Medicare Reimbursement for CPT 21450

CPT 21450 is a physician procedure code reported to Medicare for payment purposes; the full descriptor is maintained by the AMA and is not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount nationally and can be adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$597.88	$459.93
ALASKA* (AK)	$682.30	$535.38
ALABAMA (AL)	$534.02	$413.32
ARKANSAS (AR)	$525.91	$407.42
ARIZONA (AZ)	$581.54	$447.87
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$791.43	$596.93
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$807.68	$608.77
OXNARD-THOUSAND OAKS-VENTURA (CA)	$680.41	$517.36
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$683.01	$519.82
NAPA (CA)	$746.08	$564.26
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$791.89	$597.39
VALLEJO (CA)	$745.40	$563.59
BAKERSFIELD (CA)	$639.29	$488.10
CHICO (CA)	$638.05	$486.86
FRESNO (CA)	$638.05	$486.86
HANFORD-CORCORAN (CA)	$638.05	$486.86
MADERA (CA)	$638.05	$486.86
MERCED (CA)	$638.05	$486.86
MODESTO (CA)	$638.05	$486.86
REDDING (CA)	$638.05	$486.86
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$642.51	$491.32
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$671.39	$510.96
SALINAS (CA)	$668.93	$509.05
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$809.59	$610.67
SANTA CRUZ-WATSONVILLE (CA)	$693.66	$526.06
SANTA ROSA-PETALUMA (CA)	$700.77	$531.38
STOCKTON (CA)	$638.05	$486.86
VISALIA (CA)	$638.05	$486.86
YUBA CITY (CA)	$638.05	$486.86
EL CENTRO (CA)	$638.12	$486.93
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$686.03	$521.05
SAN LUIS OBISPO-PASO ROBLES (CA)	$657.97	$500.85
SANTA MARIA-SANTA BARBARA (CA)	$671.81	$510.97
REST OF CALIFORNIA (CA)	$638.05	$486.86
COLORADO (CO)	$625.98	$479.20
CONNECTICUT (CT)	$638.84	$490.27
DC + MD/VA SUBURBS (DC)	$688.41	$525.91
DELAWARE (DE)	$591.54	$455.25
FORT LAUDERDALE (FL)	$614.96	$475.22
MIAMI (FL)	$637.81	$494.21
REST OF FLORIDA (FL)	$584.38	$452.50
ATLANTA (GA)	$608.40	$468.25
REST OF GEORGIA (GA)	$550.47	$427.42
HAWAII, GUAM (HI)	$655.58	$498.73
IOWA (IA)	$550.24	$424.02
IDAHO (ID)	$553.60	$426.69
EAST ST. LOUIS (IL)	$574.70	$447.79
SUBURBAN CHICAGO (IL)	$621.80	$480.13
CHICAGO (IL)	$618.77	$480.14
REST OF ILLINOIS (IL)	$565.28	$439.34
INDIANA (IN)	$557.02	$429.14
KANSAS (KS)	$546.61	$421.91
KENTUCKY (KY)	$545.29	$422.66
NEW ORLEANS (LA)	$572.41	$442.60
REST OF LOUISIANA (LA)	$544.02	$421.94
METROPOLITAN BOSTON (MA)	$691.20	$526.49
REST OF MASSACHUSETTS (MA)	$621.58	$476.33
BALTIMORE/SURR. CNTYS (MD)	$636.88	$488.86
REST OF MARYLAND (MD)	$603.52	$463.92
SOUTHERN MAINE (ME)	$588.65	$451.95
REST OF MAINE (ME)	$555.64	$428.73
DETROIT (MI)	$591.06	$457.94
REST OF MICHIGAN (MI)	$559.34	$433.39
MINNESOTA (MN)	$601.67	$459.72
METROPOLITAN ST. LOUIS (MO)	$575.67	$444.34
METROPOLITAN KANSAS CITY (MO)	$569.30	$439.77
REST OF MISSOURI (MO)	$533.59	$414.68
MISSISSIPPI (MS)	$529.91	$411.14
MONTANA** (MT)	$597.85	$459.90
NORTH CAROLINA (NC)	$561.89	$433.19
NORTH DAKOTA** (ND)	$589.74	$451.80
NEBRASKA (NE)	$553.69	$426.36
NEW HAMPSHIRE (NH)	$615.16	$471.56
NORTHERN NJ (NJ)	$680.55	$520.53
REST OF NEW JERSEY (NJ)	$646.66	$496.03
NEW MEXICO (NM)	$562.18	$435.68
NEVADA** (NV)	$596.05	$457.97
MANHATTAN (NY)	$688.69	$528.40
NYC SUBURBS/LONG ISLAND (NY)	$704.91	$540.89
POUGHKPSIE/N NYC SUBURBS (NY)	$650.20	$499.15
QUEENS (NY)	$695.98	$532.93
REST OF NEW YORK (NY)	$570.65	$439.60
OHIO (OH)	$557.68	$431.74
OKLAHOMA (OK)	$545.25	$422.07
PORTLAND (OR)	$647.73	$494.47
REST OF OREGON (OR)	$591.96	$454.56
METROPOLITAN PHILADELPHIA (PA)	$621.69	$478.09
REST OF PENNSYLVANIA (PA)	$559.13	$432.50
PUERTO RICO (PR)	$602.77	$463.30
RHODE ISLAND (RI)	$613.98	$471.48
SOUTH CAROLINA (SC)	$560.61	$433.15
SOUTH DAKOTA** (SD)	$588.78	$450.84
TENNESSEE (TN)	$549.38	$423.99
BRAZORIA (TX)	$591.66	$454.96
DALLAS (TX)	$595.17	$457.77
GALVESTON (TX)	$593.25	$456.26
HOUSTON (TX)	$600.75	$463.77
BEAUMONT (TX)	$555.21	$429.68
FORT WORTH (TX)	$590.71	$454.70
AUSTIN (TX)	$623.43	$477.48
REST OF TEXAS (TX)	$572.92	$442.01
UTAH (UT)	$568.68	$439.01
VIRGINIA (VA)	$585.97	$450.37
VIRGIN ISLANDS (VI)	$602.77	$463.30
VERMONT (VT)	$586.48	$449.91
SEATTLE (KING CNTY) (WA)	$706.58	$537.32
REST OF WASHINGTON (WA)	$620.73	$475.47
WISCONSIN (WI)	$568.94	$436.79
WEST VIRGINIA (WV)	$543.09	$423.22
WYOMING** (WY)	$594.32	$456.37

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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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific 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. Practice-expense RVUs differ depending on whether the service is reported in a non-facility setting (like a physician office) or a facility setting (like a hospital), which is why two different allowed amounts are shown. The national figures use national GPCI averages; actual payment in a specific locality will differ based on that area's cost index values.

RVUs — work 3.62, practice expense 13.87 (non-facility) / 9.74 (facility), malpractice 0.41 — × 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 annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs can cause the actual allowed amount to differ meaningfully from the national figure shown.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why are there two different amounts for this code?

Medicare uses separate practice-expense RVUs for non-facility (e.g., physician office) and facility (e.g., hospital) settings because overhead costs differ, resulting in two distinct allowed amounts.

Why might my locality's payment differ from the national amount shown?

The national amount uses national average GPCIs. Actual payment is calculated using the GPCIs specific to the locality where the service was rendered, which can raise or lower the final amount.

Does this amount include the patient's share?

No. The figure represents the total Medicare allowed amount. Medicare generally pays 80% after the deductible, with the remaining 20% typically owed by the patient or a secondary payer.

Will modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple-procedure reductions can increase or decrease the final payment relative to the base fee schedule amount shown here.

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.