Medicare Reimbursement for CPT 21260

CPT 21260 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and 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)	$1251.87	$1251.87
ALASKA* (AK)	$1531.32	$1531.32
ALABAMA (AL)	$1134.90	$1134.90
ARKANSAS (AR)	$1120.42	$1120.42
ARIZONA (AZ)	$1218.94	$1218.94
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1475.27	$1475.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1498.95	$1498.95
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1329.64	$1329.64
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1342.20	$1342.20
NAPA (CA)	$1413.95	$1413.95
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1478.94	$1478.94
VALLEJO (CA)	$1408.66	$1408.66
BAKERSFIELD (CA)	$1274.63	$1274.63
CHICO (CA)	$1265.58	$1265.58
FRESNO (CA)	$1265.58	$1265.58
HANFORD-CORCORAN (CA)	$1265.58	$1265.58
MADERA (CA)	$1265.58	$1265.58
MERCED (CA)	$1265.58	$1265.58
MODESTO (CA)	$1265.58	$1265.58
REDDING (CA)	$1265.58	$1265.58
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1300.37	$1300.37
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1314.25	$1314.25
SALINAS (CA)	$1309.10	$1309.10
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1513.94	$1513.94
SANTA CRUZ-WATSONVILLE (CA)	$1334.69	$1334.69
SANTA ROSA-PETALUMA (CA)	$1347.23	$1347.23
STOCKTON (CA)	$1265.58	$1265.58
VISALIA (CA)	$1265.58	$1265.58
YUBA CITY (CA)	$1265.58	$1265.58
EL CENTRO (CA)	$1266.12	$1266.12
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1329.92	$1329.92
SAN LUIS OBISPO-PASO ROBLES (CA)	$1289.71	$1289.71
SANTA MARIA-SANTA BARBARA (CA)	$1311.28	$1311.28
REST OF CALIFORNIA (CA)	$1265.58	$1265.58
COLORADO (CO)	$1271.15	$1271.15
CONNECTICUT (CT)	$1329.39	$1329.39
DC + MD/VA SUBURBS (DC)	$1395.41	$1395.41
DELAWARE (DE)	$1237.15	$1237.15
FORT LAUDERDALE (FL)	$1346.33	$1346.33
MIAMI (FL)	$1439.83	$1439.83
REST OF FLORIDA (FL)	$1281.44	$1281.44
ATLANTA (GA)	$1284.28	$1284.28
REST OF GEORGIA (GA)	$1211.98	$1211.98
HAWAII, GUAM (HI)	$1283.32	$1283.32
IOWA (IA)	$1139.11	$1139.11
IDAHO (ID)	$1150.12	$1150.12
EAST ST. LOUIS (IL)	$1316.37	$1316.37
SUBURBAN CHICAGO (IL)	$1354.38	$1354.38
CHICAGO (IL)	$1398.46	$1398.46
REST OF ILLINOIS (IL)	$1263.79	$1263.79
INDIANA (IN)	$1155.45	$1155.45
KANSAS (KS)	$1144.49	$1144.49
KENTUCKY (KY)	$1180.41	$1180.41
NEW ORLEANS (LA)	$1233.43	$1233.43
REST OF LOUISIANA (LA)	$1182.80	$1182.80
METROPOLITAN BOSTON (MA)	$1372.76	$1372.76
REST OF MASSACHUSETTS (MA)	$1269.03	$1269.03
BALTIMORE/SURR. CNTYS (MD)	$1327.72	$1327.72
REST OF MARYLAND (MD)	$1255.58	$1255.58
SOUTHERN MAINE (ME)	$1207.01	$1207.01
REST OF MAINE (ME)	$1166.19	$1166.19
DETROIT (MI)	$1306.24	$1306.24
REST OF MICHIGAN (MI)	$1216.96	$1216.96
MINNESOTA (MN)	$1192.19	$1192.19
METROPOLITAN ST. LOUIS (MO)	$1225.15	$1225.15
METROPOLITAN KANSAS CITY (MO)	$1215.16	$1215.16
REST OF MISSOURI (MO)	$1171.62	$1171.62
MISSISSIPPI (MS)	$1145.71	$1145.71
MONTANA** (MT)	$1251.65	$1251.65
NORTH CAROLINA (NC)	$1175.32	$1175.32
NORTH DAKOTA** (ND)	$1187.78	$1187.78
NEBRASKA (NE)	$1141.55	$1141.55
NEW HAMPSHIRE (NH)	$1261.39	$1261.39
