Medicare Reimbursement for CPT 21390

CPT 21390 is a procedure code defined by the American Medical Association; because CPT descriptors are proprietary, this page refers to it generically. It shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$708.43	$708.43
ALASKA* (AK)	$888.34	$888.34
ALABAMA (AL)	$650.42	$650.42
ARKANSAS (AR)	$643.22	$643.22
ARIZONA (AZ)	$692.26	$692.26
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$835.32	$835.32
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$848.83	$848.83
OXNARD-THOUSAND OAKS-VENTURA (CA)	$753.60	$753.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$760.66	$760.66
NAPA (CA)	$800.68	$800.68
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$836.99	$836.99
VALLEJO (CA)	$798.27	$798.27
BAKERSFIELD (CA)	$724.37	$724.37
CHICO (CA)	$720.05	$720.05
FRESNO (CA)	$720.05	$720.05
HANFORD-CORCORAN (CA)	$720.05	$720.05
MADERA (CA)	$720.05	$720.05
MERCED (CA)	$720.05	$720.05
MODESTO (CA)	$720.05	$720.05
REDDING (CA)	$720.05	$720.05
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$735.98	$735.98
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$746.67	$746.67
SALINAS (CA)	$743.67	$743.67
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$855.65	$855.65
SANTA CRUZ-WATSONVILLE (CA)	$756.45	$756.45
SANTA ROSA-PETALUMA (CA)	$763.56	$763.56
STOCKTON (CA)	$720.05	$720.05
VISALIA (CA)	$720.05	$720.05
YUBA CITY (CA)	$720.05	$720.05
EL CENTRO (CA)	$720.30	$720.30
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$754.46	$754.46
SAN LUIS OBISPO-PASO ROBLES (CA)	$732.68	$732.68
SANTA MARIA-SANTA BARBARA (CA)	$744.63	$744.63
REST OF CALIFORNIA (CA)	$720.05	$720.05
COLORADO (CO)	$720.86	$720.86
CONNECTICUT (CT)	$748.67	$748.67
DC + MD/VA SUBURBS (DC)	$785.99	$785.99
DELAWARE (DE)	$701.78	$701.78
FORT LAUDERDALE (FL)	$751.92	$751.92
MIAMI (FL)	$795.54	$795.54
REST OF FLORIDA (FL)	$720.21	$720.21
ATLANTA (GA)	$724.10	$724.10
REST OF GEORGIA (GA)	$686.15	$686.15
HAWAII, GUAM (HI)	$727.98	$727.98
IOWA (IA)	$653.87	$653.87
IDAHO (ID)	$659.07	$659.07
EAST ST. LOUIS (IL)	$734.73	$734.73
SUBURBAN CHICAGO (IL)	$756.82	$756.82
CHICAGO (IL)	$776.04	$776.04
REST OF ILLINOIS (IL)	$710.53	$710.53
INDIANA (IN)	$661.76	$661.76
KANSAS (KS)	$655.89	$655.89
KENTUCKY (KY)	$671.67	$671.67
NEW ORLEANS (LA)	$697.79	$697.79
REST OF LOUISIANA (LA)	$672.61	$672.61
METROPOLITAN BOSTON (MA)	$774.98	$774.98
REST OF MASSACHUSETTS (MA)	$719.88	$719.88
BALTIMORE/SURR. CNTYS (MD)	$747.35	$747.35
REST OF MARYLAND (MD)	$711.59	$711.59
SOUTHERN MAINE (ME)	$687.67	$687.67
REST OF MAINE (ME)	$666.39	$666.39
DETROIT (MI)	$731.84	$731.84
REST OF MICHIGAN (MI)	$689.22	$689.22
MINNESOTA (MN)	$682.38	$682.38
METROPOLITAN ST. LOUIS (MO)	$694.44	$694.44
METROPOLITAN KANSAS CITY (MO)	$689.39	$689.39
REST OF MISSOURI (MO)	$666.64	$666.64
MISSISSIPPI (MS)	$654.81	$654.81
MONTANA** (MT)	$708.33	$708.33
NORTH CAROLINA (NC)	$671.04	$671.04
NORTH DAKOTA** (ND)	$679.27	$679.27
NEBRASKA (NE)	$655.29	$655.29
NEW HAMPSHIRE (NH)	$714.33	$714.33
NORTHERN NJ (NJ)	$781.79	$781.79
REST OF NEW JERSEY (NJ)	$754.84	$754.84
NEW MEXICO (NM)	$693.93	$693.93
NEVADA** (NV)	$700.53	$700.53
MANHATTAN (NY)	$808.17	$808.17
NYC SUBURBS/LONG ISLAND (NY)	$829.41	$829.41
POUGHKPSIE/N NYC SUBURBS (NY)	$763.09	$763.09
QUEENS (NY)	$806.98	$806.98
REST OF NEW YORK (NY)	$679.17	$679.17
OHIO (OH)	$683.28	$683.28
OKLAHOMA (OK)	$666.07	$666.07
PORTLAND (OR)	$734.30	$734.30
REST OF OREGON (OR)	$692.68	$692.68
METROPOLITAN PHILADELPHIA (PA)	$736.53	$736.53
REST OF PENNSYLVANIA (PA)	$681.66	$681.66
PUERTO RICO (PR)	$710.93	$710.93
RHODE ISLAND (RI)	$719.77	$719.77
SOUTH CAROLINA (SC)	$678.76	$678.76
SOUTH DAKOTA** (SD)	$675.83	$675.83
TENNESSEE (TN)	$658.98	$658.98
BRAZORIA (TX)	$697.91	$697.91
DALLAS (TX)	$703.58	$703.58
GALVESTON (TX)	$700.86	$700.86
HOUSTON (TX)	$727.77	$727.77
BEAUMONT (TX)	$678.52	$678.52
FORT WORTH (TX)	$701.28	$701.28
AUSTIN (TX)	$720.60	$720.60
REST OF TEXAS (TX)	$688.70	$688.70
UTAH (UT)	$685.81	$685.81
VIRGINIA (VA)	$689.01	$689.01
VIRGIN ISLANDS (VI)	$710.93	$710.93
VERMONT (VT)	$681.24	$681.24
SEATTLE (KING CNTY) (WA)	$784.38	$784.38
REST OF WASHINGTON (WA)	$717.01	$717.01
WISCONSIN (WI)	$662.13	$662.13
WEST VIRGINIA (WV)	$691.13	$691.13
WYOMING** (WY)	$695.67	$695.67

