Medicare Reimbursement for CPT 21249

CPT 21249 is a procedure code defined by the American Medical Association; its full descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, nationally and adjusted by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1404.51	$1010.38
ALASKA* (AK)	$1722.03	$1302.28
ALABAMA (AL)	$1281.51	$936.64
ARKANSAS (AR)	$1266.11	$927.56
ARIZONA (AZ)	$1371.20	$989.29
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1711.82	$1156.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1741.74	$1173.41
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1522.87	$1057.01
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1534.69	$1068.44
NAPA (CA)	$1632.78	$1113.32
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1714.44	$1158.72
VALLEJO (CA)	$1629.00	$1109.53
BAKERSFIELD (CA)	$1454.70	$1022.73
CHICO (CA)	$1447.85	$1015.88
FRESNO (CA)	$1447.85	$1015.88
HANFORD-CORCORAN (CA)	$1447.85	$1015.88
MADERA (CA)	$1447.85	$1015.88
MERCED (CA)	$1447.85	$1015.88
MODESTO (CA)	$1447.85	$1015.88
REDDING (CA)	$1447.85	$1015.88
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1472.92	$1040.95
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1507.44	$1049.06
SALINAS (CA)	$1501.52	$1044.72
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1752.47	$1184.13
SANTA CRUZ-WATSONVILLE (CA)	$1535.51	$1056.64
SANTA ROSA-PETALUMA (CA)	$1550.32	$1066.33
STOCKTON (CA)	$1447.85	$1015.88
VISALIA (CA)	$1447.85	$1015.88
YUBA CITY (CA)	$1447.85	$1015.88
EL CENTRO (CA)	$1448.23	$1016.26
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1527.87	$1056.49
SAN LUIS OBISPO-PASO ROBLES (CA)	$1478.64	$1029.72
SANTA MARIA-SANTA BARBARA (CA)	$1504.70	$1045.14
REST OF CALIFORNIA (CA)	$1447.85	$1015.88
COLORADO (CO)	$1440.78	$1021.42
CONNECTICUT (CT)	$1488.08	$1063.60
DC + MD/VA SUBURBS (DC)	$1573.70	$1109.42
DELAWARE (DE)	$1391.18	$1001.78
FORT LAUDERDALE (FL)	$1476.16	$1076.91
MIAMI (FL)	$1551.84	$1141.55
REST OF FLORIDA (FL)	$1411.81	$1035.02
ATLANTA (GA)	$1433.31	$1032.87
REST OF GEORGIA (GA)	$1341.98	$990.42
HAWAII, GUAM (HI)	$1470.13	$1022.01
IOWA (IA)	$1297.11	$936.48
IDAHO (ID)	$1306.56	$943.96
EAST ST. LOUIS (IL)	$1425.45	$1062.85
SUBURBAN CHICAGO (IL)	$1487.69	$1082.91
CHICAGO (IL)	$1512.28	$1116.18
REST OF ILLINOIS (IL)	$1385.64	$1025.80
INDIANA (IN)	$1312.57	$947.21
KANSAS (KS)	$1297.49	$941.20
KENTUCKY (KY)	$1318.46	$968.08
NEW ORLEANS (LA)	$1372.75	$1001.87
REST OF LOUISIANA (LA)	$1318.91	$970.11
METROPOLITAN BOSTON (MA)	$1560.01	$1089.42
REST OF MASSACHUSETTS (MA)	$1436.58	$1021.56
BALTIMORE/SURR. CNTYS (MD)	$1484.85	$1061.95
REST OF MARYLAND (MD)	$1412.89	$1014.03
SOUTHERN MAINE (ME)	$1369.59	$979.01
REST OF MAINE (ME)	$1318.05	$955.45
DETROIT (MI)	$1432.37	$1052.04
REST OF MICHIGAN (MI)	$1352.16	$992.32
MINNESOTA (MN)	$1370.96	$965.40
METROPOLITAN ST. LOUIS (MO)	$1370.29	$995.08
METROPOLITAN KANSAS CITY (MO)	$1359.05	$988.96
REST OF MISSOURI (MO)	$1303.68	$963.94
MISSISSIPPI (MS)	$1284.83	$945.48
MONTANA** (MT)	$1404.35	$1010.22
NORTH CAROLINA (NC)	$1328.67	$960.95
NORTH DAKOTA** (ND)	$1358.68	$964.55
NEBRASKA (NE)	$1301.38	$937.59
NEW HAMPSHIRE (NH)	$1424.22	$1013.93
NORTHERN NJ (NJ)	$1562.84	$1105.65
REST OF NEW JERSEY (NJ)	$1502.32	$1071.93
