Medicare Reimbursement for CPT 21366

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code (CPT descriptors are licensed by the AMA and not reproduced here). It shows the national estimate as well as how the amount can vary by locality and by place of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1138.64	$1138.64
ALASKA* (AK)	$1418.53	$1418.53
ALABAMA (AL)	$1037.37	$1037.37
ARKANSAS (AR)	$1024.91	$1024.91
ARIZONA (AZ)	$1109.44	$1109.44
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1304.08	$1304.08
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1323.48	$1323.48
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1189.83	$1189.83
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1202.72	$1202.72
NAPA (CA)	$1255.32	$1255.32
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1307.89	$1307.89
VALLEJO (CA)	$1249.82	$1249.82
BAKERSFIELD (CA)	$1146.64	$1146.64
CHICO (CA)	$1137.23	$1137.23
FRESNO (CA)	$1137.23	$1137.23
HANFORD-CORCORAN (CA)	$1137.23	$1137.23
MADERA (CA)	$1137.23	$1137.23
MERCED (CA)	$1137.23	$1137.23
MODESTO (CA)	$1137.23	$1137.23
REDDING (CA)	$1137.23	$1137.23
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1173.42	$1173.42
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1176.92	$1176.92
SALINAS (CA)	$1172.21	$1172.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1339.08	$1339.08
SANTA CRUZ-WATSONVILLE (CA)	$1189.70	$1189.70
SANTA ROSA-PETALUMA (CA)	$1200.62	$1200.62
STOCKTON (CA)	$1137.23	$1137.23
VISALIA (CA)	$1137.23	$1137.23
YUBA CITY (CA)	$1137.23	$1137.23
EL CENTRO (CA)	$1137.79	$1137.79
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1187.83	$1187.83
SAN LUIS OBISPO-PASO ROBLES (CA)	$1155.32	$1155.32
SANTA MARIA-SANTA BARBARA (CA)	$1173.33	$1173.33
REST OF CALIFORNIA (CA)	$1137.23	$1137.23
COLORADO (CO)	$1148.24	$1148.24
CONNECTICUT (CT)	$1206.70	$1206.70
DC + MD/VA SUBURBS (DC)	$1258.89	$1258.89
DELAWARE (DE)	$1125.29	$1125.29
FORT LAUDERDALE (FL)	$1234.78	$1234.78
MIAMI (FL)	$1327.47	$1327.47
REST OF FLORIDA (FL)	$1176.58	$1176.58
ATLANTA (GA)	$1169.74	$1169.74
REST OF GEORGIA (GA)	$1114.77	$1114.77
HAWAII, GUAM (HI)	$1149.00	$1149.00
IOWA (IA)	$1035.22	$1035.22
IDAHO (ID)	$1045.85	$1045.85
EAST ST. LOUIS (IL)	$1218.79	$1218.79
SUBURBAN CHICAGO (IL)	$1240.87	$1240.87
CHICAGO (IL)	$1290.31	$1290.31
REST OF ILLINOIS (IL)	$1165.24	$1165.24
INDIANA (IN)	$1050.25	$1050.25
KANSAS (KS)	$1042.60	$1042.60
KENTUCKY (KY)	$1082.42	$1082.42
NEW ORLEANS (LA)	$1129.09	$1129.09
REST OF LOUISIANA (LA)	$1085.56	$1085.56
METROPOLITAN BOSTON (MA)	$1232.71	$1232.71
REST OF MASSACHUSETTS (MA)	$1147.84	$1147.84
BALTIMORE/SURR. CNTYS (MD)	$1205.63	$1205.63
REST OF MARYLAND (MD)	$1140.54	$1140.54
SOUTHERN MAINE (ME)	$1093.44	$1093.44
REST OF MAINE (ME)	$1062.57	$1062.57
DETROIT (MI)	$1200.91	$1200.91
REST OF MICHIGAN (MI)	$1116.53	$1116.53
MINNESOTA (MN)	$1071.82	$1071.82
METROPOLITAN ST. LOUIS (MO)	$1118.68	$1118.68
METROPOLITAN KANSAS CITY (MO)	$1110.40	$1110.40
REST OF MISSOURI (MO)	$1077.69	$1077.69
MISSISSIPPI (MS)	$1050.89	$1050.89
MONTANA** (MT)	$1138.41	$1138.41
NORTH CAROLINA (NC)	$1069.95	$1069.95
NORTH DAKOTA** (ND)	$1071.97	$1071.97
NEBRASKA (NE)	$1036.45	$1036.45
NEW HAMPSHIRE (NH)	$1141.85	$1141.85
