Medicare Reimbursement for CPT 21325

CPT 21325 is a physician procedure code billed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare 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)	$413.50	$413.50
ALASKA* (AK)	$489.53	$489.53
ALABAMA (AL)	$372.76	$372.76
ARKANSAS (AR)	$367.64	$367.64
ARIZONA (AZ)	$402.68	$402.68
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$520.70	$520.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$530.43	$530.43
OXNARD-THOUSAND OAKS-VENTURA (CA)	$456.76	$456.76
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$459.60	$459.60
NAPA (CA)	$494.28	$494.28
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$521.37	$521.37
VALLEJO (CA)	$493.32	$493.32
BAKERSFIELD (CA)	$433.11	$433.11
CHICO (CA)	$431.40	$431.40
FRESNO (CA)	$431.40	$431.40
HANFORD-CORCORAN (CA)	$431.40	$431.40
MADERA (CA)	$431.40	$431.40
MERCED (CA)	$431.40	$431.40
MODESTO (CA)	$431.40	$431.40
REDDING (CA)	$431.40	$431.40
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$437.78	$437.78
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$451.24	$451.24
SALINAS (CA)	$449.53	$449.53
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$533.17	$533.17
SANTA CRUZ-WATSONVILLE (CA)	$462.59	$462.59
SANTA ROSA-PETALUMA (CA)	$467.16	$467.16
STOCKTON (CA)	$431.40	$431.40
VISALIA (CA)	$431.40	$431.40
YUBA CITY (CA)	$431.40	$431.40
EL CENTRO (CA)	$431.50	$431.50
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$459.04	$459.04
SAN LUIS OBISPO-PASO ROBLES (CA)	$442.47	$442.47
SANTA MARIA-SANTA BARBARA (CA)	$450.92	$450.92
REST OF CALIFORNIA (CA)	$431.40	$431.40
COLORADO (CO)	$427.30	$427.30
CONNECTICUT (CT)	$440.20	$440.20
DC + MD/VA SUBURBS (DC)	$468.93	$468.93
DELAWARE (DE)	$409.10	$409.10
FORT LAUDERDALE (FL)	$432.77	$432.77
MIAMI (FL)	$454.19	$454.19
REST OF FLORIDA (FL)	$412.08	$412.08
ATLANTA (GA)	$421.99	$421.99
REST OF GEORGIA (GA)	$389.47	$389.47
HAWAII, GUAM (HI)	$440.49	$440.49
IOWA (IA)	$379.73	$379.73
IDAHO (ID)	$382.52	$382.52
EAST ST. LOUIS (IL)	$412.88	$412.88
SUBURBAN CHICAGO (IL)	$436.62	$436.62
CHICAGO (IL)	$441.26	$441.26
REST OF ILLINOIS (IL)	$402.19	$402.19
INDIANA (IN)	$384.57	$384.57
KANSAS (KS)	$379.01	$379.01
KENTUCKY (KY)	$383.24	$383.24
NEW ORLEANS (LA)	$400.99	$400.99
REST OF LOUISIANA (LA)	$383.06	$383.06
METROPOLITAN BOSTON (MA)	$466.88	$466.88
REST OF MASSACHUSETTS (MA)	$425.33	$425.33
BALTIMORE/SURR. CNTYS (MD)	$439.15	$439.15
REST OF MARYLAND (MD)	$416.34	$416.34
SOUTHERN MAINE (ME)	$403.91	$403.91
REST OF MAINE (ME)	$385.45	$385.45
DETROIT (MI)	$418.01	$418.01
REST OF MICHIGAN (MI)	$393.64	$393.64
MINNESOTA (MN)	$407.10	$407.10
METROPOLITAN ST. LOUIS (MO)	$401.18	$401.18
METROPOLITAN KANSAS CITY (MO)	$397.34	$397.34
REST OF MISSOURI (MO)	$377.45	$377.45
MISSISSIPPI (MS)	$372.56	$372.56
MONTANA** (MT)	$413.46	$413.46
NORTH CAROLINA (NC)	$389.14	$389.14
NORTH DAKOTA** (ND)	$401.80	$401.80
NEBRASKA (NE)	$381.42	$381.42
NEW HAMPSHIRE (NH)	$421.60	$421.60
NORTHERN NJ (NJ)	$464.63	$464.63
REST OF NEW JERSEY (NJ)	$444.56	$444.56
NEW MEXICO (NM)	$396.09	$396.09
NEVADA** (NV)	$410.47	$410.47
MANHATTAN (NY)	$475.49	$475.49
NYC SUBURBS/LONG ISLAND (NY)	$487.78	$487.78
POUGHKPSIE/N NYC SUBURBS (NY)	$448.24	$448.24
QUEENS (NY)	$477.80	$477.80
REST OF NEW YORK (NY)	$394.77	$394.77
OHIO (OH)	$391.26	$391.26
OKLAHOMA (OK)	$381.55	$381.55
PORTLAND (OR)	$439.22	$439.22
REST OF OREGON (OR)	$406.62	$406.62
METROPOLITAN PHILADELPHIA (PA)	$430.32	$430.32
REST OF PENNSYLVANIA (PA)	$391.30	$391.30
PUERTO RICO (PR)	$416.04	$416.04
RHODE ISLAND (RI)	$422.46	$422.46
SOUTH CAROLINA (SC)	$390.98	$390.98
SOUTH DAKOTA** (SD)	$400.42	$400.42
TENNESSEE (TN)	$380.94	$380.94
BRAZORIA (TX)	$407.94	$407.94
DALLAS (TX)	$410.90	$410.90
GALVESTON (TX)	$409.40	$409.40
HOUSTON (TX)	$420.20	$420.20
BEAUMONT (TX)	$388.93	$388.93
FORT WORTH (TX)	$408.58	$408.58
AUSTIN (TX)	$426.47	$426.47
REST OF TEXAS (TX)	$398.46	$398.46
UTAH (UT)	$396.04	$396.04
VIRGINIA (VA)	$403.33	$403.33
VIRGIN ISLANDS (VI)	$416.04	$416.04
VERMONT (VT)	$401.19	$401.19
SEATTLE (KING CNTY) (WA)	$475.17	$475.17
REST OF WASHINGTON (WA)	$424.21	$424.21
WISCONSIN (WI)	$389.05	$389.05
WEST VIRGINIA (WV)	$388.26	$388.26
WYOMING** (WY)	$408.38	$408.38

