Medicare Reimbursement for CPT 21296

This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code, both at the national level and adjusted for local cost differences. Because CPT descriptors are licensed by the AMA, this page refers to the code generically rather than reproducing its official description. Amounts are shown for both non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$369.75	$369.75
ALASKA* (AK)	$449.99	$449.99
ALABAMA (AL)	$336.07	$336.07
ARKANSAS (AR)	$331.86	$331.86
ARIZONA (AZ)	$360.58	$360.58
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$450.27	$450.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$458.12	$458.12
OXNARD-THOUSAND OAKS-VENTURA (CA)	$400.56	$400.56
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$403.70	$403.70
NAPA (CA)	$429.51	$429.51
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$451.03	$451.03
VALLEJO (CA)	$428.41	$428.41
BAKERSFIELD (CA)	$382.36	$382.36
CHICO (CA)	$380.42	$380.42
FRESNO (CA)	$380.42	$380.42
HANFORD-CORCORAN (CA)	$380.42	$380.42
MADERA (CA)	$380.42	$380.42
MERCED (CA)	$380.42	$380.42
MODESTO (CA)	$380.42	$380.42
REDDING (CA)	$380.42	$380.42
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$387.67	$387.67
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$396.22	$396.22
SALINAS (CA)	$394.67	$394.67
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$461.23	$461.23
SANTA CRUZ-WATSONVILLE (CA)	$403.85	$403.85
SANTA ROSA-PETALUMA (CA)	$407.75	$407.75
STOCKTON (CA)	$380.42	$380.42
VISALIA (CA)	$380.42	$380.42
YUBA CITY (CA)	$380.42	$380.42
EL CENTRO (CA)	$380.53	$380.53
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$401.75	$401.75
SAN LUIS OBISPO-PASO ROBLES (CA)	$388.66	$388.66
SANTA MARIA-SANTA BARBARA (CA)	$395.55	$395.55
REST OF CALIFORNIA (CA)	$380.42	$380.42
COLORADO (CO)	$378.98	$378.98
CONNECTICUT (CT)	$392.32	$392.32
DC + MD/VA SUBURBS (DC)	$414.81	$414.81
DELAWARE (DE)	$365.97	$365.97
FORT LAUDERDALE (FL)	$390.32	$390.32
MIAMI (FL)	$411.83	$411.83
REST OF FLORIDA (FL)	$372.57	$372.57
ATLANTA (GA)	$377.78	$377.78
REST OF GEORGIA (GA)	$353.34	$353.34
HAWAII, GUAM (HI)	$386.59	$386.59
IOWA (IA)	$339.96	$339.96
IDAHO (ID)	$342.62	$342.62
EAST ST. LOUIS (IL)	$377.10	$377.10
SUBURBAN CHICAGO (IL)	$393.29	$393.29
CHICAGO (IL)	$400.78	$400.78
REST OF ILLINOIS (IL)	$365.67	$365.67
INDIANA (IN)	$344.25	$344.25
KANSAS (KS)	$340.24	$340.24
KENTUCKY (KY)	$346.56	$346.56
NEW ORLEANS (LA)	$361.48	$361.48
REST OF LOUISIANA (LA)	$346.76	$346.76
METROPOLITAN BOSTON (MA)	$410.86	$410.86
REST OF MASSACHUSETTS (MA)	$377.86	$377.86
BALTIMORE/SURR. CNTYS (MD)	$391.54	$391.54
REST OF MARYLAND (MD)	$371.77	$371.77
SOUTHERN MAINE (ME)	$359.76	$359.76
REST OF MAINE (ME)	$345.95	$345.95
DETROIT (MI)	$378.39	$378.39
REST OF MICHIGAN (MI)	$355.96	$355.96
MINNESOTA (MN)	$359.55	$359.55
METROPOLITAN ST. LOUIS (MO)	$360.59	$360.59
METROPOLITAN KANSAS CITY (MO)	$357.54	$357.54
REST OF MISSOURI (MO)	$342.71	$342.71
MISSISSIPPI (MS)	$337.26	$337.26
MONTANA** (MT)	$369.70	$369.70
NORTH CAROLINA (NC)	$348.82	$348.82
NORTH DAKOTA** (ND)	$356.46	$356.46
NEBRASKA (NE)	$341.07	$341.07
NEW HAMPSHIRE (NH)	$374.81	$374.81
