Medicare Reimbursement for CPT 21346

CPT code 21346 is a procedure code defined by the American Medical Association; because CPT descriptors are proprietary, this page refers to it generically. The page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$913.85	$913.85
ALASKA* (AK)	$1107.41	$1107.41
ALABAMA (AL)	$829.39	$829.39
ARKANSAS (AR)	$818.83	$818.83
ARIZONA (AZ)	$890.92	$890.92
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1117.48	$1117.48
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1137.12	$1137.12
OXNARD-THOUSAND OAKS-VENTURA (CA)	$992.33	$992.33
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$999.90	$999.90
NAPA (CA)	$1065.30	$1065.30
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1119.33	$1119.33
VALLEJO (CA)	$1062.63	$1062.63
BAKERSFIELD (CA)	$946.36	$946.36
CHICO (CA)	$941.64	$941.64
FRESNO (CA)	$941.64	$941.64
HANFORD-CORCORAN (CA)	$941.64	$941.64
MADERA (CA)	$941.64	$941.64
MERCED (CA)	$941.64	$941.64
MODESTO (CA)	$941.64	$941.64
REDDING (CA)	$941.64	$941.64
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$959.27	$959.27
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$981.33	$981.33
SALINAS (CA)	$977.52	$977.52
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1144.69	$1144.69
SANTA CRUZ-WATSONVILLE (CA)	$1001.04	$1001.04
SANTA ROSA-PETALUMA (CA)	$1010.73	$1010.73
STOCKTON (CA)	$941.64	$941.64
VISALIA (CA)	$941.64	$941.64
YUBA CITY (CA)	$941.64	$941.64
EL CENTRO (CA)	$941.91	$941.91
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$995.48	$995.48
SAN LUIS OBISPO-PASO ROBLES (CA)	$962.57	$962.57
SANTA MARIA-SANTA BARBARA (CA)	$979.81	$979.81
REST OF CALIFORNIA (CA)	$941.64	$941.64
COLORADO (CO)	$937.54	$937.54
CONNECTICUT (CT)	$970.21	$970.21
DC + MD/VA SUBURBS (DC)	$1026.75	$1026.75
DELAWARE (DE)	$904.37	$904.37
FORT LAUDERDALE (FL)	$964.17	$964.17
MIAMI (FL)	$1017.05	$1017.05
REST OF FLORIDA (FL)	$919.82	$919.82
ATLANTA (GA)	$933.70	$933.70
REST OF GEORGIA (GA)	$871.74	$871.74
HAWAII, GUAM (HI)	$957.60	$957.60
IOWA (IA)	$839.65	$839.65
IDAHO (ID)	$846.22	$846.22
EAST ST. LOUIS (IL)	$930.12	$930.12
SUBURBAN CHICAGO (IL)	$971.63	$971.63
CHICAGO (IL)	$989.40	$989.40
REST OF ILLINOIS (IL)	$902.16	$902.16
INDIANA (IN)	$850.34	$850.34
KANSAS (KS)	$840.13	$840.13
KENTUCKY (KY)	$855.20	$855.20
NEW ORLEANS (LA)	$892.54	$892.54
REST OF LOUISIANA (LA)	$855.60	$855.60
METROPOLITAN BOSTON (MA)	$1017.55	$1017.55
REST OF MASSACHUSETTS (MA)	$934.55	$934.55
BALTIMORE/SURR. CNTYS (MD)	$968.24	$968.24
REST OF MARYLAND (MD)	$918.95	$918.95
SOUTHERN MAINE (ME)	$889.38	$889.38
REST OF MAINE (ME)	$854.34	$854.34
DETROIT (MI)	$934.16	$934.16
REST OF MICHIGAN (MI)	$878.53	$878.53
MINNESOTA (MN)	$889.63	$889.63
METROPOLITAN ST. LOUIS (MO)	$890.60	$890.60
METROPOLITAN KANSAS CITY (MO)	$882.91	$882.91
REST OF MISSOURI (MO)	$845.28	$845.28
MISSISSIPPI (MS)	$831.99	$831.99
MONTANA** (MT)	$913.74	$913.74
NORTH CAROLINA (NC)	$861.59	$861.59
NORTH DAKOTA** (ND)	$881.51	$881.51
NEBRASKA (NE)	$842.51	$842.51
NEW HAMPSHIRE (NH)	$927.00	$927.00
NORTHERN NJ (NJ)	$1018.90	$1018.90
REST OF NEW JERSEY (NJ)	$978.81	$978.81
NEW MEXICO (NM)	$884.40	$884.40
NEVADA** (NV)	$905.24	$905.24
MANHATTAN (NY)	$1048.45	$1048.45
NYC SUBURBS/LONG ISLAND (NY)	$1076.34	$1076.34
POUGHKPSIE/N NYC SUBURBS (NY)	$988.29	$988.29
QUEENS (NY)	$1050.34	$1050.34
REST OF NEW YORK (NY)	$873.35	$873.35
OHIO (OH)	$871.95	$871.95
OKLAHOMA (OK)	$849.64	$849.64
PORTLAND (OR)	$959.89	$959.89
REST OF OREGON (OR)	$895.73	$895.73
METROPOLITAN PHILADELPHIA (PA)	$951.02	$951.02
REST OF PENNSYLVANIA (PA)	$870.95	$870.95
PUERTO RICO (PR)	$918.39	$918.39
RHODE ISLAND (RI)	$931.11	$931.11
SOUTH CAROLINA (SC)	$868.70	$868.70
SOUTH DAKOTA** (SD)	$877.70	$877.70
TENNESSEE (TN)	$844.36	$844.36
BRAZORIA (TX)	$900.47	$900.47
DALLAS (TX)	$907.53	$907.53
GALVESTON (TX)	$904.06	$904.06
HOUSTON (TX)	$933.89	$933.89
BEAUMONT (TX)	$866.18	$866.18
FORT WORTH (TX)	$903.37	$903.37
AUSTIN (TX)	$936.61	$936.61
REST OF TEXAS (TX)	$883.75	$883.75
UTAH (UT)	$879.10	$879.10
VIRGINIA (VA)	$889.57	$889.57
VIRGIN ISLANDS (VI)	$918.39	$918.39
VERMONT (VT)	$882.09	$882.09
SEATTLE (KING CNTY) (WA)	$1032.99	$1032.99
REST OF WASHINGTON (WA)	$931.47	$931.47
WISCONSIN (WI)	$855.73	$855.73
WEST VIRGINIA (WV)	$873.56	$873.56
WYOMING** (WY)	$899.69	$899.69

