Medicare Reimbursement for CPT 21386

CPT 21386 is a physician procedure code reported to Medicare and other payers; the exact clinical description is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjustable by locality, and broken out by non-facility versus facility place of service.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$630.94	$630.94
ALASKA* (AK)	$777.81	$777.81
ALABAMA (AL)	$573.17	$573.17
ARKANSAS (AR)	$566.04	$566.04
ARIZONA (AZ)	$614.51	$614.51
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$734.55	$734.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$745.97	$745.97
OXNARD-THOUSAND OAKS-VENTURA (CA)	$665.48	$665.48
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$672.16	$672.16
NAPA (CA)	$705.31	$705.31
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$736.51	$736.51
VALLEJO (CA)	$702.48	$702.48
BAKERSFIELD (CA)	$639.38	$639.38
CHICO (CA)	$634.54	$634.54
FRESNO (CA)	$634.54	$634.54
HANFORD-CORCORAN (CA)	$634.54	$634.54
MADERA (CA)	$634.54	$634.54
MERCED (CA)	$634.54	$634.54
MODESTO (CA)	$634.54	$634.54
REDDING (CA)	$634.54	$634.54
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$653.16	$653.16
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$657.98	$657.98
SALINAS (CA)	$655.38	$655.38
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$754.01	$754.01
SANTA CRUZ-WATSONVILLE (CA)	$666.90	$666.90
SANTA ROSA-PETALUMA (CA)	$673.11	$673.11
STOCKTON (CA)	$634.54	$634.54
VISALIA (CA)	$634.54	$634.54
YUBA CITY (CA)	$634.54	$634.54
EL CENTRO (CA)	$634.82	$634.82
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$665.09	$665.09
SAN LUIS OBISPO-PASO ROBLES (CA)	$645.78	$645.78
SANTA MARIA-SANTA BARBARA (CA)	$656.27	$656.27
REST OF CALIFORNIA (CA)	$634.54	$634.54
COLORADO (CO)	$638.77	$638.77
CONNECTICUT (CT)	$669.45	$669.45
DC + MD/VA SUBURBS (DC)	$700.85	$700.85
DELAWARE (DE)	$623.53	$623.53
FORT LAUDERDALE (FL)	$681.03	$681.03
MIAMI (FL)	$730.02	$730.02
REST OF FLORIDA (FL)	$648.50	$648.50
ATLANTA (GA)	$647.68	$647.68
REST OF GEORGIA (GA)	$613.79	$613.79
HAWAII, GUAM (HI)	$642.45	$642.45
IOWA (IA)	$573.87	$573.87
IDAHO (ID)	$579.57	$579.57
EAST ST. LOUIS (IL)	$668.61	$668.61
SUBURBAN CHICAGO (IL)	$684.79	$684.79
CHICAGO (IL)	$709.26	$709.26
REST OF ILLINOIS (IL)	$640.72	$640.72
INDIANA (IN)	$582.15	$582.15
KANSAS (KS)	$577.18	$577.18
KENTUCKY (KY)	$597.00	$597.00
NEW ORLEANS (LA)	$623.37	$623.37
REST OF LOUISIANA (LA)	$598.44	$598.44
METROPOLITAN BOSTON (MA)	$688.10	$688.10
REST OF MASSACHUSETTS (MA)	$638.06	$638.06
BALTIMORE/SURR. CNTYS (MD)	$668.72	$668.72
REST OF MARYLAND (MD)	$632.46	$632.46
SOUTHERN MAINE (ME)	$607.27	$607.27
REST OF MAINE (ME)	$588.18	$588.18
DETROIT (MI)	$661.43	$661.43
REST OF MICHIGAN (MI)	$615.64	$615.64
MINNESOTA (MN)	$597.85	$597.85
METROPOLITAN ST. LOUIS (MO)	$618.51	$618.51
METROPOLITAN KANSAS CITY (MO)	$613.66	$613.66
REST OF MISSOURI (MO)	$593.35	$593.35
MISSISSIPPI (MS)	$579.51	$579.51
MONTANA** (MT)	$630.83	$630.83
NORTH CAROLINA (NC)	$592.56	$592.56
NORTH DAKOTA** (ND)	$596.62	$596.62
NEBRASKA (NE)	$574.86	$574.86
NEW HAMPSHIRE (NH)	$634.44	$634.44
NORTHERN NJ (NJ)	$696.35	$696.35
REST OF NEW JERSEY (NJ)	$673.07	$673.07
NEW MEXICO (NM)	$620.85	$620.85
NEVADA** (NV)	$621.55	$621.55
MANHATTAN (NY)	$727.12	$727.12
NYC SUBURBS/LONG ISLAND (NY)	$749.84	$749.84
POUGHKPSIE/N NYC SUBURBS (NY)	$681.95	$681.95
QUEENS (NY)	$724.03	$724.03
REST OF NEW YORK (NY)	$600.70	$600.70
OHIO (OH)	$608.65	$608.65
OKLAHOMA (OK)	$590.07	$590.07
PORTLAND (OR)	$650.17	$650.17
REST OF OREGON (OR)	$612.74	$612.74
METROPOLITAN PHILADELPHIA (PA)	$658.43	$658.43
REST OF PENNSYLVANIA (PA)	$606.32	$606.32
PUERTO RICO (PR)	$632.95	$632.95
RHODE ISLAND (RI)	$639.25	$639.25
SOUTH CAROLINA (SC)	$602.40	$602.40
SOUTH DAKOTA** (SD)	$592.57	$592.57
TENNESSEE (TN)	$580.39	$580.39
BRAZORIA (TX)	$618.37	$618.37
DALLAS (TX)	$624.50	$624.50
GALVESTON (TX)	$621.67	$621.67
HOUSTON (TX)	$653.33	$653.33
BEAUMONT (TX)	$603.30	$603.30
FORT WORTH (TX)	$622.63	$622.63
AUSTIN (TX)	$640.15	$640.15
REST OF TEXAS (TX)	$612.00	$612.00
UTAH (UT)	$609.36	$609.36
VIRGINIA (VA)	$609.51	$609.51
VIRGIN ISLANDS (VI)	$632.95	$632.95
VERMONT (VT)	$599.78	$599.78
SEATTLE (KING CNTY) (WA)	$695.32	$695.32
REST OF WASHINGTON (WA)	$635.04	$635.04
WISCONSIN (WI)	$579.97	$579.97
WEST VIRGINIA (WV)	$621.59	$621.59
WYOMING** (WY)	$615.92	$615.92

