Medicare Reimbursement for CPT 21355

CPT 21355 is a procedure code defined by the American Medical Association; its specific descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjustable by locality, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$445.57	$294.26
ALASKA* (AK)	$526.94	$365.80
ALABAMA (AL)	$401.59	$269.20
ARKANSAS (AR)	$396.06	$266.09
ARIZONA (AZ)	$433.91	$287.29
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$562.19	$348.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$572.74	$354.56
OXNARD-THOUSAND OAKS-VENTURA (CA)	$492.76	$313.92
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$495.77	$316.78
NAPA (CA)	$533.52	$334.10
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$562.89	$349.55
VALLEJO (CA)	$532.51	$333.08
BAKERSFIELD (CA)	$467.10	$301.26
CHICO (CA)	$465.29	$299.46
FRESNO (CA)	$465.29	$299.46
HANFORD-CORCORAN (CA)	$465.29	$299.46
MADERA (CA)	$465.29	$299.46
MERCED (CA)	$465.29	$299.46
MODESTO (CA)	$465.29	$299.46
REDDING (CA)	$465.29	$299.46
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$472.00	$306.17
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$486.80	$310.83
SALINAS (CA)	$484.96	$309.59
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$575.62	$357.44
SANTA CRUZ-WATSONVILLE (CA)	$499.18	$315.34
SANTA ROSA-PETALUMA (CA)	$504.13	$318.32
STOCKTON (CA)	$465.29	$299.46
VISALIA (CA)	$465.29	$299.46
YUBA CITY (CA)	$465.29	$299.46
EL CENTRO (CA)	$465.40	$299.57
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$495.29	$314.33
SAN LUIS OBISPO-PASO ROBLES (CA)	$477.33	$304.99
SANTA MARIA-SANTA BARBARA (CA)	$486.48	$310.06
REST OF CALIFORNIA (CA)	$465.29	$299.46
COLORADO (CO)	$460.69	$299.70
CONNECTICUT (CT)	$474.37	$311.41
DC + MD/VA SUBURBS (DC)	$505.56	$327.32
DELAWARE (DE)	$440.84	$291.35
FORT LAUDERDALE (FL)	$465.94	$312.67
MIAMI (FL)	$488.71	$331.20
REST OF FLORIDA (FL)	$443.67	$299.02
ATLANTA (GA)	$454.64	$300.92
REST OF GEORGIA (GA)	$419.31	$284.35
HAWAII, GUAM (HI)	$475.20	$303.16
IOWA (IA)	$409.29	$270.84
IDAHO (ID)	$412.26	$273.06
EAST ST. LOUIS (IL)	$444.17	$304.97
SUBURBAN CHICAGO (IL)	$470.13	$314.74
CHICAGO (IL)	$474.80	$322.74
REST OF ILLINOIS (IL)	$432.88	$294.73
INDIANA (IN)	$414.49	$274.23
KANSAS (KS)	$408.43	$271.65
KENTUCKY (KY)	$412.74	$278.23
NEW ORLEANS (LA)	$431.87	$289.49
REST OF LOUISIANA (LA)	$412.51	$278.60
METROPOLITAN BOSTON (MA)	$503.53	$322.87
REST OF MASSACHUSETTS (MA)	$458.52	$299.19
BALTIMORE/SURR. CNTYS (MD)	$473.23	$310.88
REST OF MARYLAND (MD)	$448.68	$295.56
SOUTHERN MAINE (ME)	$435.41	$285.46
REST OF MAINE (ME)	$415.35	$276.15
DETROIT (MI)	$449.98	$303.97
REST OF MICHIGAN (MI)	$423.89	$285.75
MINNESOTA (MN)	$439.11	$283.41
METROPOLITAN ST. LOUIS (MO)	$432.17	$288.13
METROPOLITAN KANSAS CITY (MO)	$428.02	$285.94
REST OF MISSOURI (MO)	$406.40	$275.98
MISSISSIPPI (MS)	$401.26	$270.98
MONTANA** (MT)	$445.53	$294.22
NORTH CAROLINA (NC)	$419.34	$278.17
NORTH DAKOTA** (ND)	$433.27	$281.96
NEBRASKA (NE)	$411.14	$271.48
NEW HAMPSHIRE (NH)	$454.46	$296.95
NORTHERN NJ (NJ)	$500.89	$325.38
REST OF NEW JERSEY (NJ)	$479.13	$313.90
NEW MEXICO (NM)	$426.50	$287.75
NEVADA** (NV)	$442.39	$290.93
MANHATTAN (NY)	$512.32	$336.51
NYC SUBURBS/LONG ISLAND (NY)	$525.49	$345.59
POUGHKPSIE/N NYC SUBURBS (NY)	$483.03	$317.35
QUEENS (NY)	$514.94	$336.10
REST OF NEW YORK (NY)	$425.42	$281.68
OHIO (OH)	$421.38	$283.24
OKLAHOMA (OK)	$411.00	$275.88
PORTLAND (OR)	$473.65	$305.55
REST OF OREGON (OR)	$438.30	$287.60
METROPOLITAN PHILADELPHIA (PA)	$463.65	$306.14
REST OF PENNSYLVANIA (PA)	$421.48	$282.58
PUERTO RICO (PR)	$448.34	$295.37
RHODE ISLAND (RI)	$455.32	$299.02
SOUTH CAROLINA (SC)	$421.19	$281.38
SOUTH DAKOTA** (SD)	$431.82	$280.51
TENNESSEE (TN)	$410.51	$272.97
BRAZORIA (TX)	$439.65	$289.71
DALLAS (TX)	$442.81	$292.11
GALVESTON (TX)	$441.21	$290.96
HOUSTON (TX)	$452.55	$302.31
BEAUMONT (TX)	$418.91	$281.22
FORT WORTH (TX)	$440.28	$291.09
AUSTIN (TX)	$459.73	$299.65
REST OF TEXAS (TX)	$429.28	$285.69
UTAH (UT)	$426.66	$284.43
VIRGINIA (VA)	$434.72	$285.99
VIRGIN ISLANDS (VI)	$448.34	$295.37
VERMONT (VT)	$432.54	$282.75
SEATTLE (KING CNTY) (WA)	$512.56	$326.91
REST OF WASHINGTON (WA)	$457.34	$298.01
WISCONSIN (WI)	$419.48	$274.53
WEST VIRGINIA (WV)	$417.83	$286.34
WYOMING** (WY)	$440.18	$288.88

