Medicare Reimbursement for CPT 21246
This page covers a Medicare Physician Fee Schedule (PFS) procedure code identified by CPT 21246. Because CPT descriptors are proprietary to the AMA, we refer to it generically as 'this procedure code.' The page shows the estimated Medicare-allowed amount nationally and by locality, with non-facility and facility rates broken out.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $767.89 | $767.89 |
| ALASKA* (AK) | $969.45 | $969.45 |
| ALABAMA (AL) | $705.62 | $705.62 |
| ARKANSAS (AR) | $697.93 | $697.93 |
| ARIZONA (AZ) | $750.22 | $750.22 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $889.95 | $889.95 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $903.70 | $903.70 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $808.66 | $808.66 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $816.93 | $816.93 |
| NAPA (CA) | $855.25 | $855.25 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $892.02 | $892.02 |
| VALLEJO (CA) | $852.25 | $852.25 |
| BAKERSFIELD (CA) | $779.43 | $779.43 |
| CHICO (CA) | $774.13 | $774.13 |
| FRESNO (CA) | $774.13 | $774.13 |
| HANFORD-CORCORAN (CA) | $774.13 | $774.13 |
| MADERA (CA) | $774.13 | $774.13 |
| MERCED (CA) | $774.13 | $774.13 |
| MODESTO (CA) | $774.13 | $774.13 |
| REDDING (CA) | $774.13 | $774.13 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $793.92 | $793.92 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $801.28 | $801.28 |
| SALINAS (CA) | $798.03 | $798.03 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $912.19 | $912.19 |
| SANTA CRUZ-WATSONVILLE (CA) | $809.83 | $809.83 |
| SANTA ROSA-PETALUMA (CA) | $817.34 | $817.34 |
| STOCKTON (CA) | $774.13 | $774.13 |
| VISALIA (CA) | $774.13 | $774.13 |
| YUBA CITY (CA) | $774.13 | $774.13 |
| EL CENTRO (CA) | $774.43 | $774.43 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $808.56 | $808.56 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $786.42 | $786.42 |
| SANTA MARIA-SANTA BARBARA (CA) | $798.77 | $798.77 |
| REST OF CALIFORNIA (CA) | $774.13 | $774.13 |
| COLORADO (CO) | $777.85 | $777.85 |
| CONNECTICUT (CT) | $811.15 | $811.15 |
| DC + MD/VA SUBURBS (DC) | $848.41 | $848.41 |
| DELAWARE (DE) | $760.39 | $760.39 |
| FORT LAUDERDALE (FL) | $820.99 | $820.99 |
| MIAMI (FL) | $873.07 | $873.07 |
| REST OF FLORIDA (FL) | $786.05 | $786.05 |
| ATLANTA (GA) | $786.01 | $786.01 |
| REST OF GEORGIA (GA) | $748.74 | $748.74 |
| HAWAII, GUAM (HI) | $781.32 | $781.32 |
| IOWA (IA) | $706.73 | $706.73 |
| IDAHO (ID) | $712.80 | $712.80 |
| EAST ST. LOUIS (IL) | $806.99 | $806.99 |
| SUBURBAN CHICAGO (IL) | $825.74 | $825.74 |
| CHICAGO (IL) | $851.42 | $851.42 |
| REST OF ILLINOIS (IL) | $777.42 | $777.42 |
| INDIANA (IN) | $715.60 | $715.60 |
| KANSAS (KS) | $710.12 | $710.12 |
| KENTUCKY (KY) | $730.95 | $730.95 |
| NEW ORLEANS (LA) | $759.33 | $759.33 |
| REST OF LOUISIANA (LA) | $732.44 | $732.44 |
| METROPOLITAN BOSTON (MA) | $833.88 | $833.88 |
| REST OF MASSACHUSETTS (MA) | $777.37 | $777.37 |
| BALTIMORE/SURR. CNTYS (MD) | $809.98 | $809.98 |
| REST OF MARYLAND (MD) | $770.51 | $770.51 |
| SOUTHERN MAINE (ME) | $742.76 | $742.76 |
| REST OF MAINE (ME) | $721.91 | $721.91 |
| DETROIT (MI) | $799.81 | $799.81 |
| REST OF MICHIGAN (MI) | $750.90 | $750.90 |
| MINNESOTA (MN) | $733.15 | $733.15 |
| METROPOLITAN ST. LOUIS (MO) | $754.29 | $754.29 |
| METROPOLITAN KANSAS CITY (MO) | $749.04 | $749.04 |
| REST OF MISSOURI (MO) | $726.84 | $726.84 |
| MISSISSIPPI (MS) | $712.19 | $712.19 |
| MONTANA** (MT) | $767.76 | $767.76 |
