Medicare Reimbursement for CPT 21268

This page covers a surgical procedure code identified by CPT 21268, with the generic descriptor omitted because CPT descriptors are licensed by the AMA. It shows the Medicare Physician Fee Schedule (PFS) allowed amount nationally and lets you compare non-facility versus facility settings. Figures are based on the current year's published RVUs and conversion factor.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1821.35	$1821.35
ALASKA* (AK)	$2239.22	$2239.22
ALABAMA (AL)	$1653.39	$1653.39
ARKANSAS (AR)	$1632.64	$1632.64
ARIZONA (AZ)	$1773.76	$1773.76
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2129.57	$2129.57
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2163.07	$2163.07
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1925.79	$1925.79
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1944.72	$1944.72
NAPA (CA)	$2043.47	$2043.47
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2135.12	$2135.12
VALLEJO (CA)	$2035.47	$2035.47
BAKERSFIELD (CA)	$1848.79	$1848.79
CHICO (CA)	$1835.10	$1835.10
FRESNO (CA)	$1835.10	$1835.10
HANFORD-CORCORAN (CA)	$1835.10	$1835.10
MADERA (CA)	$1835.10	$1835.10
MERCED (CA)	$1835.10	$1835.10
MODESTO (CA)	$1835.10	$1835.10
REDDING (CA)	$1835.10	$1835.10
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1887.76	$1887.76
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1903.88	$1903.88
SALINAS (CA)	$1896.37	$1896.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2185.77	$2185.77
SANTA CRUZ-WATSONVILLE (CA)	$1931.04	$1931.04
SANTA ROSA-PETALUMA (CA)	$1949.07	$1949.07
STOCKTON (CA)	$1835.10	$1835.10
VISALIA (CA)	$1835.10	$1835.10
YUBA CITY (CA)	$1835.10	$1835.10
EL CENTRO (CA)	$1835.92	$1835.92
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1925.20	$1925.20
SAN LUIS OBISPO-PASO ROBLES (CA)	$1868.49	$1868.49
SANTA MARIA-SANTA BARBARA (CA)	$1899.16	$1899.16
REST OF CALIFORNIA (CA)	$1835.10	$1835.10
COLORADO (CO)	$1845.86	$1845.86
CONNECTICUT (CT)	$1933.08	$1933.08
DC + MD/VA SUBURBS (DC)	$2025.64	$2025.64
DELAWARE (DE)	$1799.94	$1799.94
FORT LAUDERDALE (FL)	$1963.42	$1963.42
MIAMI (FL)	$2102.92	$2102.92
REST OF FLORIDA (FL)	$1869.34	$1869.34
ATLANTA (GA)	$1869.25	$1869.25
REST OF GEORGIA (GA)	$1768.84	$1768.84
HAWAII, GUAM (HI)	$1858.98	$1858.98
IOWA (IA)	$1656.85	$1656.85
IDAHO (ID)	$1673.15	$1673.15
EAST ST. LOUIS (IL)	$1924.84	$1924.84
SUBURBAN CHICAGO (IL)	$1974.58	$1974.58
CHICAGO (IL)	$2042.92	$2042.92
REST OF ILLINOIS (IL)	$1845.74	$1845.74
INDIANA (IN)	$1680.71	$1680.71
KANSAS (KS)	$1665.79	$1665.79
KENTUCKY (KY)	$1721.27	$1721.27
NEW ORLEANS (LA)	$1797.75	$1797.75
REST OF LOUISIANA (LA)	$1725.19	$1725.19
METROPOLITAN BOSTON (MA)	$1990.18	$1990.18
REST OF MASSACHUSETTS (MA)	$1843.46	$1843.46
BALTIMORE/SURR. CNTYS (MD)	$1930.85	$1930.85
REST OF MARYLAND (MD)	$1826.09	$1826.09
SOUTHERN MAINE (ME)	$1754.09	$1754.09
REST OF MAINE (ME)	$1697.49	$1697.49
DETROIT (MI)	$1906.22	$1906.22
REST OF MICHIGAN (MI)	$1774.86	$1774.86
MINNESOTA (MN)	$1728.89	$1728.89
METROPOLITAN ST. LOUIS (MO)	$1784.40	$1784.40
METROPOLITAN KANSAS CITY (MO)	$1770.22	$1770.22
REST OF MISSOURI (MO)	$1709.94	$1709.94
MISSISSIPPI (MS)	$1670.78	$1670.78
MONTANA** (MT)	$1821.02	$1821.02
NORTH CAROLINA (NC)	$1710.36	$1710.36
NORTH DAKOTA** (ND)	$1724.33	$1724.33
NEBRASKA (NE)	$1659.96	$1659.96
NEW HAMPSHIRE (NH)	$1832.77	$1832.77
NORTHERN NJ (NJ)	$2012.24	$2012.24
REST OF NEW JERSEY (NJ)	$1943.90	$1943.90
NEW MEXICO (NM)	$1789.73	$1789.73
NEVADA** (NV)	$1794.85	$1794.85
MANHATTAN (NY)	$2099.28	$2099.28
NYC SUBURBS/LONG ISLAND (NY)	$2164.51	$2164.51
POUGHKPSIE/N NYC SUBURBS (NY)	$1969.09	$1969.09
QUEENS (NY)	$2091.29	$2091.29
REST OF NEW YORK (NY)	$1734.01	$1734.01
OHIO (OH)	$1755.10	$1755.10
OKLAHOMA (OK)	$1701.84	$1701.84
PORTLAND (OR)	$1879.84	$1879.84
REST OF OREGON (OR)	$1769.74	$1769.74
METROPOLITAN PHILADELPHIA (PA)	$1900.58	$1900.58
REST OF PENNSYLVANIA (PA)	$1748.69	$1748.69
PUERTO RICO (PR)	$1827.44	$1827.44
RHODE ISLAND (RI)	$1846.09	$1846.09
SOUTH CAROLINA (SC)	$1737.83	$1737.83
SOUTH DAKOTA** (SD)	$1712.90	$1712.90
TENNESSEE (TN)	$1675.06	$1675.06
BRAZORIA (TX)	$1785.48	$1785.48
DALLAS (TX)	$1802.98	$1802.98
GALVESTON (TX)	$1794.87	$1794.87
HOUSTON (TX)	$1884.38	$1884.38
BEAUMONT (TX)	$1739.86	$1739.86
FORT WORTH (TX)	$1797.34	$1797.34
AUSTIN (TX)	$1849.54	$1849.54
REST OF TEXAS (TX)	$1765.90	$1765.90
UTAH (UT)	$1758.10	$1758.10
VIRGINIA (VA)	$1760.13	$1760.13
VIRGIN ISLANDS (VI)	$1827.44	$1827.44
VERMONT (VT)	$1732.90	$1732.90
SEATTLE (KING CNTY) (WA)	$2011.82	$2011.82
REST OF WASHINGTON (WA)	$1834.93	$1834.93
WISCONSIN (WI)	$1675.71	$1675.71
WEST VIRGINIA (WV)	$1790.02	$1790.02
WYOMING** (WY)	$1778.89	$1778.89

