Medicare Reimbursement for CPT 21406

CPT 21406 is a physician procedure code identified by this numeric code; the specific clinical description is maintained by the AMA and is not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and, where available, by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$542.43	$542.43
ALASKA* (AK)	$659.90	$659.90
ALABAMA (AL)	$491.09	$491.09
ARKANSAS (AR)	$484.72	$484.72
ARIZONA (AZ)	$528.08	$528.08
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$645.00	$645.00
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$655.59	$655.59
OXNARD-THOUSAND OAKS-VENTURA (CA)	$579.13	$579.13
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$584.35	$584.35
NAPA (CA)	$617.36	$617.36
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$646.51	$646.51
VALLEJO (CA)	$615.18	$615.18
BAKERSFIELD (CA)	$554.28	$554.28
CHICO (CA)	$550.55	$550.55
FRESNO (CA)	$550.55	$550.55
HANFORD-CORCORAN (CA)	$550.55	$550.55
MADERA (CA)	$550.55	$550.55
MERCED (CA)	$550.55	$550.55
MODESTO (CA)	$550.55	$550.55
REDDING (CA)	$550.55	$550.55
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$564.87	$564.87
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$572.32	$572.32
SALINAS (CA)	$570.09	$570.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$661.76	$661.76
SANTA CRUZ-WATSONVILLE (CA)	$582.04	$582.04
SANTA ROSA-PETALUMA (CA)	$587.55	$587.55
STOCKTON (CA)	$550.55	$550.55
VISALIA (CA)	$550.55	$550.55
YUBA CITY (CA)	$550.55	$550.55
EL CENTRO (CA)	$550.77	$550.77
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$579.61	$579.61
SAN LUIS OBISPO-PASO ROBLES (CA)	$561.58	$561.58
SANTA MARIA-SANTA BARBARA (CA)	$571.16	$571.16
REST OF CALIFORNIA (CA)	$550.55	$550.55
COLORADO (CO)	$552.02	$552.02
CONNECTICUT (CT)	$576.34	$576.34
DC + MD/VA SUBURBS (DC)	$606.15	$606.15
DELAWARE (DE)	$536.07	$536.07
FORT LAUDERDALE (FL)	$581.66	$581.66
MIAMI (FL)	$620.87	$620.87
REST OF FLORIDA (FL)	$553.49	$553.49
ATLANTA (GA)	$556.19	$556.19
REST OF GEORGIA (GA)	$523.26	$523.26
HAWAII, GUAM (HI)	$558.87	$558.87
IOWA (IA)	$493.84	$493.84
IDAHO (ID)	$498.50	$498.50
EAST ST. LOUIS (IL)	$566.95	$566.95
SUBURBAN CHICAGO (IL)	$585.34	$585.34
CHICAGO (IL)	$602.93	$602.93
REST OF ILLINOIS (IL)	$545.12	$545.12
INDIANA (IN)	$500.87	$500.87
KANSAS (KS)	$495.77	$495.77
KENTUCKY (KY)	$510.18	$510.18
NEW ORLEANS (LA)	$533.34	$533.34
REST OF LOUISIANA (LA)	$511.07	$511.07
METROPOLITAN BOSTON (MA)	$597.21	$597.21
REST OF MASSACHUSETTS (MA)	$550.87	$550.87
BALTIMORE/SURR. CNTYS (MD)	$575.55	$575.55
REST OF MARYLAND (MD)	$544.28	$544.28
SOUTHERN MAINE (ME)	$523.73	$523.73
REST OF MAINE (ME)	$505.12	$505.12
DETROIT (MI)	$563.93	$563.93
REST OF MICHIGAN (MI)	$525.84	$525.84
MINNESOTA (MN)	$518.60	$518.60
METROPOLITAN ST. LOUIS (MO)	$530.21	$530.21
METROPOLITAN KANSAS CITY (MO)	$525.76	$525.76
REST OF MISSOURI (MO)	$505.88	$505.88
MISSISSIPPI (MS)	$495.18	$495.18
MONTANA** (MT)	$542.34	$542.34
NORTH CAROLINA (NC)	$509.21	$509.21
NORTH DAKOTA** (ND)	$516.04	$516.04
NEBRASKA (NE)	$495.05	$495.05
NEW HAMPSHIRE (NH)	$547.39	$547.39
NORTHERN NJ (NJ)	$601.71	$601.71
REST OF NEW JERSEY (NJ)	$580.00	$580.00
NEW MEXICO (NM)	$530.07	$530.07
NEVADA** (NV)	$535.27	$535.27
MANHATTAN (NY)	$625.47	$625.47
NYC SUBURBS/LONG ISLAND (NY)	$644.44	$644.44
POUGHKPSIE/N NYC SUBURBS (NY)	$587.00	$587.00
QUEENS (NY)	$624.21	$624.21
REST OF NEW YORK (NY)	$516.41	$516.41
OHIO (OH)	$520.47	$520.47
OKLAHOMA (OK)	$505.08	$505.08
PORTLAND (OR)	$563.40	$563.40
REST OF OREGON (OR)	$528.21	$528.21
METROPOLITAN PHILADELPHIA (PA)	$565.87	$565.87
REST OF PENNSYLVANIA (PA)	$518.95	$518.95
PUERTO RICO (PR)	$544.59	$544.59
RHODE ISLAND (RI)	$550.69	$550.69
SOUTH CAROLINA (SC)	$516.27	$516.27
SOUTH DAKOTA** (SD)	$512.93	$512.93
TENNESSEE (TN)	$498.52	$498.52
BRAZORIA (TX)	$532.28	$532.28
DALLAS (TX)	$537.27	$537.27
GALVESTON (TX)	$534.93	$534.93
HOUSTON (TX)	$559.27	$559.27
BEAUMONT (TX)	$516.19	$516.19
FORT WORTH (TX)	$535.28	$535.28
AUSTIN (TX)	$552.73	$552.73
REST OF TEXAS (TX)	$525.04	$525.04
UTAH (UT)	$522.51	$522.51
VIRGINIA (VA)	$525.01	$525.01
VIRGIN ISLANDS (VI)	$544.59	$544.59
VERMONT (VT)	$517.92	$517.92
SEATTLE (KING CNTY) (WA)	$604.61	$604.61
REST OF WASHINGTON (WA)	$548.55	$548.55
WISCONSIN (WI)	$500.92	$500.92
WEST VIRGINIA (WV)	$527.97	$527.97
WYOMING** (WY)	$530.88	$530.88

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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) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar 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, though for this code they currently align.

RVUs — work 7.23, practice expense 7.68 (non-facility) / 7.68 (facility), malpractice 1.33 — × 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 patient meets their deductible; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Always verify final pricing with your Medicare Administrative Contractor (MAC), as locality-specific GPCIs and local coverage policies may apply.

Frequently asked

Why do non-facility and facility amounts sometimes differ?

They differ when the practice expense RVU assigned to the code varies by setting, reflecting the different overhead costs of performing the service in an office versus a hospital or facility. For this code, the practice expense RVUs are the same in both settings, so the amounts match.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare allowed amount before the 20% coinsurance, deductible, and any applicable modifiers, sequestration, or local adjustments are applied.

Why isn't the CPT code description shown?

CPT code descriptors are copyrighted by the American Medical Association, so this page references the code generically rather than reproducing the official descriptor.

Will this amount change next year?

Yes. The conversion factor, RVUs, and GPCIs are updated annually by CMS, which can increase or decrease the allowed amount even if the code itself doesn't change.

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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.