Medicare Reimbursement for CPT Code 21282

This page summarizes the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code. It shows the national estimate as well as how the amount may be adjusted for your locality, and compares non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$369.41	$369.41
ALASKA* (AK)	$445.11	$445.11
ALABAMA (AL)	$335.34	$335.34
ARKANSAS (AR)	$331.06	$331.06
ARIZONA (AZ)	$360.34	$360.34
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$460.33	$460.33
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$468.76	$468.76
OXNARD-THOUSAND OAKS-VENTURA (CA)	$405.73	$405.73
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$408.45	$408.45
NAPA (CA)	$437.66	$437.66
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$460.91	$460.91
VALLEJO (CA)	$436.82	$436.82
BAKERSFIELD (CA)	$385.88	$385.88
CHICO (CA)	$384.36	$384.36
FRESNO (CA)	$384.36	$384.36
HANFORD-CORCORAN (CA)	$384.36	$384.36
MADERA (CA)	$384.36	$384.36
MERCED (CA)	$384.36	$384.36
MODESTO (CA)	$384.36	$384.36
REDDING (CA)	$384.36	$384.36
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$389.90	$389.90
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$401.30	$401.30
SALINAS (CA)	$399.75	$399.75
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$471.13	$471.13
SANTA CRUZ-WATSONVILLE (CA)	$410.32	$410.32
SANTA ROSA-PETALUMA (CA)	$414.34	$414.34
STOCKTON (CA)	$384.36	$384.36
VISALIA (CA)	$384.36	$384.36
YUBA CITY (CA)	$384.36	$384.36
EL CENTRO (CA)	$384.45	$384.45
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$407.61	$407.61
SAN LUIS OBISPO-PASO ROBLES (CA)	$393.54	$393.54
SANTA MARIA-SANTA BARBARA (CA)	$400.83	$400.83
REST OF CALIFORNIA (CA)	$384.36	$384.36
COLORADO (CO)	$381.01	$381.01
CONNECTICUT (CT)	$392.20	$392.20
DC + MD/VA SUBURBS (DC)	$416.83	$416.83
DELAWARE (DE)	$365.83	$365.83
FORT LAUDERDALE (FL)	$385.95	$385.95
MIAMI (FL)	$404.21	$404.21
REST OF FLORIDA (FL)	$368.59	$368.59
ATLANTA (GA)	$376.67	$376.67
REST OF GEORGIA (GA)	$349.63	$349.63
HAWAII, GUAM (HI)	$391.48	$391.48
IOWA (IA)	$341.00	$341.00
IDAHO (ID)	$343.36	$343.36
EAST ST. LOUIS (IL)	$369.61	$369.61
SUBURBAN CHICAGO (IL)	$389.30	$389.30
CHICAGO (IL)	$393.51	$393.51
REST OF ILLINOIS (IL)	$360.44	$360.44
INDIANA (IN)	$345.08	$345.08
KANSAS (KS)	$340.48	$340.48
KENTUCKY (KY)	$344.28	$344.28
NEW ORLEANS (LA)	$359.14	$359.14
REST OF LOUISIANA (LA)	$344.15	$344.15
METROPOLITAN BOSTON (MA)	$414.64	$414.64
REST OF MASSACHUSETTS (MA)	$379.49	$379.49
BALTIMORE/SURR. CNTYS (MD)	$391.25	$391.25
REST OF MARYLAND (MD)	$371.97	$371.97
SOUTHERN MAINE (ME)	$361.21	$361.21
REST OF MAINE (ME)	$345.90	$345.90
DETROIT (MI)	$373.63	$373.63
REST OF MICHIGAN (MI)	$353.04	$353.04
MINNESOTA (MN)	$363.61	$363.61
METROPOLITAN ST. LOUIS (MO)	$359.20	$359.20
METROPOLITAN KANSAS CITY (MO)	$356.00	$356.00
REST OF MISSOURI (MO)	$339.52	$339.52
MISSISSIPPI (MS)	$335.30	$335.30
MONTANA** (MT)	$369.38	$369.38
NORTH CAROLINA (NC)	$348.96	$348.96
NORTH DAKOTA** (ND)	$359.30	$359.30
NEBRASKA (NE)	$342.38	$342.38
NEW HAMPSHIRE (NH)	$376.04	$376.04
NORTHERN NJ (NJ)	$413.48	$413.48
REST OF NEW JERSEY (NJ)	$396.26	$396.26
NEW MEXICO (NM)	$355.12	$355.12