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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 allowed amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — that are each adjusted by the Geographic Practice Cost Indices (GPCIs) for a given locality. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the payment amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which can change the final amount even though work and malpractice RVUs stay the same. For this code, the non-facility and facility national amounts shown are equal, reflecting identical practice-expense RVUs in both settings at the national level; locality-specific GPCIs can still cause them to diverge in your area.

RVUs — work 26.39, practice expense 23.25 (non-facility) / 23.25 (facility), malpractice 4.89 — × 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 patient or secondary insurer is responsible for the remainder.
Actual payment varies by locality GPCIs, applicable modifiers, sequestration, and annual budget-neutrality adjustments.
Always verify the exact amount and any applicable edits with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why don't the non-facility and facility amounts always match?

They can differ when the practice-expense RVU assigned to the code varies by site of service, since overhead costs differ between an office and a hospital or ambulatory surgical center.

Does this amount reflect what my locality will actually pay?

No. The national figure uses standardized GPCI values; your local Medicare Administrative Contractor applies locality-specific GPCIs, which can raise or lower the final allowed amount.

Why is the CPT descriptor not shown on this page?

CPT code descriptions are copyrighted by the American Medical Association and cannot be republished without a license, so this page refers to the code generically.

Can modifiers change this amount?

Yes. Modifiers such as bilateral, multiple procedure, or assistant-at-surgery indicators can increase or decrease the calculated payment relative to the base fee schedule amount shown here.

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.