Medicare Reimbursement for CPT 21385

CPT 21385 is a surgical procedure code; this page shows the Medicare Physician Fee Schedule (PFS) allowed amount for it, both as a national average and adjusted for local cost differences. Amounts are displayed separately for 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)	$674.36	$674.36
ALASKA* (AK)	$824.06	$824.06
ALABAMA (AL)	$611.17	$611.17
ARKANSAS (AR)	$603.34	$603.34
ARIZONA (AZ)	$656.59	$656.59
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$795.77	$795.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$808.59	$808.59
OXNARD-THOUSAND OAKS-VENTURA (CA)	$716.81	$716.81
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$723.53	$723.53
NAPA (CA)	$762.54	$762.54
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$797.74	$797.74
VALLEJO (CA)	$759.71	$759.71
BAKERSFIELD (CA)	$686.97	$686.97
CHICO (CA)	$682.13	$682.13
FRESNO (CA)	$682.13	$682.13
HANFORD-CORCORAN (CA)	$682.13	$682.13
MADERA (CA)	$682.13	$682.13
MERCED (CA)	$682.13	$682.13
MODESTO (CA)	$682.13	$682.13
REDDING (CA)	$682.13	$682.13
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$700.75	$700.75
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$708.48	$708.48
SALINAS (CA)	$705.70	$705.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$816.62	$816.62
SANTA CRUZ-WATSONVILLE (CA)	$719.66	$719.66
SANTA ROSA-PETALUMA (CA)	$726.43	$726.43
STOCKTON (CA)	$682.13	$682.13
VISALIA (CA)	$682.13	$682.13
YUBA CITY (CA)	$682.13	$682.13
EL CENTRO (CA)	$682.41	$682.41
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$717.02	$717.02
SAN LUIS OBISPO-PASO ROBLES (CA)	$695.24	$695.24
SANTA MARIA-SANTA BARBARA (CA)	$706.90	$706.90
REST OF CALIFORNIA (CA)	$682.13	$682.13
COLORADO (CO)	$684.97	$684.97
CONNECTICUT (CT)	$716.21	$716.21
DC + MD/VA SUBURBS (DC)	$752.00	$752.00
DELAWARE (DE)	$666.43	$666.43
FORT LAUDERDALE (FL)	$725.02	$725.02
MIAMI (FL)	$775.22	$775.22
REST OF FLORIDA (FL)	$690.01	$690.01
ATLANTA (GA)	$691.79	$691.79
REST OF GEORGIA (GA)	$652.52	$652.52
HAWAII, GUAM (HI)	$691.82	$691.82
IOWA (IA)	$613.60	$613.60
IDAHO (ID)	$619.52	$619.52
EAST ST. LOUIS (IL)	$708.56	$708.56
SUBURBAN CHICAGO (IL)	$729.39	$729.39
CHICAGO (IL)	$752.90	$752.90
REST OF ILLINOIS (IL)	$680.37	$680.37
INDIANA (IN)	$622.40	$622.40
KANSAS (KS)	$616.43	$616.43
KENTUCKY (KY)	$635.60	$635.60
NEW ORLEANS (LA)	$664.23	$664.23
REST OF LOUISIANA (LA)	$636.87	$636.87
METROPOLITAN BOSTON (MA)	$739.95	$739.95
REST OF MASSACHUSETTS (MA)	$683.78	$683.78
BALTIMORE/SURR. CNTYS (MD)	$715.31	$715.31
REST OF MARYLAND (MD)	$676.40	$676.40
SOUTHERN MAINE (ME)	$650.30	$650.30
REST OF MAINE (ME)	$628.13	$628.13
DETROIT (MI)	$703.33	$703.33
REST OF MICHIGAN (MI)	$655.29	$655.29
MINNESOTA (MN)	$642.53	$642.53
METROPOLITAN ST. LOUIS (MO)	$659.84	$659.84
METROPOLITAN KANSAS CITY (MO)	$654.43	$654.43
REST OF MISSOURI (MO)	$630.78	$630.78
MISSISSIPPI (MS)	$616.89	$616.89
MONTANA** (MT)	$674.25	$674.25
NORTH CAROLINA (NC)	$633.07	$633.07
NORTH DAKOTA** (ND)	$640.04	$640.04
NEBRASKA (NE)	$614.94	$614.94
NEW HAMPSHIRE (NH)	$679.64	$679.64
NORTHERN NJ (NJ)	$746.72	$746.72
REST OF NEW JERSEY (NJ)	$720.49	$720.49
NEW MEXICO (NM)	$660.67	$660.67
NEVADA** (NV)	$665.02	$665.02
MANHATTAN (NY)	$777.57	$777.57
NYC SUBURBS/LONG ISLAND (NY)	$801.46	$801.46
POUGHKPSIE/N NYC SUBURBS (NY)	$729.49	$729.49
QUEENS (NY)	$775.35	$775.35
REST OF NEW YORK (NY)	$641.95	$641.95
OHIO (OH)	$648.30	$648.30
OKLAHOMA (OK)	$628.85	$628.85
PORTLAND (OR)	$698.41	$698.41
REST OF OREGON (OR)	$655.98	$655.98
METROPOLITAN PHILADELPHIA (PA)	$703.63	$703.63
REST OF PENNSYLVANIA (PA)	$646.18	$646.18
PUERTO RICO (PR)	$676.85	$676.85
RHODE ISLAND (RI)	$684.11	$684.11
SOUTH CAROLINA (SC)	$642.52	$642.52
SOUTH DAKOTA** (SD)	$636.00	$636.00
TENNESSEE (TN)	$619.86	$619.86
BRAZORIA (TX)	$661.40	$661.40
DALLAS (TX)	$667.74	$667.74
GALVESTON (TX)	$664.78	$664.78
HOUSTON (TX)	$696.45	$696.45
BEAUMONT (TX)	$642.82	$642.82
FORT WORTH (TX)	$665.45	$665.45
AUSTIN (TX)	$686.09	$686.09
REST OF TEXAS (TX)	$653.21	$653.21
UTAH (UT)	$650.17	$650.17
VIRGINIA (VA)	$652.19	$652.19
VIRGIN ISLANDS (VI)	$676.85	$676.85
VERMONT (VT)	$642.77	$642.77
SEATTLE (KING CNTY) (WA)	$748.59	$748.59
REST OF WASHINGTON (WA)	$680.77	$680.77
WISCONSIN (WI)	$621.57	$621.57
WEST VIRGINIA (WV)	$659.32	$659.32
WYOMING** (WY)	$659.34	$659.34