| NORTH CAROLINA (NC) | $726.66 | $726.66 |
| NORTH DAKOTA** (ND) | $731.58 | $731.58 |
| NEBRASKA (NE) | $707.85 | $707.85 |
| NEW HAMPSHIRE (NH) | $771.97 | $771.97 |
| NORTHERN NJ (NJ) | $844.30 | $844.30 |
| REST OF NEW JERSEY (NJ) | $816.95 | $816.95 |
| NEW MEXICO (NM) | $756.44 | $756.44 |
| NEVADA** (NV) | $757.96 | $757.96 |
| MANHATTAN (NY) | $876.96 | $876.96 |
| NYC SUBURBS/LONG ISLAND (NY) | $901.24 | $901.24 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $826.82 | $826.82 |
| QUEENS (NY) | $873.87 | $873.87 |
| REST OF NEW YORK (NY) | $735.44 | $735.44 |
| OHIO (OH) | $743.50 | $743.50 |
| OKLAHOMA (OK) | $723.66 | $723.66 |
| PORTLAND (OR) | $790.71 | $790.71 |
| REST OF OREGON (OR) | $748.59 | $748.59 |
| METROPOLITAN PHILADELPHIA (PA) | $798.98 | $798.98 |
| REST OF PENNSYLVANIA (PA) | $741.08 | $741.08 |
| PUERTO RICO (PR) | $770.11 | $770.11 |
| RHODE ISLAND (RI) | $778.72 | $778.72 |
| SOUTH CAROLINA (SC) | $736.99 | $736.99 |
| SOUTH DAKOTA** (SD) | $727.30 | $727.30 |
| TENNESSEE (TN) | $713.57 | $713.57 |
| BRAZORIA (TX) | $755.23 | $755.23 |
| DALLAS (TX) | $761.85 | $761.85 |
| GALVESTON (TX) | $758.74 | $758.74 |
| HOUSTON (TX) | $792.23 | $792.23 |
| BEAUMONT (TX) | $737.81 | $737.81 |
| FORT WORTH (TX) | $759.79 | $759.79 |
| AUSTIN (TX) | $778.34 | $778.34 |
| REST OF TEXAS (TX) | $747.38 | $747.38 |
| UTAH (UT) | $744.50 | $744.50 |
| VIRGINIA (VA) | $745.06 | $745.06 |
| VIRGIN ISLANDS (VI) | $770.11 | $770.11 |
| VERMONT (VT) | $734.83 | $734.83 |
| SEATTLE (KING CNTY) (WA) | $842.65 | $842.65 |
| REST OF WASHINGTON (WA) | $773.90 | $773.90 |
| WISCONSIN (WI) | $713.58 | $713.58 |
| WEST VIRGINIA (WV) | $756.78 | $756.78 |
| WYOMING** (WY) | $751.99 | $751.99 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 1 unit 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 — assigned to the code each year. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs, since facility settings assume some overhead is covered separately by the facility.
RVUs — work 12.6, practice expense 8.56 (non-facility) / 8.56 (facility), malpractice 1.83 — × 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.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
- Locality-specific GPCIs mean the national amount shown may differ from what a specific Medicare Administrative Contractor (MAC) pays in your area.
- Always verify current rates and coverage policy with your MAC before billing or appealing a claim.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The practice-expense RVU component is typically lower in the facility setting because the facility (not the physician's practice) bears costs like equipment, supplies, and staff for that encounter.
Why might my actual payment differ from the amount shown here?
Actual payment depends on your specific locality's GPCIs, any applicable modifiers, multiple-procedure payment reductions, sequestration, and in-year budget-neutrality adjustments made by CMS.
Does this amount include the patient's share?
No. The figure shown is the total Medicare-allowed amount before cost-sharing; Medicare generally pays 80% after the deductible, with the remaining 20% billed to the patient or a secondary payer.
Can I use this number to predict an appeal outcome?
No. This page provides a reference estimate for billing purposes only and should not be used as the sole basis for a payment dispute or appeal; consult your MAC's specific determination.
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.
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