applied, and before any locality-specific or modifier-based adjustments.

Why might my MAC's payment differ from this estimate?

Local GPCIs, sequestration cuts, bundling edits, and annual budget-neutrality adjustments to the conversion factor can all cause the actual paid amount to differ from a national estimate.

Can I use this figure to predict patient responsibility?

You can estimate the 20% coinsurance portion from this allowed amount, but actual patient responsibility depends on deductible status, secondary coverage, and any applicable modifiers.

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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.