Medicare Reimbursement for CPT 21240

CPT 21240 is a physician procedure code reported to Medicare for payment under the Physician Fee Schedule (PFS). This page shows the national average Medicare-allowed amount for this code, along with how the amount is derived and adjusted by locality and site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$943.58	$943.58
ALASKA* (AK)	$1196.53	$1196.53
ALABAMA (AL)	$869.38	$869.38
ARKANSAS (AR)	$860.20	$860.20
ARIZONA (AZ)	$922.62	$922.62
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1096.48	$1096.48
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1113.57	$1113.57
OXNARD-THOUSAND OAKS-VENTURA (CA)	$995.49	$995.49
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1005.52	$1005.52
NAPA (CA)	$1053.35	$1053.35
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1098.87	$1098.87
VALLEJO (CA)	$1049.92	$1049.92
BAKERSFIELD (CA)	$959.70	$959.70
CHICO (CA)	$953.53	$953.53
FRESNO (CA)	$953.53	$953.53
HANFORD-CORCORAN (CA)	$953.53	$953.53
MADERA (CA)	$953.53	$953.53
MERCED (CA)	$953.53	$953.53
MODESTO (CA)	$953.53	$953.53
REDDING (CA)	$953.53	$953.53
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$976.29	$976.29
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$986.93	$986.93
SALINAS (CA)	$982.91	$982.91
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1123.32	$1123.32
SANTA CRUZ-WATSONVILLE (CA)	$997.28	$997.28
SANTA ROSA-PETALUMA (CA)	$1006.54	$1006.54
STOCKTON (CA)	$953.53	$953.53
VISALIA (CA)	$953.53	$953.53
YUBA CITY (CA)	$953.53	$953.53
EL CENTRO (CA)	$953.88	$953.88
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$995.76	$995.76
SAN LUIS OBISPO-PASO ROBLES (CA)	$968.58	$968.58
SANTA MARIA-SANTA BARBARA (CA)	$983.79	$983.79
REST OF CALIFORNIA (CA)	$953.53	$953.53
COLORADO (CO)	$956.90	$956.90
CONNECTICUT (CT)	$995.73	$995.73
DC + MD/VA SUBURBS (DC)	$1042.07	$1042.07
DELAWARE (DE)	$934.91	$934.91
FORT LAUDERDALE (FL)	$1004.80	$1004.80
MIAMI (FL)	$1065.17	$1065.17
REST OF FLORIDA (FL)	$963.45	$963.45
ATLANTA (GA)	$964.84	$964.84
REST OF GEORGIA (GA)	$919.24	$919.24
HAWAII, GUAM (HI)	$962.00	$962.00
IOWA (IA)	$871.53	$871.53
IDAHO (ID)	$878.61	$878.61
EAST ST. LOUIS (IL)	$986.70	$986.70
SUBURBAN CHICAGO (IL)	$1010.84	$1010.84
CHICAGO (IL)	$1039.82	$1039.82
REST OF ILLINOIS (IL)	$952.61	$952.61
INDIANA (IN)	$881.97	$881.97
KANSAS (KS)	$875.18	$875.18
KENTUCKY (KY)	$898.76	$898.76
NEW ORLEANS (LA)	$932.46	$932.46
REST OF LOUISIANA (LA)	$900.37	$900.37
METROPOLITAN BOSTON (MA)	$1025.23	$1025.23
REST OF MASSACHUSETTS (MA)	$956.26	$956.26
BALTIMORE/SURR. CNTYS (MD)	$994.13	$994.13
REST OF MARYLAND (MD)	$947.26	$947.26
SOUTHERN MAINE (ME)	$914.54	$914.54
REST OF MAINE (ME)	$889.06	$889.06
DETROIT (MI)	$979.44	$979.44
REST OF MICHIGAN (MI)	$922.17	$922.17
MINNESOTA (MN)	$904.35	$904.35
METROPOLITAN ST. LOUIS (MO)	$926.91	$926.91
METROPOLITAN KANSAS CITY (MO)	$920.61	$920.61
REST OF MISSOURI (MO)	$893.45	$893.45
MISSISSIPPI (MS)	$876.61	$876.61
MONTANA** (MT)	$943.44	$943.44
NORTH CAROLINA (NC)	$894.80	$894.80
NORTH DAKOTA** (ND)	$901.91	$901.91
NEBRASKA (NE)	$872.99	$872.99
NEW HAMPSHIRE (NH)	$949.16	$949.16
NORTHERN NJ (NJ)	$1037.33	$1037.33
REST OF NEW JERSEY (NJ)	$1003.52	$1003.52
NEW MEXICO (NM)	$928.62	$928.62
NEVADA** (NV)	$932.21	$932.21
MANHATTAN (NY)	$1074.88	$1074.88
NYC SUBURBS/LONG ISLAND (NY)	$1103.34	$1103.34
POUGHKPSIE/N NYC SUBURBS (NY)	$1015.11	$1015.11
QUEENS (NY)	$1071.78	$1071.78
REST OF NEW YORK (NY)	$905.24	$905.24
OHIO (OH)	$913.68	$913.68
OKLAHOMA (OK)	$890.48	$890.48
PORTLAND (OR)	$972.85	$972.85
REST OF OREGON (OR)	$921.34	$921.34
METROPOLITAN PHILADELPHIA (PA)	$980.89	$980.89
REST OF PENNSYLVANIA (PA)	$911.01	$911.01
PUERTO RICO (PR)	$946.37	$946.37
RHODE ISLAND (RI)	$957.50	$957.50
SOUTH CAROLINA (SC)	$906.45	$906.45
SOUTH DAKOTA** (SD)	$897.00	$897.00
TENNESSEE (TN)	$879.25	$879.25
BRAZORIA (TX)	$929.18	$929.18
DALLAS (TX)	$936.93	$936.93
GALVESTON (TX)	$933.25	$933.25
HOUSTON (TX)	$971.69	$971.69
BEAUMONT (TX)	$907.09	$907.09
FORT WORTH (TX)	$934.34	$934.34
AUSTIN (TX)	$956.93	$956.93
REST OF TEXAS (TX)	$918.92	$918.92
UTAH (UT)	$915.42	$915.42
VIRGINIA (VA)	$917.00	$917.00
VIRGIN ISLANDS (VI)	$946.37	$946.37
VERMONT (VT)	$905.42	$905.42
SEATTLE (KING CNTY) (WA)	$1036.37	$1036.37
REST OF WASHINGTON (WA)	$952.17	$952.17
WISCONSIN (WI)	$880.34	$880.34
WEST VIRGINIA (WV)	$927.95	$927.95
WYOMING** (WY)	$925.34	$925.34

