Medicare Reimbursement for CPT 21435

CPT 21435 is a procedure code defined by the American Medical Association; its specific clinical description is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1261.55	$1261.55
ALASKA* (AK)	$1567.67	$1567.67
ALABAMA (AL)	$1148.54	$1148.54
ARKANSAS (AR)	$1134.63	$1134.63
ARIZONA (AZ)	$1229.08	$1229.08
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1450.58	$1450.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1472.40	$1472.40
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1321.23	$1321.23
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1335.30	$1335.30
NAPA (CA)	$1395.49	$1395.49
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1454.74	$1454.74
VALLEJO (CA)	$1389.50	$1389.50
BAKERSFIELD (CA)	$1272.33	$1272.33
CHICO (CA)	$1262.09	$1262.09
FRESNO (CA)	$1262.09	$1262.09
HANFORD-CORCORAN (CA)	$1262.09	$1262.09
MADERA (CA)	$1262.09	$1262.09
MERCED (CA)	$1262.09	$1262.09
MODESTO (CA)	$1262.09	$1262.09
REDDING (CA)	$1262.09	$1262.09
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1301.50	$1301.50
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1306.76	$1306.76
SALINAS (CA)	$1301.54	$1301.54
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1489.39	$1489.39
SANTA CRUZ-WATSONVILLE (CA)	$1321.80	$1321.80
SANTA ROSA-PETALUMA (CA)	$1333.98	$1333.98
STOCKTON (CA)	$1262.09	$1262.09
VISALIA (CA)	$1262.09	$1262.09
YUBA CITY (CA)	$1262.09	$1262.09
EL CENTRO (CA)	$1262.70	$1262.70
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1319.36	$1319.36
SAN LUIS OBISPO-PASO ROBLES (CA)	$1282.71	$1282.71
SANTA MARIA-SANTA BARBARA (CA)	$1302.92	$1302.92
REST OF CALIFORNIA (CA)	$1262.09	$1262.09
COLORADO (CO)	$1273.39	$1273.39
CONNECTICUT (CT)	$1337.35	$1337.35
DC + MD/VA SUBURBS (DC)	$1396.36	$1396.36
DELAWARE (DE)	$1246.75	$1246.75
FORT LAUDERDALE (FL)	$1366.56	$1366.56
MIAMI (FL)	$1468.13	$1468.13
REST OF FLORIDA (FL)	$1301.94	$1301.94
ATLANTA (GA)	$1295.78	$1295.78
REST OF GEORGIA (GA)	$1233.22	$1233.22
HAWAII, GUAM (HI)	$1275.80	$1275.80
IOWA (IA)	$1147.07	$1147.07
IDAHO (ID)	$1158.76	$1158.76
EAST ST. LOUIS (IL)	$1347.14	$1347.14
SUBURBAN CHICAGO (IL)	$1373.49	$1373.49
CHICAGO (IL)	$1426.88	$1426.88
REST OF ILLINOIS (IL)	$1288.65	$1288.65
INDIANA (IN)	$1163.70	$1163.70
KANSAS (KS)	$1154.87	$1154.87
KENTUCKY (KY)	$1197.92	$1197.92
NEW ORLEANS (LA)	$1249.88	$1249.88
REST OF LOUISIANA (LA)	$1201.26	$1201.26
METROPOLITAN BOSTON (MA)	$1368.20	$1368.20
REST OF MASSACHUSETTS (MA)	$1272.71	$1272.71
BALTIMORE/SURR. CNTYS (MD)	$1336.09	$1336.09
REST OF MARYLAND (MD)	$1263.88	$1263.88
SOUTHERN MAINE (ME)	$1212.13	$1212.13
REST OF MAINE (ME)	$1176.97	$1176.97
DETROIT (MI)	$1328.63	$1328.63
REST OF MICHIGAN (MI)	$1235.59	$1235.59
MINNESOTA (MN)	$1189.40	$1189.40
METROPOLITAN ST. LOUIS (MO)	$1238.77	$1238.77
METROPOLITAN KANSAS CITY (MO)	$1229.48	$1229.48
REST OF MISSOURI (MO)	$1192.18	$1192.18
MISSISSIPPI (MS)	$1162.98	$1162.98
MONTANA** (MT)	$1261.31	$1261.31
NORTH CAROLINA (NC)	$1185.29	$1185.29
NORTH DAKOTA** (ND)	$1188.94	$1188.94
NEBRASKA (NE)	$1148.58	$1148.58
NEW HAMPSHIRE (NH)	$1265.94	$1265.94
NORTHERN NJ (NJ)	$1388.17	$1388.17
REST OF NEW JERSEY (NJ)	$1343.92	$1343.92
NEW MEXICO (NM)	$1246.31	$1246.31
NEVADA** (NV)	$1241.62	$1241.62
MANHATTAN (NY)	$1453.11	$1453.11
NYC SUBURBS/LONG ISLAND (NY)	$1499.19	$1499.19
POUGHKPSIE/N NYC SUBURBS (NY)	$1362.47	$1362.47
QUEENS (NY)	$1445.10	$1445.10
REST OF NEW YORK (NY)	$1201.26	$1201.26
OHIO (OH)	$1220.80	$1220.80
OKLAHOMA (OK)	$1182.97	$1182.97
PORTLAND (OR)	$1294.05	$1294.05
REST OF OREGON (OR)	$1223.33	$1223.33
METROPOLITAN PHILADELPHIA (PA)	$1316.68	$1316.68
REST OF PENNSYLVANIA (PA)	$1215.50	$1215.50
PUERTO RICO (PR)	$1264.99	$1264.99
RHODE ISLAND (RI)	$1276.71	$1276.71
SOUTH CAROLINA (SC)	$1206.76	$1206.76
SOUTH DAKOTA** (SD)	$1180.38	$1180.38
TENNESSEE (TN)	$1161.30	$1161.30
BRAZORIA (TX)	$1235.62	$1235.62
DALLAS (TX)	$1248.21	$1248.21
GALVESTON (TX)	$1242.45	$1242.45
HOUSTON (TX)	$1309.44	$1309.44
BEAUMONT (TX)	$1209.71	$1209.71
FORT WORTH (TX)	$1245.00	$1245.00
AUSTIN (TX)	$1276.75	$1276.75
REST OF TEXAS (TX)	$1225.23	$1225.23
UTAH (UT)	$1220.30	$1220.30
VIRGINIA (VA)	$1217.46	$1217.46
VIRGIN ISLANDS (VI)	$1264.99	$1264.99
VERMONT (VT)	$1196.37	$1196.37
SEATTLE (KING CNTY) (WA)	$1381.04	$1381.04
REST OF WASHINGTON (WA)	$1266.33	$1266.33
WISCONSIN (WI)	$1156.81	$1156.81
WEST VIRGINIA (WV)	$1251.41	$1251.41
WYOMING** (WY)	$1229.77	$1229.77

