Medicare Reimbursement for CPT 21395

This page covers CPT code 21395, a procedure code valued under the Medicare Physician Fee Schedule (PFS). Because CPT descriptors are licensed by the AMA, this code is referenced generically here rather than described in detail. The figures shown reflect the estimated Medicare allowed amount nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$896.81	$896.81
ALASKA* (AK)	$1117.82	$1117.82
ALABAMA (AL)	$817.19	$817.19
ARKANSAS (AR)	$807.40	$807.40
ARIZONA (AZ)	$873.85	$873.85
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1026.55	$1026.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1041.80	$1041.80
OXNARD-THOUSAND OAKS-VENTURA (CA)	$936.85	$936.85
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$947.03	$947.03
NAPA (CA)	$988.25	$988.25
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1029.56	$1029.56
VALLEJO (CA)	$983.92	$983.92
BAKERSFIELD (CA)	$902.95	$902.95
CHICO (CA)	$895.53	$895.53
FRESNO (CA)	$895.53	$895.53
HANFORD-CORCORAN (CA)	$895.53	$895.53
MADERA (CA)	$895.53	$895.53
MERCED (CA)	$895.53	$895.53
MODESTO (CA)	$895.53	$895.53
REDDING (CA)	$895.53	$895.53
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$924.07	$924.07
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$926.71	$926.71
SALINAS (CA)	$923.00	$923.00
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1054.11	$1054.11
SANTA CRUZ-WATSONVILLE (CA)	$936.67	$936.67
SANTA ROSA-PETALUMA (CA)	$945.27	$945.27
STOCKTON (CA)	$895.53	$895.53
VISALIA (CA)	$895.53	$895.53
YUBA CITY (CA)	$895.53	$895.53
EL CENTRO (CA)	$895.97	$895.97
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$935.25	$935.25
SAN LUIS OBISPO-PASO ROBLES (CA)	$909.70	$909.70
SANTA MARIA-SANTA BARBARA (CA)	$923.87	$923.87
REST OF CALIFORNIA (CA)	$895.53	$895.53
COLORADO (CO)	$904.27	$904.27
CONNECTICUT (CT)	$950.36	$950.36
DC + MD/VA SUBURBS (DC)	$991.34	$991.34
DELAWARE (DE)	$886.31	$886.31
FORT LAUDERDALE (FL)	$972.62	$972.62
MIAMI (FL)	$1045.67	$1045.67
REST OF FLORIDA (FL)	$926.83	$926.83
ATLANTA (GA)	$921.32	$921.32
REST OF GEORGIA (GA)	$878.20	$878.20
HAWAII, GUAM (HI)	$904.71	$904.71
IOWA (IA)	$815.42	$815.42
IDAHO (ID)	$823.79	$823.79
EAST ST. LOUIS (IL)	$960.19	$960.19
SUBURBAN CHICAGO (IL)	$977.40	$977.40
CHICAGO (IL)	$1016.44	$1016.44
REST OF ILLINOIS (IL)	$917.97	$917.97
INDIANA (IN)	$827.25	$827.25
KANSAS (KS)	$821.26	$821.26
KENTUCKY (KY)	$852.70	$852.70
NEW ORLEANS (LA)	$889.40	$889.40
REST OF LOUISIANA (LA)	$855.18	$855.18
METROPOLITAN BOSTON (MA)	$970.66	$970.66
REST OF MASSACHUSETTS (MA)	$903.98	$903.98
BALTIMORE/SURR. CNTYS (MD)	$949.52	$949.52
REST OF MARYLAND (MD)	$898.30	$898.30
SOUTHERN MAINE (ME)	$861.19	$861.19
REST OF MAINE (ME)	$836.98	$836.98
DETROIT (MI)	$946.00	$946.00
REST OF MICHIGAN (MI)	$879.55	$879.55
MINNESOTA (MN)	$844.06	$844.06
METROPOLITAN ST. LOUIS (MO)	$881.17	$881.17
METROPOLITAN KANSAS CITY (MO)	$874.67	$874.67
REST OF MISSOURI (MO)	$849.02	$849.02
MISSISSIPPI (MS)	$827.89	$827.89
MONTANA** (MT)	$896.64	$896.64
NORTH CAROLINA (NC)	$842.77	$842.77
NORTH DAKOTA** (ND)	$844.24	$844.24
NEBRASKA (NE)	$816.38	$816.38
NEW HAMPSHIRE (NH)	$899.27	$899.27
NORTHERN NJ (NJ)	$985.73	$985.73
REST OF NEW JERSEY (NJ)	$954.87	$954.87
NEW MEXICO (NM)	$887.24	$887.24
NEVADA** (NV)	$882.36	$882.36
MANHATTAN (NY)	$1032.72	$1032.72
NYC SUBURBS/LONG ISLAND (NY)	$1065.61	$1065.61
POUGHKPSIE/N NYC SUBURBS (NY)	$968.26	$968.26
QUEENS (NY)	$1026.57	$1026.57
REST OF NEW YORK (NY)	$854.04	$854.04
OHIO (OH)	$868.84	$868.84
OKLAHOMA (OK)	$841.80	$841.80
PORTLAND (OR)	$918.41	$918.41
REST OF OREGON (OR)	$869.21	$869.21
METROPOLITAN PHILADELPHIA (PA)	$936.03	$936.03
REST OF PENNSYLVANIA (PA)	$864.91	$864.91
PUERTO RICO (PR)	$899.11	$899.11
RHODE ISLAND (RI)	$907.23	$907.23
SOUTH CAROLINA (SC)	$858.48	$858.48
SOUTH DAKOTA** (SD)	$838.04	$838.04
TENNESSEE (TN)	$825.83	$825.83
BRAZORIA (TX)	$878.20	$878.20
DALLAS (TX)	$887.23	$887.23
GALVESTON (TX)	$883.11	$883.11
HOUSTON (TX)	$931.62	$931.62
BEAUMONT (TX)	$860.86	$860.86
FORT WORTH (TX)	$885.09	$885.09
AUSTIN (TX)	$906.80	$906.80
REST OF TEXAS (TX)	$871.42	$871.42
UTAH (UT)	$868.01	$868.01
VIRGINIA (VA)	$865.19	$865.19
VIRGIN ISLANDS (VI)	$899.11	$899.11
VERMONT (VT)	$849.79	$849.79
SEATTLE (KING CNTY) (WA)	$979.38	$979.38
REST OF WASHINGTON (WA)	$899.35	$899.35
WISCONSIN (WI)	$821.72	$821.72
WEST VIRGINIA (WV)	$891.78	$891.78
WYOMING** (WY)	$873.80	$873.80

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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 — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can have different practice-expense RVUs, which is why separate amounts may be shown for each; for some codes, as appears to be the case here, those values are the same.

RVUs — work 14.33, practice expense 9.87 (non-facility) / 9.87 (facility), malpractice 2.65 — × 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.
Actual payment can vary by locality, applicable modifiers, claim-level adjustments, sequestration, and yearly budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

When the practice-expense RVU is identical in both settings, the calculated allowed amount is the same. For other codes, facility and non-facility PE RVUs often differ because the facility absorbs more of the overhead costs.

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

The national amount uses a standard adjustment, while actual payments apply locality-specific GPCIs for work, practice expense, and malpractice, which raise or lower the amount based on regional cost-of-living and practice cost data.

Does this amount reflect what Medicare will actually pay me?

No. This is the allowed amount estimate before the patient's deductible and 20% coinsurance are applied, and before any modifier, sequestration, or claim-specific adjustments.

Where can I find the official, binding fee for my area?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules, which should be used as the authoritative source for billing and appeals.

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.