Medicare Reimbursement for CPT 21247

CPT 21247 is a procedure code used in Medicare billing; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1419.20	$1419.20
ALASKA* (AK)	$1797.44	$1797.44
ALABAMA (AL)	$1305.40	$1305.40
ARKANSAS (AR)	$1291.35	$1291.35
ARIZONA (AZ)	$1386.79	$1386.79
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1637.59	$1637.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1662.60	$1662.60
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1490.87	$1490.87
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1506.42	$1506.42
NAPA (CA)	$1574.80	$1574.80
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1641.51	$1641.51
VALLEJO (CA)	$1569.16	$1569.16
BAKERSFIELD (CA)	$1438.22	$1438.22
CHICO (CA)	$1428.22	$1428.22
FRESNO (CA)	$1428.22	$1428.22
HANFORD-CORCORAN (CA)	$1428.22	$1428.22
MADERA (CA)	$1428.22	$1428.22
MERCED (CA)	$1428.22	$1428.22
MODESTO (CA)	$1428.22	$1428.22
REDDING (CA)	$1428.22	$1428.22
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1465.54	$1465.54
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1477.50	$1477.50
SALINAS (CA)	$1471.49	$1471.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1678.61	$1678.61
SANTA CRUZ-WATSONVILLE (CA)	$1492.13	$1492.13
SANTA ROSA-PETALUMA (CA)	$1505.91	$1505.91
STOCKTON (CA)	$1428.22	$1428.22
VISALIA (CA)	$1428.22	$1428.22
YUBA CITY (CA)	$1428.22	$1428.22
EL CENTRO (CA)	$1428.80	$1428.80
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1490.27	$1490.27
SAN LUIS OBISPO-PASO ROBLES (CA)	$1450.17	$1450.17
SANTA MARIA-SANTA BARBARA (CA)	$1472.68	$1472.68
REST OF CALIFORNIA (CA)	$1428.22	$1428.22
COLORADO (CO)	$1436.15	$1436.15
CONNECTICUT (CT)	$1498.57	$1498.57
DC + MD/VA SUBURBS (DC)	$1565.93	$1565.93
DELAWARE (DE)	$1405.41	$1405.41
FORT LAUDERDALE (FL)	$1518.95	$1518.95
MIAMI (FL)	$1616.32	$1616.32
REST OF FLORIDA (FL)	$1454.71	$1454.71
ATLANTA (GA)	$1452.91	$1452.91
REST OF GEORGIA (GA)	$1386.21	$1386.21
HAWAII, GUAM (HI)	$1440.61	$1440.61
IOWA (IA)	$1306.34	$1306.34
IDAHO (ID)	$1317.65	$1317.65
EAST ST. LOUIS (IL)	$1495.22	$1495.22
SUBURBAN CHICAGO (IL)	$1527.50	$1527.50
CHICAGO (IL)	$1576.54	$1576.54
REST OF ILLINOIS (IL)	$1439.68	$1439.68
INDIANA (IN)	$1322.72	$1322.72
KANSAS (KS)	$1313.05	$1313.05
KENTUCKY (KY)	$1352.76	$1352.76
NEW ORLEANS (LA)	$1404.76	$1404.76
REST OF LOUISIANA (LA)	$1355.67	$1355.67
METROPOLITAN BOSTON (MA)	$1538.08	$1538.08
REST OF MASSACHUSETTS (MA)	$1435.56	$1435.56
BALTIMORE/SURR. CNTYS (MD)	$1496.47	$1496.47
REST OF MARYLAND (MD)	$1423.82	$1423.82
SOUTHERN MAINE (ME)	$1372.09	$1372.09
REST OF MAINE (ME)	$1334.82	$1334.82
DETROIT (MI)	$1480.39	$1480.39
REST OF MICHIGAN (MI)	$1389.67	$1389.67
MINNESOTA (MN)	$1352.88	$1352.88
METROPOLITAN ST. LOUIS (MO)	$1394.94	$1394.94
METROPOLITAN KANSAS CITY (MO)	$1385.42	$1385.42
REST OF MISSOURI (MO)	$1345.78	$1345.78
MISSISSIPPI (MS)	$1318.19	$1318.19
MONTANA** (MT)	$1418.97	$1418.97
NORTH CAROLINA (NC)	$1343.41	$1343.41
NORTH DAKOTA** (ND)	$1350.76	$1350.76
NEBRASKA (NE)	$1308.23	$1308.23
NEW HAMPSHIRE (NH)	$1425.73	$1425.73
NORTHERN NJ (NJ)	$1558.70	$1558.70
REST OF NEW JERSEY (NJ)	$1509.08	$1509.08
NEW MEXICO (NM)	$1400.01	$1400.01
NEVADA** (NV)	$1400.47	$1400.47
MANHATTAN (NY)	$1620.20	$1620.20
NYC SUBURBS/LONG ISLAND (NY)	$1665.21	$1665.21
POUGHKPSIE/N NYC SUBURBS (NY)	$1527.60	$1527.60
QUEENS (NY)	$1613.81	$1613.81
REST OF NEW YORK (NY)	$1359.46	$1359.46
OHIO (OH)	$1375.72	$1375.72
OKLAHOMA (OK)	$1338.90	$1338.90
PORTLAND (OR)	$1459.05	$1459.05
REST OF OREGON (OR)	$1382.94	$1382.94
METROPOLITAN PHILADELPHIA (PA)	$1476.65	$1476.65
REST OF PENNSYLVANIA (PA)	$1371.02	$1371.02
PUERTO RICO (PR)	$1423.09	$1423.09
RHODE ISLAND (RI)	$1438.68	$1438.68
SOUTH CAROLINA (SC)	$1363.13	$1363.13
SOUTH DAKOTA** (SD)	$1342.69	$1342.69
TENNESSEE (TN)	$1319.41	$1319.41
BRAZORIA (TX)	$1395.61	$1395.61
DALLAS (TX)	$1407.94	$1407.94
GALVESTON (TX)	$1402.16	$1402.16
HOUSTON (TX)	$1465.31	$1465.31
BEAUMONT (TX)	$1365.09	$1365.09
FORT WORTH (TX)	$1404.34	$1404.34
AUSTIN (TX)	$1437.26	$1437.26
REST OF TEXAS (TX)	$1382.00	$1382.00
UTAH (UT)	$1376.83	$1376.83
VIRGINIA (VA)	$1376.65	$1376.65
VIRGIN ISLANDS (VI)	$1423.09	$1423.09
VERMONT (VT)	$1357.18	$1357.18
SEATTLE (KING CNTY) (WA)	$1553.65	$1553.65
REST OF WASHINGTON (WA)	$1429.03	$1429.03
WISCONSIN (WI)	$1318.03	$1318.03
WEST VIRGINIA (WV)	$1402.01	$1402.01
WYOMING** (WY)	$1389.24	$1389.24