NORTHERN NJ (NJ)	$1385.70	$1385.70
REST OF NEW JERSEY (NJ)	$1337.27	$1337.27
NEW MEXICO (NM)	$1226.98	$1226.98
NEVADA** (NV)	$1234.41	$1234.41
MANHATTAN (NY)	$1443.29	$1443.29
NYC SUBURBS/LONG ISLAND (NY)	$1487.68	$1487.68
POUGHKPSIE/N NYC SUBURBS (NY)	$1354.06	$1354.06
QUEENS (NY)	$1438.98	$1438.98
REST OF NEW YORK (NY)	$1191.77	$1191.77
OHIO (OH)	$1203.91	$1203.91
OKLAHOMA (OK)	$1167.77	$1167.77
PORTLAND (OR)	$1295.86	$1295.86
REST OF OREGON (OR)	$1217.58	$1217.58
METROPOLITAN PHILADELPHIA (PA)	$1306.19	$1306.19
REST OF PENNSYLVANIA (PA)	$1199.92	$1199.92
PUERTO RICO (PR)	$1256.42	$1256.42
RHODE ISLAND (RI)	$1269.81	$1269.81
SOUTH CAROLINA (SC)	$1193.04	$1193.04
SOUTH DAKOTA** (SD)	$1180.23	$1180.23
TENNESSEE (TN)	$1150.85	$1150.85
BRAZORIA (TX)	$1227.74	$1227.74
DALLAS (TX)	$1239.55	$1239.55
GALVESTON (TX)	$1234.04	$1234.04
HOUSTON (TX)	$1293.17	$1293.17
BEAUMONT (TX)	$1193.70	$1193.70
FORT WORTH (TX)	$1235.34	$1235.34
AUSTIN (TX)	$1273.28	$1273.28
REST OF TEXAS (TX)	$1212.78	$1212.78
UTAH (UT)	$1207.19	$1207.19
VIRGINIA (VA)	$1210.61	$1210.61
VIRGIN ISLANDS (VI)	$1256.42	$1256.42
VERMONT (VT)	$1192.96	$1192.96
SEATTLE (KING CNTY) (WA)	$1388.64	$1388.64
REST OF WASHINGTON (WA)	$1263.40	$1263.40
WISCONSIN (WI)	$1153.64	$1153.64
WEST VIRGINIA (WV)	$1224.86	$1224.86
WYOMING** (WY)	$1223.82	$1223.82

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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 PFS amount is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs differ when a service is performed in a physician's office versus a hospital or ambulatory surgical center. The resulting national and locality-specific amounts shown on this page reflect that calculation for the current year.

RVUs — work 17.45, practice expense 16.8 (non-facility) / 16.8 (facility), malpractice 3.23 — × 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 patient meets their deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual budget-neutrality adjustments and RVU updates mean amounts change each year.
Always confirm the exact allowed 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 two settings use different practice-expense RVUs because overhead costs (staff, equipment, supplies) are allocated differently when the procedure is done in a facility versus a non-facility setting like a physician's office.

Why does the payment amount vary by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust work, practice expense, and malpractice RVUs for regional differences in labor and operating costs before applying the conversion factor.

Does this page show what Medicare will actually pay me?

No. It shows the estimated PFS-allowed amount. Actual reimbursement depends on the patient's deductible status, any applicable modifiers, secondary payer coordination, and claim-specific adjustments.

Why might the amount change next year?

The conversion factor and RVUs are updated annually by CMS, and budget-neutrality adjustments can shift payment amounts even if the RVUs for this code stay the same.

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.