Medicare Reimbursement for CPT 21436

CPT 21436 is a physician procedure code (descriptor not shown here due to AMA licensing restrictions). This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1804.65	$1804.65
ALASKA* (AK)	$2256.90	$2256.90
ALABAMA (AL)	$1645.74	$1645.74
ARKANSAS (AR)	$1626.23	$1626.23
ARIZONA (AZ)	$1758.57	$1758.57
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2053.14	$2053.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2083.11	$2083.11
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1878.65	$1878.65
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1899.63	$1899.63
NAPA (CA)	$1978.40	$1978.40
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2059.37	$2059.37
VALLEJO (CA)	$1969.41	$1969.41
BAKERSFIELD (CA)	$1812.62	$1812.62
CHICO (CA)	$1797.26	$1797.26
FRESNO (CA)	$1797.26	$1797.26
HANFORD-CORCORAN (CA)	$1797.26	$1797.26
MADERA (CA)	$1797.26	$1797.26
MERCED (CA)	$1797.26	$1797.26
MODESTO (CA)	$1797.26	$1797.26
REDDING (CA)	$1797.26	$1797.26
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1856.38	$1856.38
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1858.53	$1858.53
SALINAS (CA)	$1851.06	$1851.06
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2108.60	$2108.60
SANTA CRUZ-WATSONVILLE (CA)	$1876.73	$1876.73
SANTA ROSA-PETALUMA (CA)	$1893.86	$1893.86
STOCKTON (CA)	$1797.26	$1797.26
VISALIA (CA)	$1797.26	$1797.26
YUBA CITY (CA)	$1797.26	$1797.26
EL CENTRO (CA)	$1798.18	$1798.18
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1874.65	$1874.65
SAN LUIS OBISPO-PASO ROBLES (CA)	$1824.55	$1824.55
SANTA MARIA-SANTA BARBARA (CA)	$1852.54	$1852.54
REST OF CALIFORNIA (CA)	$1797.26	$1797.26
COLORADO (CO)	$1816.95	$1816.95
CONNECTICUT (CT)	$1911.76	$1911.76
DC + MD/VA SUBURBS (DC)	$1991.61	$1991.61
DELAWARE (DE)	$1783.45	$1783.45
FORT LAUDERDALE (FL)	$1961.06	$1961.06
MIAMI (FL)	$2111.04	$2111.04
REST OF FLORIDA (FL)	$1868.96	$1868.96
ATLANTA (GA)	$1854.62	$1854.62
REST OF GEORGIA (GA)	$1771.32	$1771.32
HAWAII, GUAM (HI)	$1814.39	$1814.39
IOWA (IA)	$1640.14	$1640.14
IDAHO (ID)	$1657.24	$1657.24
EAST ST. LOUIS (IL)	$1939.82	$1939.82
SUBURBAN CHICAGO (IL)	$1970.25	$1970.25
CHICAGO (IL)	$2052.20	$2052.20
REST OF ILLINOIS (IL)	$1852.68	$1852.68
INDIANA (IN)	$1664.07	$1664.07
KANSAS (KS)	$1652.78	$1652.78
KENTUCKY (KY)	$1718.62	$1718.62
NEW ORLEANS (LA)	$1792.15	$1792.15
REST OF LOUISIANA (LA)	$1723.97	$1723.97
METROPOLITAN BOSTON (MA)	$1948.05	$1948.05
REST OF MASSACHUSETTS (MA)	$1816.85	$1816.85
BALTIMORE/SURR. CNTYS (MD)	$1910.22	$1910.22
REST OF MARYLAND (MD)	$1807.10	$1807.10
SOUTHERN MAINE (ME)	$1731.28	$1731.28
REST OF MAINE (ME)	$1684.57	$1684.57
DETROIT (MI)	$1908.23	$1908.23
REST OF MICHIGAN (MI)	$1773.09	$1773.09
MINNESOTA (MN)	$1693.96	$1693.96
METROPOLITAN ST. LOUIS (MO)	$1774.56	$1774.56
METROPOLITAN KANSAS CITY (MO)	$1761.72	$1761.72
REST OF MISSOURI (MO)	$1712.31	$1712.31
MISSISSIPPI (MS)	$1668.58	$1668.58
MONTANA** (MT)	$1804.28	$1804.28
NORTH CAROLINA (NC)	$1695.93	$1695.93
NORTH DAKOTA** (ND)	$1695.73	$1695.73
NEBRASKA (NE)	$1641.73	$1641.73
NEW HAMPSHIRE (NH)	$1807.75	$1807.75
NORTHERN NJ (NJ)	$1980.82	$1980.82
REST OF NEW JERSEY (NJ)	$1920.29	$1920.29