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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

Each CPT/HCPCS code is assigned three Relative Value Units (RVUs) — for physician work, practice expense, and malpractice risk. These RVUs are each multiplied by a Geographic Practice Cost Index (GPCI) specific to the Medicare locality where the service is performed, to reflect local cost-of-living and practice-cost differences. The geographically adjusted RVUs are summed and then multiplied by the national Conversion Factor (CF) for the payment year to produce the allowed amount. Non-facility and facility allowed amounts can differ because the practice-expense RVU is typically lower in facility settings, where the facility itself bears certain overhead costs.

RVUs — work 9.33, practice expense 9.13 (non-facility) / 9.13 (facility), malpractice 1.73 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment can differ by claim.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral or assistant-surgeon rules, and other claim-specific factors can change the final paid amount.
Annual budget-neutrality adjustments and sequestration can alter the effective payment from year to year.
Always verify final allowed amounts with your Medicare Administrative Contractor (MAC), as local adjustments and claim edits may apply.

Frequently asked

Why do the non-facility and facility amounts differ for this code?

The practice-expense RVU component is generally higher in non-facility settings because the billing provider is covering more of the overhead (supplies, staff, equipment). In facility settings, some of those costs are instead billed separately by the facility, so the physician's practice-expense RVU — and resulting allowed amount — is often lower.

Does this amount apply everywhere in the country?

No. The national amount shown reflects an average under national GPCIs; actual payment in a specific locality will be higher or lower depending on that locality's wage and cost indices, which is why locality-specific amounts are also provided.

Will Medicare always pay the full allowed amount?

No. Medicare generally pays 80% of the allowed amount after the Part B deductible, with the remaining portion owed by the patient or a secondary payer, subject to any applicable modifiers or reductions.

Why might the amount change next year?

The Conversion Factor, RVUs, and GPCIs are updated annually (and sometimes mid-year) through CMS rulemaking, so the allowed amount for the same code can shift from one year to the next.

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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.