Medicare Reimbursement for CPT 21356

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code. It shows the national average along with locality-adjusted estimates, broken out by non-facility (e.g., office) and facility (e.g., hospital, ASC) settings, since practice expense inputs differ between the two.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$593.20	$379.77
ALASKA* (AK)	$685.08	$457.78
ALABAMA (AL)	$529.63	$342.88
ARKANSAS (AR)	$521.63	$338.29
ARIZONA (AZ)	$576.37	$369.55
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$757.90	$456.97
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$772.45	$464.68
OXNARD-THOUSAND OAKS-VENTURA (CA)	$660.50	$408.23
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$664.16	$411.67
NAPA (CA)	$717.91	$436.61
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$758.90	$457.97
VALLEJO (CA)	$716.47	$435.17
BAKERSFIELD (CA)	$623.72	$389.80
CHICO (CA)	$621.26	$387.34
FRESNO (CA)	$621.26	$387.34
HANFORD-CORCORAN (CA)	$621.26	$387.34
MADERA (CA)	$621.26	$387.34
MERCED (CA)	$621.26	$387.34
MODESTO (CA)	$621.26	$387.34
REDDING (CA)	$621.26	$387.34
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$630.73	$396.81
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$651.48	$403.26
SALINAS (CA)	$649.07	$401.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$776.53	$468.77
SANTA CRUZ-WATSONVILLE (CA)	$670.26	$410.94
SANTA ROSA-PETALUMA (CA)	$676.96	$414.87
STOCKTON (CA)	$621.26	$387.34
VISALIA (CA)	$621.26	$387.34
YUBA CITY (CA)	$621.26	$387.34
EL CENTRO (CA)	$621.41	$387.48
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$664.13	$408.87
SAN LUIS OBISPO-PASO ROBLES (CA)	$638.74	$395.64
SANTA MARIA-SANTA BARBARA (CA)	$651.44	$402.58
REST OF CALIFORNIA (CA)	$621.26	$387.34
COLORADO (CO)	$614.67	$387.57
CONNECTICUT (CT)	$633.82	$403.95
DC + MD/VA SUBURBS (DC)	$677.37	$425.95
DELAWARE (DE)	$586.14	$375.27
FORT LAUDERDALE (FL)	$622.23	$406.03
MIAMI (FL)	$654.81	$432.63
REST OF FLORIDA (FL)	$590.10	$386.06
ATLANTA (GA)	$606.08	$389.24
REST OF GEORGIA (GA)	$554.94	$364.56
HAWAII, GUAM (HI)	$636.51	$393.84
IOWA (IA)	$540.92	$345.63
IDAHO (ID)	$545.19	$348.83
EAST ST. LOUIS (IL)	$590.49	$394.13
SUBURBAN CHICAGO (IL)	$627.97	$408.77
CHICAGO (IL)	$634.40	$419.90
REST OF ILLINOIS (IL)	$574.38	$379.52
INDIANA (IN)	$548.42	$350.57
KANSAS (KS)	$539.60	$346.66
KENTUCKY (KY)	$545.58	$355.84
NEW ORLEANS (LA)	$573.21	$372.38
REST OF LOUISIANA (LA)	$545.22	$356.33
METROPOLITAN BOSTON (MA)	$675.28	$420.44
REST OF MASSACHUSETTS (MA)	$611.29	$386.55
BALTIMORE/SURR. CNTYS (MD)	$632.36	$403.34
REST OF MARYLAND (MD)	$597.24	$381.25
SOUTHERN MAINE (ME)	$578.70	$367.18
REST OF MAINE (ME)	$549.57	$353.21
DETROIT (MI)	$599.14	$393.17
REST OF MICHIGAN (MI)	$561.63	$366.76
MINNESOTA (MN)	$584.30	$364.67
METROPOLITAN ST. LOUIS (MO)	$573.75	$370.56
METROPOLITAN KANSAS CITY (MO)	$567.73	$367.32
REST OF MISSOURI (MO)	$536.34	$352.36
MISSISSIPPI (MS)	$529.03	$345.26
MONTANA** (MT)	$593.14	$379.71
NORTH CAROLINA (NC)	$555.35	$356.22
NORTH DAKOTA** (ND)	$575.74	$362.31
NEBRASKA (NE)	$543.62	$346.62
NEW HAMPSHIRE (NH)	$606.19	$384.01
