Medicare Reimbursement for CPT 21275

CPT 21275 is a physician procedure code reported to Medicare for payment purposes; the specific clinical description is maintained by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$764.21	$764.21
ALASKA* (AK)	$943.97	$943.97
ALABAMA (AL)	$694.59	$694.59
ARKANSAS (AR)	$686.00	$686.00
ARIZONA (AZ)	$744.36	$744.36
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$886.78	$886.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$900.46	$900.46
OXNARD-THOUSAND OAKS-VENTURA (CA)	$804.53	$804.53
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$812.74	$812.74
NAPA (CA)	$851.91	$851.91
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$889.20	$889.20
VALLEJO (CA)	$848.43	$848.43
BAKERSFIELD (CA)	$773.43	$773.43
CHICO (CA)	$767.47	$767.47
FRESNO (CA)	$767.47	$767.47
HANFORD-CORCORAN (CA)	$767.47	$767.47
MADERA (CA)	$767.47	$767.47
MERCED (CA)	$767.47	$767.47
MODESTO (CA)	$767.47	$767.47
REDDING (CA)	$767.47	$767.47
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$790.41	$790.41
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$795.52	$795.52
SALINAS (CA)	$792.36	$792.36
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$910.35	$910.35
SANTA CRUZ-WATSONVILLE (CA)	$805.89	$805.89
SANTA ROSA-PETALUMA (CA)	$813.37	$813.37
STOCKTON (CA)	$767.47	$767.47
VISALIA (CA)	$767.47	$767.47
YUBA CITY (CA)	$767.47	$767.47
EL CENTRO (CA)	$767.83	$767.83
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$803.87	$803.87
SAN LUIS OBISPO-PASO ROBLES (CA)	$780.80	$780.80
SANTA MARIA-SANTA BARBARA (CA)	$793.38	$793.38
REST OF CALIFORNIA (CA)	$767.47	$767.47
COLORADO (CO)	$773.07	$773.07
CONNECTICUT (CT)	$810.68	$810.68
DC + MD/VA SUBURBS (DC)	$848.11	$848.11
DELAWARE (DE)	$755.22	$755.22
FORT LAUDERDALE (FL)	$825.73	$825.73
MIAMI (FL)	$885.70	$885.70
REST OF FLORIDA (FL)	$786.36	$786.36
ATLANTA (GA)	$784.62	$784.62
REST OF GEORGIA (GA)	$744.40	$744.40
HAWAII, GUAM (HI)	$776.73	$776.73
IOWA (IA)	$694.97	$694.97
IDAHO (ID)	$701.92	$701.92
EAST ST. LOUIS (IL)	$811.56	$811.56
SUBURBAN CHICAGO (IL)	$830.19	$830.19
CHICAGO (IL)	$860.58	$860.58
REST OF ILLINOIS (IL)	$777.30	$777.30
INDIANA (IN)	$705.02	$705.02
KANSAS (KS)	$699.17	$699.17
KENTUCKY (KY)	$723.76	$723.76
NEW ORLEANS (LA)	$755.60	$755.60
REST OF LOUISIANA (LA)	$725.58	$725.58
METROPOLITAN BOSTON (MA)	$832.23	$832.23
REST OF MASSACHUSETTS (MA)	$772.33	$772.33
BALTIMORE/SURR. CNTYS (MD)	$809.83	$809.83
REST OF MARYLAND (MD)	$765.93	$765.93
SOUTHERN MAINE (ME)	$735.17	$735.17
REST OF MAINE (ME)	$712.52	$712.52
DETROIT (MI)	$802.17	$802.17
REST OF MICHIGAN (MI)	$746.42	$746.42
MINNESOTA (MN)	$723.12	$723.12
METROPOLITAN ST. LOUIS (MO)	$749.48	$749.48
METROPOLITAN KANSAS CITY (MO)	$743.67	$743.67
REST OF MISSOURI (MO)	$719.59	$719.59
MISSISSIPPI (MS)	$702.56	$702.56
MONTANA** (MT)	$764.07	$764.07
NORTH CAROLINA (NC)	$717.76	$717.76
NORTH DAKOTA** (ND)	$721.95	$721.95
NEBRASKA (NE)	$696.09	$696.09
NEW HAMPSHIRE (NH)	$768.03	$768.03
NORTHERN NJ (NJ)	$842.78	$842.78
REST OF NEW JERSEY (NJ)	$814.95	$814.95
NEW MEXICO (NM)	$752.79	$752.79
NEVADA** (NV)	$752.64	$752.64
MANHATTAN (NY)	$880.64	$880.64
NYC SUBURBS/LONG ISLAND (NY)	$908.28	$908.28
POUGHKPSIE/N NYC SUBURBS (NY)	$825.84	$825.84
QUEENS (NY)	$876.59	$876.59
REST OF NEW YORK (NY)	$727.58	$727.58
OHIO (OH)	$737.82	$737.82
OKLAHOMA (OK)	$715.18	$715.18
PORTLAND (OR)	$786.54	$786.54
REST OF OREGON (OR)	$741.84	$741.84
METROPOLITAN PHILADELPHIA (PA)	$797.55	$797.55
REST OF PENNSYLVANIA (PA)	$734.88	$734.88
PUERTO RICO (PR)	$766.55	$766.55
RHODE ISLAND (RI)	$774.04	$774.04
SOUTH CAROLINA (SC)	$729.98	$729.98
SOUTH DAKOTA** (SD)	$716.97	$716.97
TENNESSEE (TN)	$703.07	$703.07
BRAZORIA (TX)	$748.84	$748.84
DALLAS (TX)	$756.32	$756.32
GALVESTON (TX)	$752.87	$752.87
HOUSTON (TX)	$791.86	$791.86
BEAUMONT (TX)	$731.26	$731.26
FORT WORTH (TX)	$754.14	$754.14
AUSTIN (TX)	$774.85	$774.85
REST OF TEXAS (TX)	$741.50	$741.50
UTAH (UT)	$738.36	$738.36
VIRGINIA (VA)	$738.03	$738.03
VIRGIN ISLANDS (VI)	$766.55	$766.55
VERMONT (VT)	$725.97	$725.97
SEATTLE (KING CNTY) (WA)	$840.71	$840.71
REST OF WASHINGTON (WA)	$768.62	$768.62
WISCONSIN (WI)	$701.96	$701.96
WEST VIRGINIA (WV)	$754.27	$754.27
WYOMING** (WY)	$745.72	$745.72

Look up another code or locality →

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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The geographically adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the same code can have two different allowed amounts. The conversion factor and RVU values are updated annually and can shift due to budget-neutrality adjustments.

RVUs — work 11.47, practice expense 9.28 (non-facility) / 9.28 (facility), malpractice 2.13 — × 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, applicable modifiers, place of service, sequestration, and annual budget-neutrality adjustments.
Always verify the current allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does CPT 21275 show two different amounts?

Medicare calculates separate allowed amounts for non-facility and facility settings because practice-expense RVUs differ depending on where the service is performed.

Why isn't the CPT code description shown here?

CPT descriptors are copyrighted and licensed by the American Medical Association, so this page cannot display the official descriptor text.

Will this be the exact amount my practice is paid?

No. The figure shown is a national or locality-adjusted estimate based on current RVUs, GPCIs, and the conversion factor; your actual payment may differ due to modifiers, locality-specific adjustments, or claim-specific factors.

How often do these amounts change?

The conversion factor and RVUs are typically updated annually by CMS, and mid-year adjustments can occur due to legislation or budget-neutrality requirements.

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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.