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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

The Medicare PFS amount is calculated by taking the work, practice expense (PE), and malpractice (MP) RVUs assigned to a code and adjusting each by the corresponding Geographic Practice Cost Index (GPCI) for the billing locality. These geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates can differ because the PE RVU component reflects whether the service is furnished in a physician's office (non-facility) versus a hospital or facility setting, where some overhead costs are borne by the facility rather than the billing provider. For CPT 21247, the non-facility and facility PE RVUs are the same, so the resulting national amounts align in this case, though locality adjustments can still cause variation.

RVUs — work 23.76, practice expense 15.28 (non-facility) / 15.28 (facility), malpractice 3.45 — × 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 Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-specific circumstances, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the amount differ by locality?

Medicare adjusts the work, practice expense, and malpractice RVUs using locality-specific GPCIs to account for regional differences in cost of living and practice costs, so the same code can have different allowed amounts in different areas.

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

The practice expense RVU used in the facility setting matches the non-facility RVU for CPT 21247 in this dataset, so the calculated national amounts are equal; locality adjustments could still cause minor differences in some areas.

Does this amount reflect what the patient will owe?

No. This figure represents the Medicare-allowed amount. Medicare generally pays 80% after the deductible, and the patient or a secondary payer typically covers the remaining 20%, subject to plan-specific rules.

Can modifiers change this estimate?

Yes. Modifiers (e.g., for bilateral procedures, reduced services, or multiple procedures) can increase or decrease the final payment relative to the base PFS amount shown here.

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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.