Medicare Reimbursement for CPT 21433

This page covers a CPT procedure code billed to Medicare under the Physician Fee Schedule (PFS). Because CPT descriptors are proprietary to the AMA, the specific procedure description is not reproduced here. The figures shown represent the estimated Medicare allowed amount nationally and by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1526.42	$1526.42
ALASKA* (AK)	$1916.31	$1916.31
ALABAMA (AL)	$1393.50	$1393.50
ARKANSAS (AR)	$1377.21	$1377.21
ARIZONA (AZ)	$1487.67	$1487.67
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1725.99	$1725.99
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1750.74	$1750.74
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1583.52	$1583.52
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1601.68	$1601.68
NAPA (CA)	$1664.75	$1664.75
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1731.40	$1731.40
VALLEJO (CA)	$1656.96	$1656.96
BAKERSFIELD (CA)	$1529.61	$1529.61
CHICO (CA)	$1516.29	$1516.29
FRESNO (CA)	$1516.29	$1516.29
HANFORD-CORCORAN (CA)	$1516.29	$1516.29
MADERA (CA)	$1516.29	$1516.29
MERCED (CA)	$1516.29	$1516.29
MODESTO (CA)	$1516.29	$1516.29
REDDING (CA)	$1516.29	$1516.29
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1567.55	$1567.55
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1566.82	$1566.82
SALINAS (CA)	$1560.50	$1560.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1772.84	$1772.84
SANTA CRUZ-WATSONVILLE (CA)	$1580.57	$1580.57
SANTA ROSA-PETALUMA (CA)	$1594.92	$1594.92
STOCKTON (CA)	$1516.29	$1516.29
VISALIA (CA)	$1516.29	$1516.29
YUBA CITY (CA)	$1516.29	$1516.29
EL CENTRO (CA)	$1517.09	$1517.09
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1579.51	$1579.51
SAN LUIS OBISPO-PASO ROBLES (CA)	$1538.28	$1538.28
SANTA MARIA-SANTA BARBARA (CA)	$1561.51	$1561.51
REST OF CALIFORNIA (CA)	$1516.29	$1516.29
COLORADO (CO)	$1534.60	$1534.60
CONNECTICUT (CT)	$1616.31	$1616.31
DC + MD/VA SUBURBS (DC)	$1681.64	$1681.64
DELAWARE (DE)	$1508.51	$1508.51
FORT LAUDERDALE (FL)	$1661.53	$1661.53
MIAMI (FL)	$1790.48	$1790.48
REST OF FLORIDA (FL)	$1583.89	$1583.89
ATLANTA (GA)	$1569.13	$1569.13
REST OF GEORGIA (GA)	$1501.72	$1501.72
HAWAII, GUAM (HI)	$1529.54	$1529.54
IOWA (IA)	$1387.08	$1387.08
IDAHO (ID)	$1401.72	$1401.72
EAST ST. LOUIS (IL)	$1646.73	$1646.73
SUBURBAN CHICAGO (IL)	$1668.96	$1668.96
CHICAGO (IL)	$1740.86	$1740.86
REST OF ILLINOIS (IL)	$1571.44	$1571.44
INDIANA (IN)	$1407.37	$1407.37
KANSAS (KS)	$1398.47	$1398.47
KENTUCKY (KY)	$1456.15	$1456.15
NEW ORLEANS (LA)	$1517.87	$1517.87
REST OF LOUISIANA (LA)	$1460.94	$1460.94
METROPOLITAN BOSTON (MA)	$1643.24	$1643.24
REST OF MASSACHUSETTS (MA)	$1534.95	$1534.95
BALTIMORE/SURR. CNTYS (MD)	$1615.13	$1615.13
REST OF MARYLAND (MD)	$1528.08	$1528.08
SOUTHERN MAINE (ME)	$1463.15	$1463.15
REST OF MAINE (ME)	$1425.41	$1425.41
DETROIT (MI)	$1617.59	$1617.59
REST OF MICHIGAN (MI)	$1502.44	$1502.44
MINNESOTA (MN)	$1429.32	$1429.32
METROPOLITAN ST. LOUIS (MO)	$1502.19	$1502.19
METROPOLITAN KANSAS CITY (MO)	$1491.57	$1491.57
REST OF MISSOURI (MO)	$1451.72	$1451.72
MISSISSIPPI (MS)	$1413.85	$1413.85
MONTANA** (MT)	$1526.10	$1526.10
NORTH CAROLINA (NC)	$1434.76	$1434.76
NORTH DAKOTA** (ND)	$1431.98	$1431.98
NEBRASKA (NE)	$1388.16	$1388.16
NEW HAMPSHIRE (NH)	$1527.51	$1527.51
NORTHERN NJ (NJ)	$1672.98	$1672.98
REST OF NEW JERSEY (NJ)	$1623.13	$1623.13
NEW MEXICO (NM)	$1515.93	$1515.93
NEVADA** (NV)	$1500.38	$1500.38
MANHATTAN (NY)	$1757.22	$1757.22
NYC SUBURBS/LONG ISLAND (NY)	$1814.11	$1814.11
POUGHKPSIE/N NYC SUBURBS (NY)	$1646.91	$1646.91
QUEENS (NY)	$1744.55	$1744.55
REST OF NEW YORK (NY)	$1453.63	$1453.63
OHIO (OH)	$1483.20	$1483.20
OKLAHOMA (OK)	$1436.25	$1436.25
PORTLAND (OR)	$1556.18	$1556.18
REST OF OREGON (OR)	$1477.16	$1477.16
METROPOLITAN PHILADELPHIA (PA)	$1593.48	$1593.48
REST OF PENNSYLVANIA (PA)	$1475.74	$1475.74
PUERTO RICO (PR)	$1529.66	$1529.66
RHODE ISLAND (RI)	$1542.39	$1542.39
SOUTH CAROLINA (SC)	$1463.71	$1463.71
SOUTH DAKOTA** (SD)	$1420.85	$1420.85
TENNESSEE (TN)	$1406.28	$1406.28
BRAZORIA (TX)	$1493.69	$1493.69
DALLAS (TX)	$1509.50	$1509.50
GALVESTON (TX)	$1502.34	$1502.34
HOUSTON (TX)	$1589.47	$1589.47
BEAUMONT (TX)	$1469.11	$1469.11
FORT WORTH (TX)	$1506.46	$1506.46
AUSTIN (TX)	$1539.67	$1539.67
REST OF TEXAS (TX)	$1484.92	$1484.92
UTAH (UT)	$1479.52	$1479.52
VIRGINIA (VA)	$1470.99	$1470.99
VIRGIN ISLANDS (VI)	$1529.66	$1529.66
VERMONT (VT)	$1442.77	$1442.77
SEATTLE (KING CNTY) (WA)	$1656.21	$1656.21
REST OF WASHINGTON (WA)	$1526.65	$1526.65
WISCONSIN (WI)	$1394.92	$1394.92
WEST VIRGINIA (WV)	$1527.96	$1527.96
WYOMING** (WY)	$1485.08	$1485.08