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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: Policy. 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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is multiplied by a Geographic Practice Cost Index (GPCI) 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. Practice-expense RVUs — and therefore the total payment — can differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ; for this code the non-facility and facility amounts are currently the same, but that is not true for every code.

RVUs — work 15.67, practice expense 10.48 (non-facility) / 10.48 (facility), malpractice 2.1 — × 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 varies by locality GPCI values, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to RVUs.
Always confirm the final allowed amount and any site-of-service or modifier rules with your Medicare Administrative Contractor (MAC) or official CMS fee schedule files.

Frequently asked

Why do non-facility and facility amounts sometimes differ?

Practice-expense RVUs account for overhead such as staff and supplies. When the service is performed in a facility (e.g., hospital), Medicare assumes the facility bears more of that overhead, so the physician's practice-expense RVU — and therefore the fee — can be lower than in a non-facility setting. For some codes, including this one, the two amounts happen to be equal.

Does this amount reflect what my specific Medicare patient will owe or what I'll be paid?

No. The figure shown is a national or locality-adjusted PFS allowed amount estimate. Actual reimbursement depends on the patient's deductible status, secondary coverage, applied modifiers, and the specific locality GPCI, and is finalized by the MAC that processes the claim.

Why does the conversion factor matter?

The conversion factor is a single national dollar multiplier updated annually (often via legislation and budget-neutrality adjustments) that converts total adjusted RVUs into a payment amount. A change in the conversion factor affects the allowed amount for every PFS code, including this one.

Can I use this number to bill patients directly?

No. This page is an informational reference for estimating Medicare's allowed amount. Billing, balance-billing limits, and patient responsibility should be determined using current CMS guidance and your MAC's published fee schedule.

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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.