NEW MEXICO (NM)	$1788.83	$1788.83
NEVADA** (NV)	$1774.66	$1774.66
MANHATTAN (NY)	$2078.06	$2078.06
NYC SUBURBS/LONG ISLAND (NY)	$2144.89	$2144.89
POUGHKPSIE/N NYC SUBURBS (NY)	$1947.85	$1947.85
QUEENS (NY)	$2064.35	$2064.35
REST OF NEW YORK (NY)	$1718.46	$1718.46
OHIO (OH)	$1750.91	$1750.91
OKLAHOMA (OK)	$1695.85	$1695.85
PORTLAND (OR)	$1843.94	$1843.94
REST OF OREGON (OR)	$1747.65	$1747.65
METROPOLITAN PHILADELPHIA (PA)	$1883.82	$1883.82
REST OF PENNSYLVANIA (PA)	$1742.53	$1742.53
PUERTO RICO (PR)	$1808.88	$1808.88
RHODE ISLAND (RI)	$1824.54	$1824.54
SOUTH CAROLINA (SC)	$1728.91	$1728.91
SOUTH DAKOTA** (SD)	$1682.89	$1682.89
TENNESSEE (TN)	$1662.00	$1662.00
BRAZORIA (TX)	$1766.49	$1766.49
DALLAS (TX)	$1784.95	$1784.95
GALVESTON (TX)	$1776.56	$1776.56
HOUSTON (TX)	$1877.05	$1877.05
BEAUMONT (TX)	$1734.52	$1734.52
FORT WORTH (TX)	$1780.99	$1780.99
AUSTIN (TX)	$1822.53	$1822.53
REST OF TEXAS (TX)	$1754.50	$1754.50
UTAH (UT)	$1747.87	$1747.87
VIRGINIA (VA)	$1739.95	$1739.95
VIRGIN ISLANDS (VI)	$1808.88	$1808.88
VERMONT (VT)	$1707.72	$1707.72
SEATTLE (KING CNTY) (WA)	$1964.48	$1964.48
REST OF WASHINGTON (WA)	$1807.29	$1807.29
WISCONSIN (WI)	$1651.10	$1651.10
WEST VIRGINIA (WV)	$1800.55	$1800.55
WYOMING** (WY)	$1756.97	$1756.97

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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, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) specific to a given locality. These geographically adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Because practice expense RVUs differ depending on where the service is performed, non-facility (e.g., office) and facility (e.g., hospital) settings can show different totals. National figures use a standard set of inputs before locality-specific GPCI adjustments are applied.

RVUs — work 29.54, practice expense 19 (non-facility) / 19 (facility), malpractice 5.49 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure 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.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual budget-neutrality adjustments and RVU updates mean amounts can change year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the amount differ between non-facility and facility settings?

Practice expense RVUs reflect different overhead assumptions depending on whether the service is performed in a physician office versus a hospital or ambulatory surgical center, which can change the total payment.

Why might my local payment differ from the national amount shown here?

Local Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs to reflect cost-of-living and other regional differences, so actual payments vary by locality.

Is this the amount my practice will actually be paid?

No. This is an estimated PFS allowed amount before deductible, coinsurance, modifiers, and any claim-specific adjustments are applied.

Where can I find the official CPT descriptor for this code?

CPT code descriptors are copyrighted by the American Medical Association; consult the current CPT codebook or your MAC's fee schedule lookup tool for the official description.

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.