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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

The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to this procedure code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Because practice expense RVUs differ depending on where the service is performed, non-facility (e.g., office) and facility (e.g., hospital, ASC) amounts can differ, though for some codes they are the same.

RVUs — work 4.08, practice expense 7.71 (non-facility) / 7.71 (facility), malpractice 0.59 — × 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 patient meets their annual deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always confirm the final allowed amount and payment with your Medicare Administrative Contractor (MAC) before relying on it for billing or collections decisions.
CPT code descriptors are proprietary to the AMA and are not reproduced here.

Frequently asked

Why does the amount differ between non-facility and facility settings?

Practice expense RVUs — the cost of overhead, supplies, and staff — are typically higher in a non-facility (e.g., office) setting because the physician bears those costs directly, whereas in a facility setting the facility bills separately for overhead. For some codes, like this one, the two amounts may be identical.

Why does the allowed amount change by locality?

Each locality has its own GPCI values for work, practice expense, and malpractice, reflecting regional differences in wages, rents, and liability costs. These values adjust the base RVUs before the conversion factor is applied, so the same code can price differently from one area to another.

Does this amount reflect what the provider will actually collect?

No. The figure shown is the Medicare-allowed amount before cost-sharing. After Medicare pays its 80% share, the remaining portion is owed by the patient or a secondary payer, and the final net may be reduced further by sequestration or other claim-level adjustments.

Can modifiers change this estimate?

Yes. Modifiers (such as those indicating bilateral procedures, reduced services, or assistant-at-surgery) can increase or decrease the payable amount relative to the base PFS rate shown here.

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.