Medicare Reimbursement for CPT 21365

This page covers CPT code 21365, a procedure code defined by the American Medical Association. It shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both at the national level and adjusted for locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$962.61	$962.61
ALASKA* (AK)	$1218.27	$1218.27
ALABAMA (AL)	$883.82	$883.82
ARKANSAS (AR)	$874.13	$874.13
ARIZONA (AZ)	$939.93	$939.93
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1100.05	$1100.05
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1116.38	$1116.38
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1005.35	$1005.35
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1016.33	$1016.33
NAPA (CA)	$1059.40	$1059.40
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1102.99	$1102.99
VALLEJO (CA)	$1055.16	$1055.16
BAKERSFIELD (CA)	$970.85	$970.85
CHICO (CA)	$963.44	$963.44
FRESNO (CA)	$963.44	$963.44
HANFORD-CORCORAN (CA)	$963.44	$963.44
MADERA (CA)	$963.44	$963.44
MERCED (CA)	$963.44	$963.44
MODESTO (CA)	$963.44	$963.44
REDDING (CA)	$963.44	$963.44
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$991.41	$991.41
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$995.92	$995.92
SALINAS (CA)	$991.87	$991.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1128.41	$1128.41
SANTA CRUZ-WATSONVILLE (CA)	$1004.89	$1004.89
SANTA ROSA-PETALUMA (CA)	$1014.10	$1014.10
STOCKTON (CA)	$963.44	$963.44
VISALIA (CA)	$963.44	$963.44
YUBA CITY (CA)	$963.44	$963.44
EL CENTRO (CA)	$963.87	$963.87
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1004.06	$1004.06
SAN LUIS OBISPO-PASO ROBLES (CA)	$977.63	$977.63
SANTA MARIA-SANTA BARBARA (CA)	$992.55	$992.55
REST OF CALIFORNIA (CA)	$963.44	$963.44
COLORADO (CO)	$971.34	$971.34
CONNECTICUT (CT)	$1017.11	$1017.11
DC + MD/VA SUBURBS (DC)	$1060.62	$1060.62
DELAWARE (DE)	$952.65	$952.65
FORT LAUDERDALE (FL)	$1036.80	$1036.80
MIAMI (FL)	$1108.42	$1108.42
REST OF FLORIDA (FL)	$991.61	$991.61
ATLANTA (GA)	$986.92	$986.92
REST OF GEORGIA (GA)	$943.58	$943.58
HAWAII, GUAM (HI)	$971.40	$971.40
IOWA (IA)	$882.40	$882.40
IDAHO (ID)	$890.62	$890.62
EAST ST. LOUIS (IL)	$1023.93	$1023.93
SUBURBAN CHICAGO (IL)	$1042.13	$1042.13
CHICAGO (IL)	$1080.11	$1080.11
REST OF ILLINOIS (IL)	$982.61	$982.61
INDIANA (IN)	$894.06	$894.06
KANSAS (KS)	$888.03	$888.03
KENTUCKY (KY)	$918.63	$918.63
NEW ORLEANS (LA)	$954.91	$954.91
REST OF LOUISIANA (LA)	$921.03	$921.03
METROPOLITAN BOSTON (MA)	$1039.51	$1039.51
REST OF MASSACHUSETTS (MA)	$971.28	$971.28
BALTIMORE/SURR. CNTYS (MD)	$1015.94	$1015.94
REST OF MARYLAND (MD)	$964.94	$964.94
SOUTHERN MAINE (ME)	$927.72	$927.72
REST OF MAINE (ME)	$903.51	$903.51
DETROIT (MI)	$1010.41	$1010.41
REST OF MICHIGAN (MI)	$945.06	$945.06
MINNESOTA (MN)	$911.28	$911.28
METROPOLITAN ST. LOUIS (MO)	$946.95	$946.95
METROPOLITAN KANSAS CITY (MO)	$940.49	$940.49
REST OF MISSOURI (MO)	$914.82	$914.82
MISSISSIPPI (MS)	$894.17	$894.17
MONTANA** (MT)	$962.44	$962.44
NORTH CAROLINA (NC)	$909.27	$909.27
NORTH DAKOTA** (ND)	$911.23	$911.23
NEBRASKA (NE)	$883.40	$883.40
NEW HAMPSHIRE (NH)	$965.33	$965.33
NORTHERN NJ (NJ)	$1055.70	$1055.70
REST OF NEW JERSEY (NJ)	$1023.21	$1023.21
NEW MEXICO (NM)	$952.61	$952.61
NEVADA** (NV)	$948.50	$948.50
MANHATTAN (NY)	$1101.72	$1101.72
NYC SUBURBS/LONG ISLAND (NY)	$1134.07	$1134.07
POUGHKPSIE/N NYC SUBURBS (NY)	$1036.71	$1036.71
QUEENS (NY)	$1095.86	$1095.86
REST OF NEW YORK (NY)	$920.42	$920.42
OHIO (OH)	$934.60	$934.60
OKLAHOMA (OK)	$908.01	$908.01
PORTLAND (OR)	$985.84	$985.84
REST OF OREGON (OR)	$935.60	$935.60
METROPOLITAN PHILADELPHIA (PA)	$1002.67	$1002.67
REST OF PENNSYLVANIA (PA)	$930.80	$930.80
PUERTO RICO (PR)	$964.95	$964.95
RHODE ISLAND (RI)	$974.54	$974.54
SOUTH CAROLINA (SC)	$924.56	$924.56
SOUTH DAKOTA** (SD)	$905.17	$905.17
TENNESSEE (TN)	$892.53	$892.53
BRAZORIA (TX)	$944.98	$944.98
DALLAS (TX)	$953.92	$953.92
GALVESTON (TX)	$949.79	$949.79
HOUSTON (TX)	$997.20	$997.20
BEAUMONT (TX)	$926.77	$926.77
FORT WORTH (TX)	$951.75	$951.75
AUSTIN (TX)	$972.98	$972.98
REST OF TEXAS (TX)	$937.39	$937.39
UTAH (UT)	$933.99	$933.99
VIRGINIA (VA)	$931.57	$931.57
VIRGIN ISLANDS (VI)	$964.95	$964.95
VERMONT (VT)	$916.58	$916.58
SEATTLE (KING CNTY) (WA)	$1049.00	$1049.00
REST OF WASHINGTON (WA)	$966.53	$966.53
WISCONSIN (WI)	$888.89	$888.89
WEST VIRGINIA (WV)	$956.67	$956.67
WYOMING** (WY)	$940.12	$940.12

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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 adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two amounts can diverge. For this code, the non-facility and facility PE RVUs are equal, so the national rates shown are the same, though locality adjustments may still cause variation in given markets.

RVUs — work 16.35, practice expense 9.88 (non-facility) / 9.88 (facility), malpractice 2.59 — × 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 annual deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, place of service, and sequestration can change the actual amount paid.
Annual budget-neutrality adjustments and conversion factor updates can shift amounts year to year.
Always confirm final allowed amounts with your Medicare Administrative Contractor (MAC).

Frequently asked

Why do non-facility and facility amounts sometimes differ?

They reflect different practice-expense RVUs because overhead costs vary by setting; when the PE RVUs match, as they do here, the amounts are the same.

Does this amount reflect what Medicare actually pays?

No — it reflects the allowed amount before the standard 80/20 split and before any deductible, modifier, or sequestration adjustments are applied.

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

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust for regional differences in wages, rent, and malpractice costs, which can raise or lower the local rate relative to the national average.

Will this amount change next year?

Yes — CMS updates the conversion factor and may revise RVUs annually, so amounts are specific to the stated fee schedule year.

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.