NORTHERN NJ (NJ)	$411.75	$411.75
REST OF NEW JERSEY (NJ)	$395.78	$395.78
NEW MEXICO (NM)	$358.33	$358.33
NEVADA** (NV)	$366.20	$366.20
MANHATTAN (NY)	$423.88	$423.88
NYC SUBURBS/LONG ISLAND (NY)	$435.12	$435.12
POUGHKPSIE/N NYC SUBURBS (NY)	$399.67	$399.67
QUEENS (NY)	$424.49	$424.49
REST OF NEW YORK (NY)	$353.52	$353.52
OHIO (OH)	$353.25	$353.25
OKLAHOMA (OK)	$344.24	$344.24
PORTLAND (OR)	$387.79	$387.79
REST OF OREGON (OR)	$362.33	$362.33
METROPOLITAN PHILADELPHIA (PA)	$384.73	$384.73
REST OF PENNSYLVANIA (PA)	$352.80	$352.80
PUERTO RICO (PR)	$371.52	$371.52
RHODE ISLAND (RI)	$376.62	$376.62
SOUTH CAROLINA (SC)	$351.82	$351.82
SOUTH DAKOTA** (SD)	$354.89	$354.89
TENNESSEE (TN)	$341.94	$341.94
BRAZORIA (TX)	$364.34	$364.34
DALLAS (TX)	$367.20	$367.20
GALVESTON (TX)	$365.80	$365.80
HOUSTON (TX)	$378.07	$378.07
BEAUMONT (TX)	$350.90	$350.90
FORT WORTH (TX)	$365.58	$365.58
AUSTIN (TX)	$378.63	$378.63
REST OF TEXAS (TX)	$357.80	$357.80
UTAH (UT)	$355.96	$355.96
VIRGINIA (VA)	$359.91	$359.91
VIRGIN ISLANDS (VI)	$371.52	$371.52
VERMONT (VT)	$356.78	$356.78
SEATTLE (KING CNTY) (WA)	$416.96	$416.96
REST OF WASHINGTON (WA)	$376.58	$376.58
WISCONSIN (WI)	$346.21	$346.21
WEST VIRGINIA (WV)	$354.28	$354.28
WYOMING** (WY)	$363.93	$363.93

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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 pricing starts with three Relative Value Units (RVUs) assigned to a code — one for physician work, one for practice expense, and one for malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional differences in wages, rent, and liability costs. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the dollar allowed amount. Practice-expense RVUs often differ between non-facility and facility settings since overhead costs differ, though for some codes — including this one — the non-facility and facility PE RVUs are the same, so both settings price identically.

RVUs — work 4.66, practice expense 5.74 (non-facility) / 5.74 (facility), malpractice 0.67 — × 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 Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary based on locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount the same as the non-facility amount for this code?

For some procedure codes, CMS assigns identical practice-expense RVUs to both settings, resulting in the same allowed amount regardless of where the service is performed.

Why does the allowed amount differ by locality?

Each locality has its own GPCI values for work, practice expense, and malpractice, reflecting local cost-of-living and labor market differences, which shift the final payment up or down from the national average.

Does this amount include the patient's share?

No. The allowed amount is the total Medicare-approved payment; Medicare generally covers 80% after the deductible, with the patient or secondary insurance responsible for the rest.

Will this amount change during the year?

The conversion factor and RVUs are typically set annually, but mid-year corrections, sequestration, or policy updates can still affect the final paid amount.

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.