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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 locality where the service is performed, reflecting local cost-of-living and practice-cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs, since the relative cost of performing a service in an office versus a hospital or ambulatory surgical center differs; for some codes, as shown here, the non-facility and facility PE RVUs and resulting amounts are the same.

RVUs — work 19.75, practice expense 14.36 (non-facility) / 14.36 (facility), malpractice 3.66 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national RVUs and the standard conversion factor; your actual payment may differ.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
Final payment can be affected by modifiers, place-of-service rules, sequestration reductions, and annual budget-neutrality adjustments.
Locality-adjusted amounts depend on the GPCIs for the specific Medicare Administrative Contractor (MAC) jurisdiction and may change yearly.
Always confirm current rates and coverage policy with your MAC or official CMS fee schedule files before billing.

Frequently asked

Why do the non-facility and facility amounts look the same for this code?

When the practice-expense RVU is identical in both settings, the calculated allowed amount will also be the same, since work and malpractice RVUs don't change by setting.

Does this amount reflect what my practice will actually be paid?

No. It's a national estimate based on standard RVUs and the conversion factor. Actual payment depends on your locality's GPCIs, your contract, modifiers used, and any applicable adjustments.

Why can't you show the CPT code description?

CPT code descriptors are copyrighted by the American Medical Association and can't be reproduced without a license, so this page refers to the code generically.

How often do these fee schedule amounts change?

Medicare typically updates the conversion factor and RVUs annually, and amounts can also be affected by mid-year legislative or regulatory adjustments.

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.