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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 locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because non-facility rates assume the practice bears the overhead costs, while facility rates assume a hospital or similar facility covers those costs. This is why the same code can show two different national or locality-adjusted amounts depending on place of service.

RVUs — work 4.34, practice expense 8.38 (non-facility) / 3.85 (facility), malpractice 0.62 — × 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 approved amount after the patient's annual deductible is met; the beneficiary or secondary insurer is responsible for the rest.
Actual payment can vary due to modifiers, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments.
Locality-specific GPCIs change the amount from the national average shown here.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the facility amount differ from the non-facility amount?

The practice-expense RVU is lower in the facility setting because the facility (e.g., hospital) absorbs certain overhead and equipment costs, whereas in a non-facility setting the billing practice bears those costs directly.

Why might my locality's payment differ from the national amount shown?

Each locality has its own Geographic Practice Cost Indices for work, practice expense, and malpractice, which adjust the RVUs up or down relative to the national average before the conversion factor is applied.

Does this amount reflect what the patient will actually owe?

No. The figure shown is the Medicare-approved amount; after the deductible is met, Medicare generally pays 80% and the patient or secondary payer is responsible for the remaining 20%, subject to any applicable modifiers or adjustments.

Can modifiers change the payment for this code?

Yes. Modifiers (such as bilateral, multiple procedure, or assistant-at-surgery indicators) can increase, decrease, or otherwise adjust the base PFS amount, so the final payment may differ from the unmodified estimate shown here.

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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.