Medicare Reimbursement for CPT 21280

This page covers CPT code 21280, a physician procedure code valued under the Medicare Physician Fee Schedule (PFS). It shows the estimated Medicare-allowed amount nationally and adjusted for your locality, with both non-facility and facility settings displayed for comparison.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$524.39	$524.39
ALASKA* (AK)	$647.27	$647.27
ALABAMA (AL)	$480.53	$480.53
ARKANSAS (AR)	$475.03	$475.03
ARIZONA (AZ)	$512.65	$512.65
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$642.91	$642.91
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$654.33	$654.33
OXNARD-THOUSAND OAKS-VENTURA (CA)	$570.83	$570.83
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$575.09	$575.09
NAPA (CA)	$612.75	$612.75
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$643.72	$643.72
VALLEJO (CA)	$611.59	$611.59
BAKERSFIELD (CA)	$545.31	$545.31
CHICO (CA)	$543.12	$543.12
FRESNO (CA)	$543.12	$543.12
HANFORD-CORCORAN (CA)	$543.12	$543.12
MADERA (CA)	$543.12	$543.12
MERCED (CA)	$543.12	$543.12
MODESTO (CA)	$543.12	$543.12
REDDING (CA)	$543.12	$543.12
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$550.87	$550.87
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$565.52	$565.52
SALINAS (CA)	$563.29	$563.29
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$657.62	$657.62
SANTA CRUZ-WATSONVILLE (CA)	$576.00	$576.00
SANTA ROSA-PETALUMA (CA)	$581.58	$581.58
STOCKTON (CA)	$543.12	$543.12
VISALIA (CA)	$543.12	$543.12
YUBA CITY (CA)	$543.12	$543.12
EL CENTRO (CA)	$543.24	$543.24
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$573.13	$573.13
SAN LUIS OBISPO-PASO ROBLES (CA)	$554.66	$554.66
SANTA MARIA-SANTA BARBARA (CA)	$564.47	$564.47
REST OF CALIFORNIA (CA)	$543.12	$543.12
COLORADO (CO)	$539.17	$539.17
CONNECTICUT (CT)	$554.69	$554.69
DC + MD/VA SUBURBS (DC)	$587.41	$587.41
DELAWARE (DE)	$519.94	$519.94
FORT LAUDERDALE (FL)	$547.05	$547.05
MIAMI (FL)	$571.66	$571.66
REST OF FLORIDA (FL)	$524.51	$524.51
ATLANTA (GA)	$534.15	$534.15
REST OF GEORGIA (GA)	$499.94	$499.94
HAWAII, GUAM (HI)	$551.20	$551.20
IOWA (IA)	$487.27	$487.27
IDAHO (ID)	$490.41	$490.41
EAST ST. LOUIS (IL)	$526.96	$526.96
SUBURBAN CHICAGO (IL)	$551.58	$551.58
CHICAGO (IL)	$558.07	$558.07
REST OF ILLINOIS (IL)	$514.38	$514.38
INDIANA (IN)	$492.60	$492.60
KANSAS (KS)	$486.85	$486.85
KENTUCKY (KY)	$492.57	$492.57
NEW ORLEANS (LA)	$511.78	$511.78
REST OF LOUISIANA (LA)	$492.52	$492.52
METROPOLITAN BOSTON (MA)	$583.40	$583.40
REST OF MASSACHUSETTS (MA)	$537.53	$537.53
BALTIMORE/SURR. CNTYS (MD)	$553.33	$553.33
REST OF MARYLAND (MD)	$527.99	$527.99
SOUTHERN MAINE (ME)	$513.23	$513.23
REST OF MAINE (ME)	$493.95	$493.95
DETROIT (MI)	$531.26	$531.26
REST OF MICHIGAN (MI)	$504.09	$504.09
MINNESOTA (MN)	$515.49	$515.49
METROPOLITAN ST. LOUIS (MO)	$511.55	$511.55
METROPOLITAN KANSAS CITY (MO)	$507.47	$507.47
REST OF MISSOURI (MO)	$486.72	$486.72
MISSISSIPPI (MS)	$480.88	$480.88
MONTANA** (MT)	$524.35	$524.35
NORTH CAROLINA (NC)	$497.84	$497.84
NORTH DAKOTA** (ND)	$510.31	$510.31
NEBRASKA (NE)	$488.97	$488.97
NEW HAMPSHIRE (NH)	$532.44	$532.44
NORTHERN NJ (NJ)	$583.60	$583.60
REST OF NEW JERSEY (NJ)	$560.69	$560.69
NEW MEXICO (NM)	$506.87	$506.87
NEVADA** (NV)	$520.70	$520.70
MANHATTAN (NY)	$596.65	$596.65
NYC SUBURBS/LONG ISLAND (NY)	$610.33	$610.33
POUGHKPSIE/N NYC SUBURBS (NY)	$565.33	$565.33
QUEENS (NY)	$598.61	$598.61
REST OF NEW YORK (NY)	$503.92	$503.92
OHIO (OH)	$501.22	$501.22
OKLAHOMA (OK)	$490.37	$490.37
PORTLAND (OR)	$551.85	$551.85
REST OF OREGON (OR)	$516.28	$516.28
METROPOLITAN PHILADELPHIA (PA)	$544.16	$544.16
REST OF PENNSYLVANIA (PA)	$501.07	$501.07
PUERTO RICO (PR)	$526.99	$526.99
RHODE ISLAND (RI)	$535.11	$535.11
SOUTH CAROLINA (SC)	$500.43	$500.43
SOUTH DAKOTA** (SD)	$508.65	$508.65
TENNESSEE (TN)	$488.98	$488.98
BRAZORIA (TX)	$518.62	$518.62
DALLAS (TX)	$522.04	$522.04
GALVESTON (TX)	$520.29	$520.29
HOUSTON (TX)	$533.29	$533.29
BEAUMONT (TX)	$498.54	$498.54
FORT WORTH (TX)	$519.66	$519.66
AUSTIN (TX)	$537.73	$537.73
REST OF TEXAS (TX)	$508.40	$508.40
UTAH (UT)	$505.86	$505.86
VIRGINIA (VA)	$512.86	$512.86
VIRGIN ISLANDS (VI)	$526.99	$526.99
VERMONT (VT)	$509.99	$509.99
SEATTLE (KING CNTY) (WA)	$592.62	$592.62
REST OF WASHINGTON (WA)	$535.98	$535.98
WISCONSIN (WI)	$496.70	$496.70
WEST VIRGINIA (WV)	$499.44	$499.44
WYOMING** (WY)	$518.23	$518.23

