Medicare Reimbursement for CPT 21263

CPT 21263 is a physician procedure code reported to Medicare for payment purposes; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and, where available, by locality, comparing non-facility and facility settings. Amounts shown are estimates based on published Medicare rate-setting inputs for the selected year.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2020.75	$2020.75
ALASKA* (AK)	$2495.01	$2495.01
ALABAMA (AL)	$1836.47	$1836.47
ARKANSAS (AR)	$1813.74	$1813.74
ARIZONA (AZ)	$1968.24	$1968.24
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2346.64	$2346.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2382.89	$2382.89
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2128.29	$2128.29
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2149.92	$2149.92
NAPA (CA)	$2254.10	$2254.10
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2353.01	$2353.01
VALLEJO (CA)	$2244.92	$2244.92
BAKERSFIELD (CA)	$2045.75	$2045.75
CHICO (CA)	$2030.05	$2030.05
FRESNO (CA)	$2030.05	$2030.05
HANFORD-CORCORAN (CA)	$2030.05	$2030.05
MADERA (CA)	$2030.05	$2030.05
MERCED (CA)	$2030.05	$2030.05
MODESTO (CA)	$2030.05	$2030.05
REDDING (CA)	$2030.05	$2030.05
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2090.46	$2090.46
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2104.42	$2104.42
SALINAS (CA)	$2096.07	$2096.07
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2408.94	$2408.94
SANTA CRUZ-WATSONVILLE (CA)	$2132.10	$2132.10
SANTA ROSA-PETALUMA (CA)	$2151.90	$2151.90
STOCKTON (CA)	$2030.05	$2030.05
VISALIA (CA)	$2030.05	$2030.05
YUBA CITY (CA)	$2030.05	$2030.05
EL CENTRO (CA)	$2030.98	$2030.98
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2126.66	$2126.66
SAN LUIS OBISPO-PASO ROBLES (CA)	$2065.47	$2065.47
SANTA MARIA-SANTA BARBARA (CA)	$2098.81	$2098.81
REST OF CALIFORNIA (CA)	$2030.05	$2030.05
COLORADO (CO)	$2044.55	$2044.55
CONNECTICUT (CT)	$2143.72	$2143.72
DC + MD/VA SUBURBS (DC)	$2243.07	$2243.07
DELAWARE (DE)	$1996.99	$1996.99
FORT LAUDERDALE (FL)	$2182.86	$2182.86
MIAMI (FL)	$2341.03	$2341.03
REST OF FLORIDA (FL)	$2078.76	$2078.76
ATLANTA (GA)	$2074.63	$2074.63
REST OF GEORGIA (GA)	$1967.78	$1967.78
HAWAII, GUAM (HI)	$2054.71	$2054.71
IOWA (IA)	$1837.75	$1837.75
IDAHO (ID)	$1856.11	$1856.11
EAST ST. LOUIS (IL)	$2144.86	$2144.86
SUBURBAN CHICAGO (IL)	$2194.72	$2194.72
CHICAGO (IL)	$2274.60	$2274.60
REST OF ILLINOIS (IL)	$2054.59	$2054.59
INDIANA (IN)	$1864.31	$1864.31
KANSAS (KS)	$1848.74	$1848.74
KENTUCKY (KY)	$1913.40	$1913.40
NEW ORLEANS (LA)	$1997.64	$1997.64
REST OF LOUISIANA (LA)	$1918.16	$1918.16
METROPOLITAN BOSTON (MA)	$2201.33	$2201.33
REST OF MASSACHUSETTS (MA)	$2042.53	$2042.53
BALTIMORE/SURR. CNTYS (MD)	$2141.45	$2141.45
REST OF MARYLAND (MD)	$2025.37	$2025.37
SOUTHERN MAINE (ME)	$1944.20	$1944.20
REST OF MAINE (ME)	$1884.03	$1884.03
DETROIT (MI)	$2120.47	$2120.47
REST OF MICHIGAN (MI)	$1973.27	$1973.27
MINNESOTA (MN)	$1912.73	$1912.73
METROPOLITAN ST. LOUIS (MO)	$1981.59	$1981.59
METROPOLITAN KANSAS CITY (MO)	$1966.20	$1966.20
REST OF MISSOURI (MO)	$1902.22	$1902.22
MISSISSIPPI (MS)	$1857.36	$1857.36
MONTANA** (MT)	$2020.38	$2020.38
NORTH CAROLINA (NC)	$1897.92	$1897.92
NORTH DAKOTA** (ND)	$1909.45	$1909.45
NEBRASKA (NE)	$1840.78	$1840.78
NEW HAMPSHIRE (NH)	$2031.10	$2031.10
