Medicare Reimbursement for CPT 21445

This page covers Medicare Physician Fee Schedule (PFS) estimated allowed amounts for this procedure code (CPT 21445), a service defined by the American Medical Association's CPT code set. Amounts are shown nationally and can vary by locality, and are broken out by non-facility (e.g., office) versus facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$753.19	$566.81
ALASKA* (AK)	$878.93	$680.44
ALABAMA (AL)	$677.39	$514.31
ARKANSAS (AR)	$667.79	$507.69
ARIZONA (AZ)	$733.55	$552.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$975.12	$712.33
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$994.37	$725.62
OXNARD-THOUSAND OAKS-VENTURA (CA)	$846.01	$625.71
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$850.13	$629.65
NAPA (CA)	$922.08	$676.44
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$975.90	$713.11
VALLEJO (CA)	$920.95	$675.31
BAKERSFIELD (CA)	$798.58	$594.32
CHICO (CA)	$796.49	$592.23
FRESNO (CA)	$796.49	$592.23
HANFORD-CORCORAN (CA)	$796.49	$592.23
MADERA (CA)	$796.49	$592.23
MERCED (CA)	$796.49	$592.23
MODESTO (CA)	$796.49	$592.23
REDDING (CA)	$796.49	$592.23
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$804.00	$599.73
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$835.63	$618.88
SALINAS (CA)	$832.51	$616.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$997.58	$728.82
SANTA CRUZ-WATSONVILLE (CA)	$859.95	$633.50
SANTA ROSA-PETALUMA (CA)	$868.63	$639.76
STOCKTON (CA)	$796.49	$592.23
VISALIA (CA)	$796.49	$592.23
YUBA CITY (CA)	$796.49	$592.23
EL CENTRO (CA)	$796.61	$592.34
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$851.92	$629.01
SAN LUIS OBISPO-PASO ROBLES (CA)	$819.13	$606.85
SANTA MARIA-SANTA BARBARA (CA)	$835.58	$618.27
REST OF CALIFORNIA (CA)	$796.49	$592.23
COLORADO (CO)	$784.28	$585.97
CONNECTICUT (CT)	$802.64	$601.91
DC + MD/VA SUBURBS (DC)	$860.50	$640.94
DELAWARE (DE)	$745.56	$561.42
FORT LAUDERDALE (FL)	$778.66	$589.86
MIAMI (FL)	$810.01	$615.99
REST OF FLORIDA (FL)	$741.62	$563.44
ATLANTA (GA)	$766.86	$577.50
REST OF GEORGIA (GA)	$700.76	$534.52
HAWAII, GUAM (HI)	$815.60	$603.69
IOWA (IA)	$694.55	$524.01
IDAHO (ID)	$698.93	$527.47
EAST ST. LOUIS (IL)	$734.45	$562.98
SUBURBAN CHICAGO (IL)	$786.62	$595.21
CHICAGO (IL)	$787.09	$599.78
REST OF ILLINOIS (IL)	$720.37	$550.21
INDIANA (IN)	$702.92	$530.15
KANSAS (KS)	$691.22	$522.74
KENTUCKY (KY)	$692.80	$527.11
NEW ORLEANS (LA)	$725.27	$549.89
REST OF LOUISIANA (LA)	$691.69	$526.74
METROPOLITAN BOSTON (MA)	$861.13	$638.60
REST OF MASSACHUSETTS (MA)	$779.67	$583.42
BALTIMORE/SURR. CNTYS (MD)	$800.34	$600.36
REST OF MARYLAND (MD)	$759.65	$571.04
SOUTHERN MAINE (ME)	$739.95	$555.25
REST OF MAINE (ME)	$702.37	$530.90
DETROIT (MI)	$750.58	$570.72
REST OF MICHIGAN (MI)	$710.37	$540.20
MINNESOTA (MN)	$752.23	$560.45
METROPOLITAN ST. LOUIS (MO)	$727.97	$550.54
METROPOLITAN KANSAS CITY (MO)	$720.55	$545.54
REST OF MISSOURI (MO)	$679.95	$519.29
MISSISSIPPI (MS)	$674.01	$513.54
MONTANA** (MT)	$753.14	$566.77
NORTH CAROLINA (NC)	$709.60	$535.71
NORTH DAKOTA** (ND)	$739.50	$553.12
NEBRASKA (NE)	$698.32	$526.30
NEW HAMPSHIRE (NH)	$771.89	$577.87
NORTHERN NJ (NJ)	$851.82	$635.62
REST OF NEW JERSEY (NJ)	$812.00	$608.48
NEW MEXICO (NM)	$714.13	$543.22
NEVADA** (NV)	$749.87	$563.30
MANHATTAN (NY)	$865.01	$648.44
NYC SUBURBS/LONG ISLAND (NY)	$885.47	$663.87
POUGHKPSIE/N NYC SUBURBS (NY)	$817.21	$613.12
QUEENS (NY)	$872.22	$651.92
REST OF NEW YORK (NY)	$720.03	$542.97
OHIO (OH)	$707.58	$537.42
OKLAHOMA (OK)	$691.73	$525.29
PORTLAND (OR)	$808.98	$601.92
REST OF OREGON (OR)	$744.24	$558.61
METROPOLITAN PHILADELPHIA (PA)	$782.89	$588.87
REST OF PENNSYLVANIA (PA)	$708.76	$537.66
PUERTO RICO (PR)	$758.63	$570.21
RHODE ISLAND (RI)	$771.94	$579.42
SOUTH CAROLINA (SC)	$709.73	$537.51
SOUTH DAKOTA** (SD)	$737.89	$551.51
TENNESSEE (TN)	$694.62	$525.20
BRAZORIA (TX)	$745.01	$560.31
DALLAS (TX)	$749.65	$564.01
GALVESTON (TX)	$747.17	$562.10
HOUSTON (TX)	$759.80	$574.73
BEAUMONT (TX)	$704.18	$534.58
FORT WORTH (TX)	$744.68	$560.91
AUSTIN (TX)	$781.50	$584.31
REST OF TEXAS (TX)	$724.11	$547.24
UTAH (UT)	$719.26	$544.06
VIRGINIA (VA)	$737.47	$554.26
VIRGIN ISLANDS (VI)	$758.63	$570.21
VERMONT (VT)	$736.54	$552.03
SEATTLE (KING CNTY) (WA)	$878.65	$649.97
REST OF WASHINGTON (WA)	$778.23	$581.97
WISCONSIN (WI)	$715.13	$536.58
WEST VIRGINIA (WV)	$694.17	$532.20
WYOMING** (WY)	$747.20	$560.82