NORTHERN NJ (NJ)	$1251.72	$1251.72
REST OF NEW JERSEY (NJ)	$1212.45	$1212.45
NEW MEXICO (NM)	$1126.29	$1126.29
NEVADA** (NV)	$1120.32	$1120.32
MANHATTAN (NY)	$1311.30	$1311.30
NYC SUBURBS/LONG ISLAND (NY)	$1353.07	$1353.07
POUGHKPSIE/N NYC SUBURBS (NY)	$1229.42	$1229.42
QUEENS (NY)	$1303.55	$1303.55
REST OF NEW YORK (NY)	$1084.28	$1084.28
OHIO (OH)	$1102.95	$1102.95
OKLAHOMA (OK)	$1068.61	$1068.61
PORTLAND (OR)	$1166.28	$1166.28
REST OF OREGON (OR)	$1103.62	$1103.62
METROPOLITAN PHILADELPHIA (PA)	$1188.44	$1188.44
REST OF PENNSYLVANIA (PA)	$1097.98	$1097.98
PUERTO RICO (PR)	$1141.58	$1141.58
RHODE ISLAND (RI)	$1151.91	$1151.91
SOUTH CAROLINA (SC)	$1089.84	$1089.84
SOUTH DAKOTA** (SD)	$1064.12	$1064.12
TENNESSEE (TN)	$1048.41	$1048.41
BRAZORIA (TX)	$1115.01	$1115.01
DALLAS (TX)	$1126.47	$1126.47
GALVESTON (TX)	$1121.24	$1121.24
HOUSTON (TX)	$1182.74	$1182.74
BEAUMONT (TX)	$1092.82	$1092.82
FORT WORTH (TX)	$1123.73	$1123.73
AUSTIN (TX)	$1151.44	$1151.44
REST OF TEXAS (TX)	$1106.30	$1106.30
UTAH (UT)	$1101.96	$1101.96
VIRGINIA (VA)	$1098.49	$1098.49
VIRGIN ISLANDS (VI)	$1141.58	$1141.58
VERMONT (VT)	$1078.99	$1078.99
SEATTLE (KING CNTY) (WA)	$1243.85	$1243.85
REST OF WASHINGTON (WA)	$1141.98	$1141.98
WISCONSIN (WI)	$1043.31	$1043.31
WEST VIRGINIA (WV)	$1131.92	$1131.92
WYOMING** (WY)	$1109.46	$1109.46

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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 billed, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs (and therefore the total) can differ between non-facility settings (e.g., physician office) and facility settings (e.g., hospital), reflecting different overhead assumptions.

RVUs — work 18.14, practice expense 12.59 (non-facility) / 12.59 (facility), malpractice 3.36 — × 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's deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Amounts vary by locality due to GPCI differences; the national figure is a reference point, not a locality-specific guarantee.
Always confirm current rates and edits with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

Facility and non-facility rates use different practice-expense RVUs because Medicare assumes different overhead costs depending on whether the service is performed in a facility (e.g., hospital) versus a non-facility setting (e.g., physician office).

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

Each Medicare locality has its own GPCI values for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost-of-living and practice cost differences, resulting in a locality-specific allowed amount.

Does this amount reflect what Medicare will actually pay?

No. The figure shown is the PFS allowed amount before adjustments such as modifiers, sequestration, multiple-procedure payment reductions, or annual budget-neutrality changes, and before the patient's deductible and coinsurance are applied.

Where can I verify the exact payment for a specific claim?

Your Medicare Administrative Contractor (MAC) publishes the current, locality-specific fee schedule and can confirm the exact allowed amount, applicable modifiers, and any claim-specific adjustments.

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.