Medicare Reimbursement for CPT 21235

CPT 21235 is a procedure code defined by the American Medical Association; because CPT descriptors are proprietary, this page refers to it generically. It displays the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and shows how the figure differs by locality and by site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$737.16	$506.02
ALASKA* (AK)	$873.77	$627.61
ALABAMA (AL)	$665.01	$462.76
ARKANSAS (AR)	$655.93	$457.38
ARIZONA (AZ)	$718.03	$494.06
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$928.92	$603.02
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$946.32	$613.02
OXNARD-THOUSAND OAKS-VENTURA (CA)	$814.68	$541.47
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$819.71	$546.27
NAPA (CA)	$881.72	$577.08
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$930.08	$604.18
VALLEJO (CA)	$880.05	$575.41
BAKERSFIELD (CA)	$772.53	$519.21
CHICO (CA)	$769.56	$516.23
FRESNO (CA)	$769.56	$516.23
HANFORD-CORCORAN (CA)	$769.56	$516.23
MADERA (CA)	$769.56	$516.23
MERCED (CA)	$769.56	$516.23
MODESTO (CA)	$769.56	$516.23
REDDING (CA)	$769.56	$516.23
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$780.60	$527.28
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$804.94	$536.14
SALINAS (CA)	$801.89	$534.00
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$951.05	$617.76
SANTA CRUZ-WATSONVILLE (CA)	$825.15	$544.32
SANTA ROSA-PETALUMA (CA)	$833.31	$549.48
STOCKTON (CA)	$769.56	$516.23
VISALIA (CA)	$769.56	$516.23
YUBA CITY (CA)	$769.56	$516.23
EL CENTRO (CA)	$769.73	$516.40
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$818.83	$542.39
SAN LUIS OBISPO-PASO ROBLES (CA)	$789.29	$526.03
SANTA MARIA-SANTA BARBARA (CA)	$804.37	$534.87
REST OF CALIFORNIA (CA)	$769.56	$516.23
COLORADO (CO)	$762.00	$516.07
CONNECTICUT (CT)	$784.53	$535.60
DC + MD/VA SUBURBS (DC)	$835.88	$563.61
DELAWARE (DE)	$729.43	$501.07
FORT LAUDERDALE (FL)	$770.65	$536.51
MIAMI (FL)	$808.07	$567.45
REST OF FLORIDA (FL)	$734.10	$513.14
ATLANTA (GA)	$752.08	$517.25
REST OF GEORGIA (GA)	$694.13	$487.96
HAWAII, GUAM (HI)	$785.69	$522.89
IOWA (IA)	$677.61	$466.12
IDAHO (ID)	$682.49	$469.85
EAST ST. LOUIS (IL)	$734.99	$522.35
SUBURBAN CHICAGO (IL)	$777.56	$540.18
CHICAGO (IL)	$785.28	$552.99
REST OF ILLINOIS (IL)	$716.41	$505.39
INDIANA (IN)	$686.14	$471.88
KANSAS (KS)	$676.20	$467.26
KENTUCKY (KY)	$683.32	$477.84
NEW ORLEANS (LA)	$714.71	$497.22
REST OF LOUISIANA (LA)	$682.95	$478.40
METROPOLITAN BOSTON (MA)	$832.45	$556.48
REST OF MASSACHUSETTS (MA)	$758.47	$515.09
BALTIMORE/SURR. CNTYS (MD)	$782.64	$534.63
REST OF MARYLAND (MD)	$742.31	$508.41
SOUTHERN MAINE (ME)	$720.46	$491.40
REST OF MAINE (ME)	$687.57	$474.92
DETROIT (MI)	$744.47	$521.42
REST OF MICHIGAN (MI)	$701.63	$490.60
MINNESOTA (MN)	$726.48	$488.65
METROPOLITAN ST. LOUIS (MO)	$715.20	$495.16
METROPOLITAN KANSAS CITY (MO)	$708.38	$491.34
REST OF MISSOURI (MO)	$672.94	$473.70
MISSISSIPPI (MS)	$664.47	$465.47
MONTANA** (MT)	$737.09	$505.96
NORTH CAROLINA (NC)	$694.11	$478.46
NORTH DAKOTA** (ND)	$716.92	$485.79
NEBRASKA (NE)	$680.63	$467.29
NEW HAMPSHIRE (NH)	$751.72	$511.10
NORTHERN NJ (NJ)	$828.29	$560.17
REST OF NEW JERSEY (NJ)	$792.45	$540.05
NEW MEXICO (NM)	$705.91	$493.96
NEVADA** (NV)	$731.93	$500.56
MANHATTAN (NY)	$847.09	$578.52
NYC SUBURBS/LONG ISLAND (NY)	$868.72	$593.90
POUGHKPSIE/N NYC SUBURBS (NY)	$798.90	$545.81
QUEENS (NY)	$851.37	$578.17
REST OF NEW YORK (NY)	$704.09	$484.52
OHIO (OH)	$697.50	$486.48
OKLAHOMA (OK)	$680.46	$474.05
PORTLAND (OR)	$783.28	$526.49
REST OF OREGON (OR)	$725.20	$494.99
METROPOLITAN PHILADELPHIA (PA)	$766.94	$526.33
REST OF PENNSYLVANIA (PA)	$697.65	$485.47
PUERTO RICO (PR)	$741.70	$508.02
RHODE ISLAND (RI)	$753.26	$514.50
SOUTH CAROLINA (SC)	$697.17	$483.60
SOUTH DAKOTA** (SD)	$714.54	$483.40
TENNESSEE (TN)	$679.62	$469.52
BRAZORIA (TX)	$727.49	$498.43
DALLAS (TX)	$732.68	$502.47
GALVESTON (TX)	$730.04	$500.52
HOUSTON (TX)	$748.71	$519.19
BEAUMONT (TX)	$693.44	$483.10
FORT WORTH (TX)	$728.54	$500.64
AUSTIN (TX)	$760.38	$515.84
REST OF TEXAS (TX)	$710.45	$491.10
UTAH (UT)	$706.15	$488.88
VIRGINIA (VA)	$719.34	$492.13
VIRGIN ISLANDS (VI)	$741.70	$508.02
VERMONT (VT)	$715.74	$486.92
SEATTLE (KING CNTY) (WA)	$847.31	$563.71
REST OF WASHINGTON (WA)	$756.51	$513.13
WISCONSIN (WI)	$694.31	$472.88
WEST VIRGINIA (WV)	$691.72	$490.87
WYOMING** (WY)	$728.30	$497.17

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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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is furnished. The GPCI-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar estimate. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why the same code can have two different allowed amounts. These RVU, GPCI, and conversion factor inputs are set and updated annually by CMS.

RVUs — work 7.31, practice expense 13.74 (non-facility) / 6.82 (facility), malpractice 1.02 — × 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 insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality adjustments.
Always verify the current, locality-specific amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The facility rate uses lower practice-expense RVUs because Medicare assumes the facility (e.g., hospital) is absorbing certain overhead and equipment costs separately, whereas the non-facility rate reflects the full overhead borne by the billing practice.

Does this amount include the patient's share?

No. The figure shown represents the total allowed amount before Medicare's standard 80/20 split and before the Part B deductible is applied.

Why might my MAC pay a different amount than shown here?

Locality-specific GPCIs, modifiers, claim-level adjustments, sequestration, and mid-year or annual budget-neutrality changes can all cause the actual paid amount to differ from the estimate.

Can I use this figure to predict a denial appeal outcome?

No. This page provides a fee estimate only and does not address coverage determinations, medical necessity, or appeal likelihood.

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.