NEW MEXICO (NM)	$1360.58	$999.16
NEVADA** (NV)	$1392.34	$997.81
MANHATTAN (NY)	$1604.85	$1146.87
NYC SUBURBS/LONG ISLAND (NY)	$1645.10	$1176.47
POUGHKPSIE/N NYC SUBURBS (NY)	$1516.25	$1084.67
QUEENS (NY)	$1608.06	$1142.20
REST OF NEW YORK (NY)	$1345.79	$971.36
OHIO (OH)	$1342.82	$982.98
OKLAHOMA (OK)	$1310.68	$958.72
PORTLAND (OR)	$1474.02	$1036.15
REST OF OREGON (OR)	$1378.73	$986.17
METROPOLITAN PHILADELPHIA (PA)	$1459.76	$1049.47
REST OF PENNSYLVANIA (PA)	$1341.54	$979.73
PUERTO RICO (PR)	$1411.23	$1012.76
RHODE ISLAND (RI)	$1431.42	$1024.28
SOUTH CAROLINA (SC)	$1338.51	$974.33
SOUTH DAKOTA** (SD)	$1353.28	$959.15
TENNESSEE (TN)	$1303.62	$945.35
BRAZORIA (TX)	$1385.98	$995.39
DALLAS (TX)	$1396.19	$1003.63
GALVESTON (TX)	$1391.11	$999.74
HOUSTON (TX)	$1433.40	$1042.02
BEAUMONT (TX)	$1334.58	$975.92
FORT WORTH (TX)	$1390.03	$1001.42
AUSTIN (TX)	$1438.47	$1021.48
REST OF TEXAS (TX)	$1360.50	$986.47
UTAH (UT)	$1353.67	$983.19
VIRGINIA (VA)	$1369.65	$982.22
VIRGIN ISLANDS (VI)	$1411.23	$1012.76
VERMONT (VT)	$1359.23	$969.04
SEATTLE (KING CNTY) (WA)	$1583.51	$1099.91
REST OF WASHINGTON (WA)	$1431.97	$1016.95
WISCONSIN (WI)	$1321.04	$943.46
WEST VIRGINIA (WV)	$1343.95	$1001.45
WYOMING** (WY)	$1384.45	$990.32

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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) assigned to a code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting local cost-of-living and practice-cost differences. The locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility settings use different practice-expense RVUs because facilities absorb certain overhead costs, which typically results in a lower facility-based payment.

RVUs — work 18.3, practice expense 21.44 (non-facility) / 9.64 (facility), malpractice 2.31 — × 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 payer is responsible for the remainder.
Actual payment can vary by locality, modifiers, place of service, and provider-specific adjustments.
Annual updates, sequestration, and budget-neutrality adjustments can change the conversion factor and final amount year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount lower than the non-facility amount?

In facility settings, the facility itself bills separately for overhead and equipment costs, so the physician's practice-expense RVU is lower than when the same service is performed in a non-facility setting like an office.

Does this amount reflect what the patient will owe?

No. This is the Medicare-allowed amount before cost-sharing. Patients typically owe 20% coinsurance after meeting the deductible, and amounts can differ with secondary insurance or modifiers.

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

Payments can be affected by locality-specific GPCIs, applied modifiers, site-of-service adjustments, and any mid-year or annual policy changes not reflected in a static estimate.

Is the conversion factor the same every year?

No. CMS updates the conversion factor annually, and it can also be affected by legislative or budget-neutrality adjustments, so fee schedule amounts change from year to year.

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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.