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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 PFS amounts are built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for a given locality to reflect local cost differences. The locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two amounts can diverge for the same code. National figures use standardized GPCIs of 1.0 and represent an average rather than any specific locality's payment.

RVUs — work 10.95, practice expense 8.79 (non-facility) / 8.79 (facility), malpractice 1.47 — × 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 Part B deductible is met; the patient or secondary payer is generally responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Facility vs. non-facility amounts assume no additional adjustments (e.g., bilateral, multiple procedure reductions) are applied.
Always verify final payment policy and amounts with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does this code show the same amount for facility and non-facility settings?

When the practice-expense RVUs are identical for both settings, the calculated allowed amount will also be the same, since the other RVU components (work and malpractice) do not vary by place of service.

Why might the amount I'm actually paid differ from the national figure shown here?

The national amount uses standard GPCIs as a baseline reference. Actual payment is based on the GPCIs of the specific Medicare locality where the service was rendered, and may also reflect modifiers, sequestration, or other claim-specific adjustments.

Does this amount include the patient's cost-sharing?

No. The figure represents the total Medicare PFS allowed amount. Medicare generally pays 80% of this after the deductible, with the patient or a secondary payer typically responsible for the remaining 20%.

Will this amount change next year?

Yes. The conversion factor and RVUs are updated annually (and sometimes mid-year) through CMS rulemaking, so allowed amounts can change from year to year, even for the same code.

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.