Medicare Reimbursement for CPT 21360

CPT 21360 is a procedure code reported to Medicare and other payers; the full descriptor is maintained by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, under non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$468.61	$468.61
ALASKA* (AK)	$583.07	$583.07
ALABAMA (AL)	$428.57	$428.57
ARKANSAS (AR)	$423.60	$423.60
ARIZONA (AZ)	$457.42	$457.42
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$552.78	$552.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$561.71	$561.71
OXNARD-THOUSAND OAKS-VENTURA (CA)	$498.43	$498.43
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$503.09	$503.09
NAPA (CA)	$529.79	$529.79
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$553.96	$553.96
VALLEJO (CA)	$528.09	$528.09
BAKERSFIELD (CA)	$478.66	$478.66
CHICO (CA)	$475.65	$475.65
FRESNO (CA)	$475.65	$475.65
HANFORD-CORCORAN (CA)	$475.65	$475.65
MADERA (CA)	$475.65	$475.65
MERCED (CA)	$475.65	$475.65
MODESTO (CA)	$475.65	$475.65
REDDING (CA)	$475.65	$475.65
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$486.90	$486.90
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$493.48	$493.48
SALINAS (CA)	$491.51	$491.51
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$566.54	$566.54
SANTA CRUZ-WATSONVILLE (CA)	$500.36	$500.36
SANTA ROSA-PETALUMA (CA)	$505.06	$505.06
STOCKTON (CA)	$475.65	$475.65
VISALIA (CA)	$475.65	$475.65
YUBA CITY (CA)	$475.65	$475.65
EL CENTRO (CA)	$475.83	$475.83
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$498.88	$498.88
SAN LUIS OBISPO-PASO ROBLES (CA)	$484.24	$484.24
SANTA MARIA-SANTA BARBARA (CA)	$492.21	$492.21
REST OF CALIFORNIA (CA)	$475.65	$475.65
COLORADO (CO)	$476.60	$476.60
CONNECTICUT (CT)	$495.97	$495.97
DC + MD/VA SUBURBS (DC)	$520.74	$520.74
DELAWARE (DE)	$463.88	$463.88
FORT LAUDERDALE (FL)	$499.28	$499.28
MIAMI (FL)	$529.92	$529.92
REST OF FLORIDA (FL)	$477.30	$477.30
ATLANTA (GA)	$479.49	$479.49
REST OF GEORGIA (GA)	$453.71	$453.71
HAWAII, GUAM (HI)	$481.35	$481.35
IOWA (IA)	$430.69	$430.69
IDAHO (ID)	$434.33	$434.33
EAST ST. LOUIS (IL)	$487.86	$487.86
SUBURBAN CHICAGO (IL)	$502.46	$502.46
CHICAGO (IL)	$516.24	$516.24
REST OF ILLINOIS (IL)	$470.79	$470.79
INDIANA (IN)	$436.18	$436.18
KANSAS (KS)	$432.21	$432.21
KENTUCKY (KY)	$443.49	$443.49
NEW ORLEANS (LA)	$461.55	$461.55
REST OF LOUISIANA (LA)	$444.19	$444.19
METROPOLITAN BOSTON (MA)	$513.14	$513.14
REST OF MASSACHUSETTS (MA)	$475.90	$475.90
BALTIMORE/SURR. CNTYS (MD)	$495.17	$495.17
REST OF MARYLAND (MD)	$470.50	$470.50
SOUTHERN MAINE (ME)	$454.00	$454.00
REST OF MAINE (ME)	$439.51	$439.51
DETROIT (MI)	$485.45	$485.45
REST OF MICHIGAN (MI)	$455.72	$455.72
MINNESOTA (MN)	$449.95	$449.95
METROPOLITAN ST. LOUIS (MO)	$459.10	$459.10
METROPOLITAN KANSAS CITY (MO)	$455.63	$455.63
REST OF MISSOURI (MO)	$440.15	$440.15
MISSISSIPPI (MS)	$431.78	$431.78
MONTANA** (MT)	$468.55	$468.55
NORTH CAROLINA (NC)	$442.69	$442.69
NORTH DAKOTA** (ND)	$447.98	$447.98
NEBRASKA (NE)	$431.63	$431.63
NEW HAMPSHIRE (NH)	$472.46	$472.46
NORTHERN NJ (NJ)	$517.69	$517.69
REST OF NEW JERSEY (NJ)	$499.73	$499.73
NEW MEXICO (NM)	$459.02	$459.02
NEVADA** (NV)	$463.01	$463.01
MANHATTAN (NY)	$536.31	$536.31
NYC SUBURBS/LONG ISLAND (NY)	$551.12	$551.12
POUGHKPSIE/N NYC SUBURBS (NY)	$505.42	$505.42
QUEENS (NY)	$535.31	$535.31
REST OF NEW YORK (NY)	$448.31	$448.31
OHIO (OH)	$451.52	$451.52
OKLAHOMA (OK)	$439.50	$439.50
PORTLAND (OR)	$485.64	$485.64
REST OF OREGON (OR)	$457.50	$457.50
METROPOLITAN PHILADELPHIA (PA)	$487.72	$487.72
REST OF PENNSYLVANIA (PA)	$450.33	$450.33
PUERTO RICO (PR)	$470.29	$470.29
RHODE ISLAND (RI)	$475.90	$475.90
SOUTH CAROLINA (SC)	$448.22	$448.22
SOUTH DAKOTA** (SD)	$445.55	$445.55
TENNESSEE (TN)	$434.36	$434.36
BRAZORIA (TX)	$461.05	$461.05
DALLAS (TX)	$464.99	$464.99
GALVESTON (TX)	$463.11	$463.11
HOUSTON (TX)	$482.15	$482.15
BEAUMONT (TX)	$448.17	$448.17
FORT WORTH (TX)	$463.44	$463.44
AUSTIN (TX)	$476.71	$476.71
REST OF TEXAS (TX)	$455.06	$455.06
UTAH (UT)	$453.09	$453.09
VIRGINIA (VA)	$455.01	$455.01
VIRGIN ISLANDS (VI)	$470.29	$470.29
VERMONT (VT)	$449.46	$449.46
SEATTLE (KING CNTY) (WA)	$519.31	$519.31
REST OF WASHINGTON (WA)	$473.94	$473.94
WISCONSIN (WI)	$436.19	$436.19
WEST VIRGINIA (WV)	$457.42	$457.42
WYOMING** (WY)	$459.58	$459.58

