Medicare Reimbursement for CPT 21407

CPT 21407 is a procedure code billed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code at the national level and adjusted for your locality, broken out by non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$577.50	$577.50
ALASKA* (AK)	$721.98	$721.98
ALABAMA (AL)	$529.52	$529.52
ARKANSAS (AR)	$523.57	$523.57
ARIZONA (AZ)	$564.13	$564.13
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$681.99	$681.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$693.05	$693.05
OXNARD-THOUSAND OAKS-VENTURA (CA)	$614.80	$614.80
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$620.52	$620.52
NAPA (CA)	$653.54	$653.54
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$683.36	$683.36
VALLEJO (CA)	$651.56	$651.56
BAKERSFIELD (CA)	$590.65	$590.65
CHICO (CA)	$587.12	$587.12
FRESNO (CA)	$587.12	$587.12
HANFORD-CORCORAN (CA)	$587.12	$587.12
MADERA (CA)	$587.12	$587.12
MERCED (CA)	$587.12	$587.12
MODESTO (CA)	$587.12	$587.12
REDDING (CA)	$587.12	$587.12
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$600.22	$600.22
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$609.01	$609.01
SALINAS (CA)	$606.57	$606.57
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$698.67	$698.67
SANTA CRUZ-WATSONVILLE (CA)	$617.27	$617.27
SANTA ROSA-PETALUMA (CA)	$623.07	$623.07
STOCKTON (CA)	$587.12	$587.12
VISALIA (CA)	$587.12	$587.12
YUBA CITY (CA)	$587.12	$587.12
EL CENTRO (CA)	$587.32	$587.32
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$615.52	$615.52
SAN LUIS OBISPO-PASO ROBLES (CA)	$597.59	$597.59
SANTA MARIA-SANTA BARBARA (CA)	$607.39	$607.39
REST OF CALIFORNIA (CA)	$587.12	$587.12
COLORADO (CO)	$587.76	$587.76
CONNECTICUT (CT)	$610.61	$610.61
DC + MD/VA SUBURBS (DC)	$641.26	$641.26
DELAWARE (DE)	$571.97	$571.97
FORT LAUDERDALE (FL)	$613.32	$613.32
MIAMI (FL)	$649.28	$649.28
REST OF FLORIDA (FL)	$587.12	$587.12
ATLANTA (GA)	$590.40	$590.40
REST OF GEORGIA (GA)	$558.96	$558.96
HAWAII, GUAM (HI)	$593.85	$593.85
IOWA (IA)	$532.43	$532.43
IDAHO (ID)	$536.72	$536.72
EAST ST. LOUIS (IL)	$599.00	$599.00
SUBURBAN CHICAGO (IL)	$617.33	$617.33
CHICAGO (IL)	$633.11	$633.11
REST OF ILLINOIS (IL)	$579.07	$579.07
INDIANA (IN)	$538.95	$538.95
KANSAS (KS)	$534.08	$534.08
KENTUCKY (KY)	$547.04	$547.04
NEW ORLEANS (LA)	$568.63	$568.63
REST OF LOUISIANA (LA)	$547.80	$547.80
METROPOLITAN BOSTON (MA)	$632.33	$632.33
REST OF MASSACHUSETTS (MA)	$586.90	$586.90
BALTIMORE/SURR. CNTYS (MD)	$609.55	$609.55
REST OF MARYLAND (MD)	$580.05	$580.05
SOUTHERN MAINE (ME)	$560.40	$560.40
REST OF MAINE (ME)	$542.75	$542.75
DETROIT (MI)	$596.70	$596.70
REST OF MICHIGAN (MI)	$561.53	$561.53
MINNESOTA (MN)	$556.11	$556.11
METROPOLITAN ST. LOUIS (MO)	$565.89	$565.89
METROPOLITAN KANSAS CITY (MO)	$561.72	$561.72
REST OF MISSOURI (MO)	$542.85	$542.85
MISSISSIPPI (MS)	$533.11	$533.11
MONTANA** (MT)	$577.42	$577.42
NORTH CAROLINA (NC)	$546.60	$546.60
NORTH DAKOTA** (ND)	$553.49	$553.49
NEBRASKA (NE)	$533.61	$533.61
NEW HAMPSHIRE (NH)	$582.43	$582.43
NORTHERN NJ (NJ)	$637.71	$637.71
REST OF NEW JERSEY (NJ)	$615.57	$615.57
NEW MEXICO (NM)	$565.42	$565.42
NEVADA** (NV)	$571.00	$571.00
MANHATTAN (NY)	$659.42	$659.42
NYC SUBURBS/LONG ISLAND (NY)	$676.95	$676.95
POUGHKPSIE/N NYC SUBURBS (NY)	$622.33	$622.33
QUEENS (NY)	$658.47	$658.47
REST OF NEW YORK (NY)	$553.32	$553.32
OHIO (OH)	$556.64	$556.64
OKLAHOMA (OK)	$542.44	$542.44
PORTLAND (OR)	$598.88	$598.88
REST OF OREGON (OR)	$564.52	$564.52
METROPOLITAN PHILADELPHIA (PA)	$600.57	$600.57
REST OF PENNSYLVANIA (PA)	$555.31	$555.31
PUERTO RICO (PR)	$579.57	$579.57
RHODE ISLAND (RI)	$586.75	$586.75
SOUTH CAROLINA (SC)	$552.93	$552.93
SOUTH DAKOTA** (SD)	$550.67	$550.67
TENNESSEE (TN)	$536.63	$536.63
BRAZORIA (TX)	$568.77	$568.77
DALLAS (TX)	$573.43	$573.43
GALVESTON (TX)	$571.19	$571.19
HOUSTON (TX)	$593.34	$593.34
BEAUMONT (TX)	$552.72	$552.72
FORT WORTH (TX)	$571.52	$571.52
AUSTIN (TX)	$587.60	$587.60
REST OF TEXAS (TX)	$561.16	$561.16
UTAH (UT)	$558.77	$558.77
VIRGINIA (VA)	$561.48	$561.48
VIRGIN ISLANDS (VI)	$579.57	$579.57
VERMONT (VT)	$555.10	$555.10
SEATTLE (KING CNTY) (WA)	$640.06	$640.06
REST OF WASHINGTON (WA)	$584.56	$584.56
WISCONSIN (WI)	$539.31	$539.31
WEST VIRGINIA (WV)	$563.02	$563.02
WYOMING** (WY)	$566.99	$566.99