NEVADA** (NV)	$366.78	$366.78
MANHATTAN (NY)	$422.86	$422.86
NYC SUBURBS/LONG ISLAND (NY)	$433.24	$433.24
POUGHKPSIE/N NYC SUBURBS (NY)	$399.52	$399.52
QUEENS (NY)	$424.68	$424.68
REST OF NEW YORK (NY)	$353.68	$353.68
OHIO (OH)	$350.98	$350.98
OKLAHOMA (OK)	$342.78	$342.78
PORTLAND (OR)	$390.97	$390.97
REST OF OREGON (OR)	$363.50	$363.50
METROPOLITAN PHILADELPHIA (PA)	$383.95	$383.95
REST OF PENNSYLVANIA (PA)	$350.98	$350.98
PUERTO RICO (PR)	$371.51	$371.51
RHODE ISLAND (RI)	$377.26	$377.26
SOUTH CAROLINA (SC)	$350.64	$350.64
SOUTH DAKOTA** (SD)	$358.10	$358.10
TENNESSEE (TN)	$342.10	$342.10
BRAZORIA (TX)	$364.86	$364.86
DALLAS (TX)	$367.39	$367.39
GALVESTON (TX)	$366.10	$366.10
HOUSTON (TX)	$375.44	$375.44
BEAUMONT (TX)	$349.00	$349.00
FORT WORTH (TX)	$365.48	$365.48
AUSTIN (TX)	$380.13	$380.13
REST OF TEXAS (TX)	$356.88	$356.88
UTAH (UT)	$354.87	$354.87
VIRGINIA (VA)	$360.78	$360.78
VIRGIN ISLANDS (VI)	$371.51	$371.51
VERMONT (VT)	$358.86	$358.86
SEATTLE (KING CNTY) (WA)	$421.69	$421.69
REST OF WASHINGTON (WA)	$378.46	$378.46
WISCONSIN (WI)	$348.66	$348.66
WEST VIRGINIA (WV)	$348.80	$348.80
WYOMING** (WY)	$364.98	$364.98

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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 each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the Medicare locality where the service is furnished, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs often differ between non-facility and facility settings because overhead costs differ, though for some codes — including this one — the practice-expense RVU is the same in both settings, so the non-facility and facility amounts shown here are equal.

RVUs — work 4.16, practice expense 6.39 (non-facility) / 6.39 (facility), malpractice 0.51 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national RVUs and the conversion factor; it is 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 generally responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always confirm the exact allowed amount and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

For some procedure codes, including this one, the practice-expense RVU used in the PFS formula is identical whether the service is performed in a non-facility (e.g., office) or facility (e.g., hospital, ASC) setting, so the calculated allowed amounts come out equal.

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

No. This is a national PFS-based estimate. Your actual reimbursement depends on your Medicare locality GPCIs, any modifiers applied, sequestration, and other year-specific adjustments, so the final paid amount may differ.

How much will the patient owe for this code?

Under standard Part B cost-sharing, the patient is generally responsible for 20% of the Medicare-approved amount after the annual deductible is met, unless secondary coverage applies.

Where can I verify the exact locality-adjusted rate?

Contact your Medicare Administrative Contractor (MAC) or consult the current year's Medicare Physician Fee Schedule lookup tool for locality-specific figures.

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.