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units per patient per day — Date of Service Edit: Clinical. 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 — assigned to the code each year. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, 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 differ between non-facility and facility settings, which is why the same code typically has two different allowed amounts depending on where it's billed.

RVUs — work 6.1, practice expense 15.76 (non-facility) / 10.18 (facility), malpractice 0.69 — × 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 patient or secondary payer is responsible for the rest.
Actual payment can vary by locality, applicable modifiers, claim-specific adjustments, and sequestration.
Annual updates to RVUs, GPCIs, and the conversion factor — including budget-neutrality adjustments — can change this amount each year.
Verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does CPT 21445 show two different national amounts?

The non-facility amount applies when the service is performed in a setting like a physician's office, while the facility amount applies in settings like a hospital, where Medicare separately reimburses the facility for overhead. Practice expense RVUs differ between the two, producing different totals.

Why isn't the CPT code description shown on this page?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so they cannot be reproduced here. You can look up the official descriptor in your CPT codebook or AMA-licensed coding software.

Will the amount shown match what I actually get paid?

Not necessarily. The figure is a national or locality-adjusted estimate based on standard PFS inputs. Your actual payment can differ due to local GPCI values, modifiers, secondary payers, sequestration, and other claim-specific factors.

Does this amount change every year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and these updates — along with budget-neutrality requirements — can raise or lower the allowed amount for a given code from year to year.

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.