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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 allowed amount is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates differ because practice-expense RVUs are typically lower in facility settings, reflecting that the facility (not the physician's office) bears certain overhead costs; for this code, the practice-expense RVU and resulting allowed amount happen to be the same in both settings. The conversion factor and GPCIs are updated annually and can shift the final amount even if the code's RVUs stay constant.

RVUs — work 8.79, practice expense 7.29 (non-facility) / 7.29 (facility), malpractice 1.21 — × 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 the annual Part B deductible; the patient or secondary insurer is generally responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility and non-facility rate the same for this code?

The allowed amount depends on the practice-expense RVU assigned to each setting. When CMS assigns an identical practice-expense RVU to both facility and non-facility settings, the resulting allowed amounts are the same.

Will my locality's payment match the national amount shown?

Not necessarily. Local GPCIs adjust the work, practice-expense, and malpractice RVUs based on regional cost differences, so the amount actually paid in a given locality can be higher or lower than the national figure.

Why did the allowed amount change from last year?

Annual updates to the conversion factor, RVUs, or GPCIs — driven by CMS rulemaking and budget-neutrality requirements — can change the allowed amount even if the code description and RVUs otherwise stay the same.

Does this amount reflect what the patient will owe?

No. This figure is the Medicare-allowed amount before cost-sharing. Patient responsibility depends on deductible status, coinsurance, and any supplemental coverage.

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.