Medicare Reimbursement for CPT 21270

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code (CPT descriptors are proprietary to the AMA and not reproduced here). It shows the national estimate as well as locality-adjusted amounts, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings, since payment can differ based on where the service is performed.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1104.23	$675.37
ALASKA* (AK)	$1293.57	$836.83
ALABAMA (AL)	$989.64	$614.38
ARKANSAS (AR)	$975.27	$606.87
ARIZONA (AZ)	$1073.48	$657.91
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1384.80	$780.10
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1410.41	$791.98
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1216.07	$709.15
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1223.89	$716.54
NAPA (CA)	$1315.20	$749.95
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1386.98	$782.28
VALLEJO (CA)	$1312.05	$746.81
BAKERSFIELD (CA)	$1152.36	$682.33
CHICO (CA)	$1146.99	$676.95
FRESNO (CA)	$1146.99	$676.95
HANFORD-CORCORAN (CA)	$1146.99	$676.95
MADERA (CA)	$1146.99	$676.95
MERCED (CA)	$1146.99	$676.95
MODESTO (CA)	$1146.99	$676.95
REDDING (CA)	$1146.99	$676.95
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1167.67	$697.63
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1200.07	$701.30
SALINAS (CA)	$1195.56	$698.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1419.32	$800.89
SANTA CRUZ-WATSONVILLE (CA)	$1230.97	$709.90
SANTA ROSA-PETALUMA (CA)	$1243.11	$716.46
STOCKTON (CA)	$1146.99	$676.95
VISALIA (CA)	$1146.99	$676.95
YUBA CITY (CA)	$1146.99	$676.95
EL CENTRO (CA)	$1147.31	$677.27
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1221.28	$708.36
SAN LUIS OBISPO-PASO ROBLES (CA)	$1176.84	$688.36
SANTA MARIA-SANTA BARBARA (CA)	$1199.38	$699.32
REST OF CALIFORNIA (CA)	$1146.99	$676.95
COLORADO (CO)	$1138.76	$682.45
CONNECTICUT (CT)	$1178.07	$716.17
DC + MD/VA SUBURBS (DC)	$1253.71	$748.50
DELAWARE (DE)	$1091.16	$667.44
FORT LAUDERDALE (FL)	$1165.07	$730.63
MIAMI (FL)	$1230.75	$784.29
REST OF FLORIDA (FL)	$1105.95	$695.95
ATLANTA (GA)	$1129.27	$693.54
REST OF GEORGIA (GA)	$1041.59	$659.04
HAWAII, GUAM (HI)	$1172.32	$684.70
IOWA (IA)	$1006.57	$614.15
IDAHO (ID)	$1014.91	$620.35
EAST ST. LOUIS (IL)	$1113.74	$719.18
SUBURBAN CHICAGO (IL)	$1174.90	$734.46
CHICAGO (IL)	$1193.17	$762.16
REST OF ILLINOIS (IL)	$1079.95	$688.40
INDIANA (IN)	$1020.60	$623.04
KANSAS (KS)	$1005.79	$618.10
KENTUCKY (KY)	$1021.74	$640.48
NEW ORLEANS (LA)	$1072.01	$668.44
REST OF LOUISIANA (LA)	$1021.72	$642.17
METROPOLITAN BOSTON (MA)	$1246.02	$733.95
REST OF MASSACHUSETTS (MA)	$1133.54	$681.94
BALTIMORE/SURR. CNTYS (MD)	$1175.64	$715.46
REST OF MARYLAND (MD)	$1110.76	$676.75
SOUTHERN MAINE (ME)	$1074.32	$649.32
REST OF MAINE (ME)	$1024.47	$629.91
DETROIT (MI)	$1123.93	$710.08
REST OF MICHIGAN (MI)	$1052.12	$660.57
MINNESOTA (MN)	$1079.21	$637.91
METROPOLITAN ST. LOUIS (MO)	$1071.05	$662.76
METROPOLITAN KANSAS CITY (MO)	$1060.42	$657.71
REST OF MISSOURI (MO)	$1006.78	$637.10
MISSISSIPPI (MS)	$991.02	$621.77
MONTANA** (MT)	$1104.11	$675.24
NORTH CAROLINA (NC)	$1034.58	$634.45
NORTH DAKOTA** (ND)	$1066.14	$637.27
NEBRASKA (NE)	$1010.90	$615.06