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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 (PE), and malpractice (MP) — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to account for regional cost differences, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. The PE RVU often differs between non-facility (e.g., physician office) and facility (e.g., hospital) settings because the facility setting assumes the facility itself bears more of the overhead cost; for this code the non-facility and facility PE RVUs happen to match, so the resulting national amounts are the same. Work and malpractice RVUs are generally the same across both settings. All of this is recalculated annually and can shift due to rule changes, even if the underlying RVUs stay constant.

RVUs — work 9.33, practice expense 7.83 (non-facility) / 7.83 (facility), malpractice 1.73 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an ESTIMATE only, not a guarantee of payment — actual reimbursement depends on claim-specific factors.
Medicare typically pays 80% of the allowed amount after the patient meets the Part B deductible; the patient or secondary insurer is responsible for the remainder.
Amounts vary by locality-specific GPCIs, and can be further affected by modifiers, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments.
Always verify the final allowed amount with your Medicare Administrative Contractor (MAC) or official CMS fee schedule lookup tool before billing or appealing a denial.

Frequently asked

Why does CPT 21386 show the same amount for non-facility and facility?

The PFS amount depends partly on the practice-expense RVU, which can differ by setting. For this code, the non-facility and facility PE RVUs are equal, so the calculated national amounts are the same — this isn't true for every code.

Why isn't the CPT code description shown on this page?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so this page refers to the code generically rather than reproducing the official descriptor.

Will my locality's allowed amount match the national figure shown here?

Not necessarily. The national amount uses a GPCI value of 1.0 for all cost components; your locality's actual GPCIs can raise or lower the final allowed amount.

Does this amount reflect what Medicare will actually pay me?

No — it reflects the full PFS allowed amount estimate. Medicare generally pays 80% of this after the deductible, and the final payment can be further adjusted by modifiers, sequestration, and other claim-specific factors.

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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.