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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 the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can have different practice-expense RVUs, which is why the two amounts may differ; for this code, the practice-expense RVU is the same in both settings, so the resulting national amounts shown are equal.

RVUs — work 7.01, practice expense 5.98 (non-facility) / 5.98 (facility), malpractice 1.04 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on published national RVUs and conversion factor; it is not a guarantee of payment.
Medicare typically pays 80% of the approved amount after the patient meets the Part B deductible; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, site-of-service differentials, sequestration, and mid-year or annual budget-neutrality adjustments.
Always confirm the final allowed amount and any applicable edits with your local Medicare Administrative Contractor (MAC).

Frequently asked

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

The practice-expense RVU used in the calculation is identical for both settings for this code, so the resulting national PFS amounts come out the same. Other codes may show a difference when facility and non-facility practice-expense RVUs diverge.

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

Medicare applies Geographic Practice Cost Indices (GPCIs) to the work, practice-expense, and malpractice RVUs to account for regional cost variation, so the locality-adjusted amount can be higher or lower than the national average.

Does this amount include the patient's share?

No. The figure represents the total Medicare-approved amount before the standard 80/20 split; after the deductible is met, Medicare generally pays 80% and the remaining 20% is the patient's or secondary payer's responsibility.

Will this amount stay the same all year?

Not necessarily. Mid-year corrections, sequestration, and annual conversion factor or RVU updates (typically effective January 1) can change the allowed amount from what is 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.