NORTHERN NJ (NJ)	$670.15	$422.57
REST OF NEW JERSEY (NJ)	$639.74	$406.67
NEW MEXICO (NM)	$565.37	$369.65
NEVADA** (NV)	$588.70	$375.05
MANHATTAN (NY)	$686.34	$438.34
NYC SUBURBS/LONG ISLAND (NY)	$705.28	$451.51
POUGHKPSIE/N NYC SUBURBS (NY)	$645.07	$411.36
QUEENS (NY)	$690.24	$437.96
REST OF NEW YORK (NY)	$564.15	$361.39
OHIO (OH)	$558.07	$363.21
OKLAHOMA (OK)	$543.15	$352.56
PORTLAND (OR)	$633.31	$396.19
REST OF OREGON (OR)	$582.84	$370.27
METROPOLITAN PHILADELPHIA (PA)	$618.37	$396.19
REST OF PENNSYLVANIA (PA)	$558.25	$362.32
PUERTO RICO (PR)	$597.23	$381.45
RHODE ISLAND (RI)	$606.43	$385.95
SOUTH CAROLINA (SC)	$557.90	$360.69
SOUTH DAKOTA** (SD)	$573.68	$360.25
TENNESSEE (TN)	$542.60	$348.59
BRAZORIA (TX)	$584.33	$372.82
DALLAS (TX)	$588.82	$376.24
GALVESTON (TX)	$586.56	$374.62
HOUSTON (TX)	$602.66	$390.73
BEAUMONT (TX)	$554.53	$360.31
FORT WORTH (TX)	$585.13	$374.69
AUSTIN (TX)	$613.74	$387.93
REST OF TEXAS (TX)	$569.62	$367.07
UTAH (UT)	$565.81	$365.19
VIRGINIA (VA)	$577.65	$367.84
VIRGIN ISLANDS (VI)	$597.23	$381.45
VERMONT (VT)	$574.62	$363.32
SEATTLE (KING CNTY) (WA)	$687.96	$426.08
REST OF WASHINGTON (WA)	$609.76	$385.02
WISCONSIN (WI)	$555.79	$351.32
WEST VIRGINIA (WV)	$552.62	$367.15
WYOMING** (WY)	$585.56	$372.13

Look up another code or locality →

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 the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) specific to the provider's locality, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility amounts differ mainly because the practice expense RVU is lower when the service is performed in a facility, since the facility (not the physician's office) incurs many of the overhead costs.

RVUs — work 4.71, practice expense 12.17 (non-facility) / 5.78 (facility), malpractice 0.88 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary with modifiers, place of service, multiple-procedure or bilateral adjustments, sequestration, and mid-year or annual budget-neutrality changes.
Locality-specific GPCIs can meaningfully shift the amount away from the national average shown here.
Always confirm current rates and edits with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

The facility rate uses a lower practice expense RVU because overhead costs (equipment, supplies, staff time) are assumed to be borne by the facility rather than the physician's office.

Why does the payment differ by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs) for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost-of-living and practice cost differences before the conversion factor is applied.

Does this amount reflect what Medicare will actually pay?

No — it reflects the Medicare-allowed amount before the standard 20% coinsurance, deductible status, applicable modifiers, and any sequestration or claim-specific adjustments are applied.

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

CPT code descriptors are copyrighted by the American Medical Association; refer to your licensed CPT codebook or AMA resources for the official language, as it cannot be reproduced 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.