NEW HAMPSHIRE (NH)	$1124.67	$678.22
NORTHERN NJ (NJ)	$1241.45	$743.96
REST OF NEW JERSEY (NJ)	$1188.15	$719.83
NEW MEXICO (NM)	$1059.52	$666.24
NEVADA** (NV)	$1094.22	$664.92
MANHATTAN (NY)	$1276.40	$778.06
NYC SUBURBS/LONG ISLAND (NY)	$1312.52	$802.59
POUGHKPSIE/N NYC SUBURBS (NY)	$1199.21	$729.60
QUEENS (NY)	$1281.05	$774.12
REST OF NEW YORK (NY)	$1050.48	$643.06
OHIO (OH)	$1044.36	$652.81
OKLAHOMA (OK)	$1015.67	$632.69
PORTLAND (OR)	$1170.39	$693.92
REST OF OREGON (OR)	$1082.41	$655.26
METROPOLITAN PHILADELPHIA (PA)	$1151.30	$704.85
REST OF PENNSYLVANIA (PA)	$1043.79	$650.09
PUERTO RICO (PR)	$1110.91	$677.32
RHODE ISLAND (RI)	$1126.79	$683.77
SOUTH CAROLINA (SC)	$1041.86	$645.59
SOUTH DAKOTA** (SD)	$1061.65	$632.78
TENNESSEE (TN)	$1011.38	$621.54
BRAZORIA (TX)	$1086.65	$661.64
DALLAS (TX)	$1095.47	$668.31
GALVESTON (TX)	$1091.11	$665.25
HOUSTON (TX)	$1126.26	$700.39
BEAUMONT (TX)	$1037.21	$646.94
FORT WORTH (TX)	$1089.36	$666.49
AUSTIN (TX)	$1137.87	$684.13
REST OF TEXAS (TX)	$1062.62	$655.62
UTAH (UT)	$1056.05	$652.91
VIRGINIA (VA)	$1073.58	$652.00
VIRGIN ISLANDS (VI)	$1110.91	$677.32
VERMONT (VT)	$1065.61	$641.03
SEATTLE (KING CNTY) (WA)	$1267.35	$741.13
REST OF WASHINGTON (WA)	$1130.19	$678.59
WISCONSIN (WI)	$1030.71	$619.85
WEST VIRGINIA (WV)	$1040.95	$668.26
WYOMING** (WY)	$1087.56	$658.69

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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) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because the practice-expense RVU is lower in facility settings, reflecting that the facility (not the billing physician) incurs certain overhead costs.

RVUs — work 10.36, practice expense 20.78 (non-facility) / 7.94 (facility), malpractice 1.92 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement depends on claim-specific factors.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary insurer is responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the final paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts can shift year to year.
Always confirm current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

In a facility setting, the hospital or facility bears most of the overhead and equipment costs, so the practice-expense RVU used in the calculation is lower for the billing physician, reducing the total allowed amount.

Why does the allowed amount vary by locality?

Medicare adjusts each RVU component using locality-specific GPCIs to account for differences in local labor, rent, and malpractice costs, so the same code can price differently across geographic areas.

Does this amount reflect what the patient will owe?

No. The PFS amount is the total allowed charge; Medicare generally covers 80% after the deductible is met, with the patient or secondary coverage responsible for the rest, subject to any applicable modifiers or adjustments.

Can this estimate change during the year?

Yes. CMS can apply mid-year or annual adjustments, including conversion factor changes, budget-neutrality corrections, and sequestration, which can alter the final paid amount.

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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.