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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 — each of which is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility settings can have different practice-expense RVUs, reflecting whether overhead costs (like clinical staff and supplies) are borne by the physician's office or by a separate facility. The conversion factor and GPCIs are updated each year, which can change the amount even if the RVUs themselves stay the same.

RVUs — work 11.16, practice expense 14.57 (non-facility) / 14.57 (facility), malpractice 1.63 — × 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 deductible; the patient or secondary insurer is responsible for the remainder.
Modifiers, place-of-service rules, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Amounts vary by locality due to differing GPCIs; always confirm the exact figure with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The practice-expense RVU component differs because overhead costs are allocated differently depending on whether the service is performed in a physician's office (non-facility) or a hospital/ambulatory surgical center (facility), where the facility itself incurs those costs.

Does this amount reflect what the patient will owe?

No. The figure shown is the Medicare-allowed amount before cost-sharing. After the deductible is met, Medicare generally pays 80%, leaving the remaining 20% as coinsurance unless covered by a supplemental plan.

Why might my MAC's actual payment differ from this estimate?

Local GPCIs, applicable modifiers, sequestration cuts, and yearly budget-neutrality adjustments to the conversion factor can all cause the actual paid amount to vary from the national or locality-adjusted estimate shown here.

Where can I find the official CPT descriptor for this code?

CPT code descriptors are copyrighted by the American Medical Association. Refer to the AMA's CPT codebook or a licensed coding reference for the official language.

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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.