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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

Each CPT code is assigned three Relative Value Units (RVUs) — for physician work, practice expense, and malpractice risk. These RVUs are each adjusted by the Geographic Practice Cost Index (GPCI) values for the specific Medicare locality where the service is performed, then summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which is why the two amounts can diverge. The conversion factor is set annually by CMS and applies uniformly across all codes unless adjusted by other factors like budget neutrality.

RVUs — work 6.95, practice expense 8.04 (non-facility) / 8.04 (facility), malpractice 0.71 — × 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 insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCI values mean the final rate can differ meaningfully from the national average shown here.
Always confirm current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why do the non-facility and facility amounts differ?

They can differ because practice-expense RVUs account for overhead costs, which are generally higher when a service is performed in a non-facility setting (like a physician's office) versus a facility setting (like a hospital) where the facility bears some costs. For some codes, like this one, the practice-expense RVUs happen to be the same, so the amounts match.

Does this amount reflect what my practice will actually be paid?

No. It's a national or locality-adjusted estimate based on standard PFS inputs. Actual payment depends on your specific Medicare Administrative Contractor, applicable modifiers, claim adjustments, and sequestration.

Why does the conversion factor matter?

The conversion factor is the dollar multiplier applied to the total adjusted RVUs for every PFS code. CMS updates it annually, so fee amounts can change year to year even if the RVUs for a code stay the same.

Can I use this figure for patient estimates or collections?

It can serve as a starting reference, but it should not be presented as a final billed or collected amount, since deductibles, coinsurance, and secondary payer rules will affect what the patient actually owes.

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.