NORTHERN NJ (NJ)	$2228.89	$2228.89
REST OF NEW JERSEY (NJ)	$2155.10	$2155.10
NEW MEXICO (NM)	$1990.05	$1990.05
NEVADA** (NV)	$1990.29	$1990.29
MANHATTAN (NY)	$2328.61	$2328.61
NYC SUBURBS/LONG ISLAND (NY)	$2401.63	$2401.63
POUGHKPSIE/N NYC SUBURBS (NY)	$2183.79	$2183.79
QUEENS (NY)	$2318.10	$2318.10
REST OF NEW YORK (NY)	$1923.92	$1923.92
OHIO (OH)	$1950.59	$1950.59
OKLAHOMA (OK)	$1890.84	$1890.84
PORTLAND (OR)	$2080.37	$2080.37
REST OF OREGON (OR)	$1961.81	$1961.81
METROPOLITAN PHILADELPHIA (PA)	$2108.86	$2108.86
REST OF PENNSYLVANIA (PA)	$1942.91	$1942.91
PUERTO RICO (PR)	$2027.00	$2027.00
RHODE ISLAND (RI)	$2046.88	$2046.88
SOUTH CAROLINA (SC)	$1930.05	$1930.05
SOUTH DAKOTA** (SD)	$1896.33	$1896.33
TENNESSEE (TN)	$1859.04	$1859.04
BRAZORIA (TX)	$1980.20	$1980.20
DALLAS (TX)	$1999.94	$1999.94
GALVESTON (TX)	$1990.84	$1990.84
HOUSTON (TX)	$2093.52	$2093.52
BEAUMONT (TX)	$1933.32	$1933.32
FORT WORTH (TX)	$1994.14	$1994.14
AUSTIN (TX)	$2049.19	$2049.19
REST OF TEXAS (TX)	$1960.57	$1960.57
UTAH (UT)	$1952.22	$1952.22
VIRGINIA (VA)	$1951.66	$1951.66
VIRGIN ISLANDS (VI)	$2027.00	$2027.00
VERMONT (VT)	$1919.95	$1919.95
SEATTLE (KING CNTY) (WA)	$2223.92	$2223.92
REST OF WASHINGTON (WA)	$2032.75	$2032.75
WISCONSIN (WI)	$1856.49	$1856.49
WEST VIRGINIA (WV)	$1993.61	$1993.61
WYOMING** (WY)	$1972.04	$1972.04

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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 a code: physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by a locality-specific Geographic Practice Cost Index (GPCI) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly in the practice-expense RVU, since non-facility settings (like a physician's own office) typically carry higher overhead than facility settings (like a hospital) where the facility bears some costs separately. For this code, the non-facility and facility PE RVUs shown are the same, so the non-facility and facility estimates are equal.

RVUs — work 30.23, practice expense 24.66 (non-facility) / 24.66 (facility), malpractice 5.61 — × 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 the annual Part B deductible; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality GPCI, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality adjustments to the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

Because the practice-expense RVU inputs for non-facility and facility settings are identical for this code, so the calculated PFS amounts come out equal.

Why does the amount change by locality?

Each Medicare locality has its own GPCI values for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost-of-living and practice-cost differences before the conversion factor is applied.

Does this page tell me what CPT 21263 describes clinically?

No. CPT code descriptors are copyrighted by the AMA, so this page references the code generically and focuses on the Medicare payment calculation rather than the clinical description.

Will the amount shown be exactly what Medicare pays on my claim?

Not necessarily. The figure is a baseline PFS estimate; actual reimbursement can differ due to modifiers, claim-specific adjustments, sequestration, and other factors applied at the time of processing.

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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.