Medicare Reimbursement for CPT 21401

CPT 21401 is a procedure code defined by the AMA's CPT code set; the descriptor itself is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$552.12	$315.64
ALASKA* (AK)	$628.83	$376.98
ALABAMA (AL)	$491.28	$284.36
ARKANSAS (AR)	$483.59	$280.46
ARIZONA (AZ)	$536.23	$307.08
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$719.00	$385.56
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$733.31	$392.30
OXNARD-THOUSAND OAKS-VENTURA (CA)	$621.81	$342.30
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$624.69	$344.93
NAPA (CA)	$679.26	$367.58
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$719.75	$386.31
VALLEJO (CA)	$678.18	$366.50
BAKERSFIELD (CA)	$585.15	$325.97
CHICO (CA)	$583.30	$324.12
FRESNO (CA)	$583.30	$324.12
HANFORD-CORCORAN (CA)	$583.30	$324.12
MADERA (CA)	$583.30	$324.12
MERCED (CA)	$583.30	$324.12
MODESTO (CA)	$583.30	$324.12
REDDING (CA)	$583.30	$324.12
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$590.41	$331.23
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$613.06	$338.04
SALINAS (CA)	$610.82	$336.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$736.37	$395.37
SANTA CRUZ-WATSONVILLE (CA)	$632.59	$345.27
SANTA ROSA-PETALUMA (CA)	$639.00	$348.61
STOCKTON (CA)	$583.30	$324.12
VISALIA (CA)	$583.30	$324.12
YUBA CITY (CA)	$583.30	$324.12
EL CENTRO (CA)	$583.41	$324.23
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$626.01	$343.18
SAN LUIS OBISPO-PASO ROBLES (CA)	$600.94	$331.59
SANTA MARIA-SANTA BARBARA (CA)	$613.33	$337.60
REST OF CALIFORNIA (CA)	$583.30	$324.12
COLORADO (CO)	$574.98	$323.37
CONNECTICUT (CT)	$590.73	$336.04
DC + MD/VA SUBURBS (DC)	$634.09	$355.52
DELAWARE (DE)	$545.57	$311.93
FORT LAUDERDALE (FL)	$575.26	$335.71
MIAMI (FL)	$602.64	$356.47
REST OF FLORIDA (FL)	$545.16	$319.08
ATLANTA (GA)	$563.47	$323.21
REST OF GEORGIA (GA)	$512.05	$301.11
HAWAII, GUAM (HI)	$599.03	$330.15
IOWA (IA)	$503.96	$287.58
IDAHO (ID)	$507.69	$290.13
EAST ST. LOUIS (IL)	$541.66	$324.10
SUBURBAN CHICAGO (IL)	$581.05	$338.19
CHICAGO (IL)	$583.55	$345.89
REST OF ILLINOIS (IL)	$528.84	$312.94
INDIANA (IN)	$510.84	$291.63
KANSAS (KS)	$501.81	$288.03
KENTUCKY (KY)	$504.71	$294.49
NEW ORLEANS (LA)	$530.92	$308.39
REST OF LOUISIANA (LA)	$504.02	$294.74
METROPOLITAN BOSTON (MA)	$634.18	$351.82
REST OF MASSACHUSETTS (MA)	$571.30	$322.29
BALTIMORE/SURR. CNTYS (MD)	$589.20	$335.46
REST OF MARYLAND (MD)	$556.43	$317.11
SOUTHERN MAINE (ME)	$540.29	$305.94
REST OF MAINE (ME)	$510.97	$293.41
DETROIT (MI)	$552.88	$324.68
REST OF MICHIGAN (MI)	$519.28	$303.37
MINNESOTA (MN)	$548.49	$305.16
METROPOLITAN ST. LOUIS (MO)	$532.47	$307.35
METROPOLITAN KANSAS CITY (MO)	$526.59	$304.54
REST OF MISSOURI (MO)	$494.94	$291.10
MISSISSIPPI (MS)	$489.35	$285.74
MONTANA** (MT)	$552.07	$315.59
NORTH CAROLINA (NC)	$516.68	$296.04
NORTH DAKOTA** (ND)	$539.02	$302.54
NEBRASKA (NE)	$506.82	$288.55
NEW HAMPSHIRE (NH)	$566.18	$320.00
NORTHERN NJ (NJ)	$626.80	$352.48
REST OF NEW JERSEY (NJ)	$596.79	$338.55
NEW MEXICO (NM)	$522.50	$305.65