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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 Physician Fee Schedule amount is 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 provider's locality to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility settings can have different practice-expense RVUs, since Medicare assumes different overhead costs depending on where the service is performed (e.g., physician office vs. hospital). The resulting total is the Medicare-approved amount before patient cost-sharing is applied.

RVUs — work 25.63, practice expense 15.31 (non-facility) / 15.31 (facility), malpractice 4.76 — × 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 approved amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service codes, sequestration, and multiple-procedure payment rules can change the actual amount paid.
Annual budget-neutrality adjustments and conversion factor updates may cause amounts to differ from prior years.
Always confirm final allowed amounts and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

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

Facility and non-facility rates differ because the practice-expense RVU reflects the overhead costs typically assumed for that setting — non-facility (e.g., office) usually includes more overhead than facility (e.g., hospital), where the facility itself bears some costs.

Why does the Medicare amount vary by locality?

Locality-specific GPCIs adjust the work, practice expense, and malpractice RVUs to reflect regional differences in wages, rents, and other costs, so the same code can have different allowed amounts in different areas.

Is this the amount my practice will actually be paid?

Not necessarily. This is an estimated PFS allowed amount; actual payment depends on modifiers, secondary payer adjustments, sequestration, and any applicable payment policy exceptions.

Where can I verify the exact payment for my claim?

Your Medicare Administrative Contractor (MAC) can provide the most current and claim-specific allowed amount, including any locality or policy adjustments.

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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.