NEVADA** (NV)	$548.85	$312.13
MANHATTAN (NY)	$639.16	$364.37
NYC SUBURBS/LONG ISLAND (NY)	$656.20	$375.03
POUGHKPSIE/N NYC SUBURBS (NY)	$601.11	$342.16
QUEENS (NY)	$644.18	$364.67
REST OF NEW YORK (NY)	$525.06	$300.41
OHIO (OH)	$516.61	$300.70
OKLAHOMA (OK)	$503.31	$292.14
PORTLAND (OR)	$593.92	$331.19
REST OF OREGON (OR)	$543.93	$308.40
METROPOLITAN PHILADELPHIA (PA)	$575.35	$329.17
REST OF PENNSYLVANIA (PA)	$517.27	$300.18
PUERTO RICO (PR)	$556.30	$317.22
RHODE ISLAND (RI)	$565.55	$321.27
SOUTH CAROLINA (SC)	$517.64	$299.13
SOUTH DAKOTA** (SD)	$537.48	$301.00
TENNESSEE (TN)	$504.59	$289.63
BRAZORIA (TX)	$544.53	$310.18
DALLAS (TX)	$548.43	$312.89
GALVESTON (TX)	$546.41	$311.59
HOUSTON (TX)	$558.49	$323.67
BEAUMONT (TX)	$513.64	$298.44
FORT WORTH (TX)	$544.61	$311.44
AUSTIN (TX)	$573.63	$323.44
REST OF TEXAS (TX)	$529.06	$304.64
UTAH (UT)	$525.26	$302.97
VIRGINIA (VA)	$538.66	$306.20
VIRGIN ISLANDS (VI)	$556.30	$317.22
VERMONT (VT)	$537.13	$303.01
SEATTLE (KING CNTY) (WA)	$647.19	$357.03
REST OF WASHINGTON (WA)	$570.15	$321.13
WISCONSIN (WI)	$519.64	$293.09
WEST VIRGINIA (WV)	$507.89	$302.39
WYOMING** (WY)	$546.39	$309.91

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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). Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. The non-facility PE RVU is typically higher than the facility PE RVU because it accounts for overhead (supplies, staff, equipment) the practice bears when a procedure is done outside a hospital or facility setting; facility rates assume the hospital absorbs those costs.

RVUs — work 3.59, practice expense 12.28 (non-facility) / 5.2 (facility), malpractice 0.66 — × 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 responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, claim-level adjustments, sequestration, and annual 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 claim.

Frequently asked

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

The facility rate uses a lower practice expense RVU because the hospital or facility—not the billing practice—absorbs costs like equipment, supplies, and clinical staff time for that setting.

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

The PFS formula applies locality-specific GPICs to the work, practice expense, and malpractice RVUs, so areas with higher or lower costs of practice will see adjusted amounts above or below the national average.

Does this amount include the patient's share or secondary insurance payments?

No. The figures represent the Medicare-allowed amount before cost-sharing; Medicare generally reimburses 80% after the deductible, with the remaining 20% billed to the patient or a secondary payer.

Can modifiers change the reimbursement for this code?

Yes. Modifiers (e.g., for bilateral procedures, reduced services, or multiple procedure reductions) can increase or decrease the allowed amount, and these adjustments are not reflected in the base rate shown here.

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.