Medicare Reimbursement for CPT 21453

CPT code 21453 is a physician procedure code reported to Medicare for payment purposes; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and, where available, adjusted for your local area, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1120.60	$891.80
ALASKA* (AK)	$1270.62	$1026.95
ALABAMA (AL)	$997.42	$797.23
ARKANSAS (AR)	$981.81	$785.27
ARIZONA (AZ)	$1088.86	$867.16
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1479.73	$1157.13
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1509.95	$1180.03
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1272.97	$1002.53
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1277.99	$1007.33
NAPA (CA)	$1395.33	$1093.78
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1480.84	$1158.24
VALLEJO (CA)	$1393.73	$1092.17
BAKERSFIELD (CA)	$1195.60	$944.84
CHICO (CA)	$1192.78	$942.01
FRESNO (CA)	$1192.78	$942.01
HANFORD-CORCORAN (CA)	$1192.78	$942.01
MADERA (CA)	$1192.78	$942.01
MERCED (CA)	$1192.78	$942.01
MODESTO (CA)	$1192.78	$942.01
REDDING (CA)	$1192.78	$942.01
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1203.37	$952.61
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1255.29	$989.20
SALINAS (CA)	$1250.72	$985.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1514.50	$1184.58
SANTA CRUZ-WATSONVILLE (CA)	$1297.38	$1019.39
SANTA ROSA-PETALUMA (CA)	$1310.66	$1029.70
STOCKTON (CA)	$1192.78	$942.01
VISALIA (CA)	$1192.78	$942.01
YUBA CITY (CA)	$1192.78	$942.01
EL CENTRO (CA)	$1192.94	$942.18
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1282.96	$1009.32
SAN LUIS OBISPO-PASO ROBLES (CA)	$1230.26	$969.66
SANTA MARIA-SANTA BARBARA (CA)	$1256.18	$989.40
REST OF CALIFORNIA (CA)	$1192.78	$942.01
COLORADO (CO)	$1171.82	$928.38
CONNECTICUT (CT)	$1198.92	$952.51
DC + MD/VA SUBURBS (DC)	$1291.14	$1021.62
DELAWARE (DE)	$1107.91	$881.86
FORT LAUDERDALE (FL)	$1158.38	$926.61
MIAMI (FL)	$1206.39	$968.21
REST OF FLORIDA (FL)	$1098.71	$879.98
ATLANTA (GA)	$1141.78	$909.32
REST OF GEORGIA (GA)	$1032.73	$828.65
HAWAII, GUAM (HI)	$1226.25	$966.11
IOWA (IA)	$1026.76	$817.41
IDAHO (ID)	$1033.61	$823.12
EAST ST. LOUIS (IL)	$1084.05	$873.56
SUBURBAN CHICAGO (IL)	$1170.92	$935.95
CHICAGO (IL)	$1168.86	$938.92
REST OF ILLINOIS (IL)	$1063.19	$854.29
INDIANA (IN)	$1040.14	$828.04
KANSAS (KS)	$1020.68	$813.84
KENTUCKY (KY)	$1021.05	$817.65
NEW ORLEANS (LA)	$1073.62	$858.32
REST OF LOUISIANA (LA)	$1018.97	$816.49
METROPOLITAN BOSTON (MA)	$1294.98	$1021.80
REST OF MASSACHUSETTS (MA)	$1163.62	$922.69
BALTIMORE/SURR. CNTYS (MD)	$1195.45	$949.96
REST OF MARYLAND (MD)	$1130.54	$899.00
SOUTHERN MAINE (ME)	$1100.68	$873.94
REST OF MAINE (ME)	$1038.49	$827.99
DETROIT (MI)	$1112.54	$891.75
REST OF MICHIGAN (MI)	$1048.98	$840.09
MINNESOTA (MN)	$1122.84	$887.41
METROPOLITAN ST. LOUIS (MO)	$1078.82	$861.01
METROPOLITAN KANSAS CITY (MO)	$1066.67	$851.83
REST OF MISSOURI (MO)	$999.45	$802.22
MISSISSIPPI (MS)	$990.88	$793.89
MONTANA** (MT)	$1120.53	$891.74
NORTH CAROLINA (NC)	$1050.38	$836.91
NORTH DAKOTA** (ND)	$1101.16	$872.36
NEBRASKA (NE)	$1033.11	$821.94
NEW HAMPSHIRE (NH)	$1152.25	$914.07
NORTHERN NJ (NJ)	$1275.92	$1010.52
REST OF NEW JERSEY (NJ)	$1212.62	$962.78
NEW MEXICO (NM)	$1054.82	$845.02
NEVADA** (NV)	$1116.01	$886.98
MANHATTAN (NY)	$1294.84	$1028.98
NYC SUBURBS/LONG ISLAND (NY)	$1327.25	$1055.21
POUGHKPSIE/N NYC SUBURBS (NY)	$1220.02	$969.48
QUEENS (NY)	$1307.56	$1037.12
REST OF NEW YORK (NY)	$1067.29	$849.93
OHIO (OH)	$1045.02	$836.13
OKLAHOMA (OK)	$1020.02	$815.71
PORTLAND (OR)	$1212.44	$958.25
REST OF OREGON (OR)	$1107.39	$879.51
METROPOLITAN PHILADELPHIA (PA)	$1166.55	$928.37
REST OF PENNSYLVANIA (PA)	$1047.32	$837.28
PUERTO RICO (PR)	$1129.70	$898.39
RHODE ISLAND (RI)	$1149.94	$913.59
SOUTH CAROLINA (SC)	$1049.44	$838.03
SOUTH DAKOTA** (SD)	$1098.87	$870.07
TENNESSEE (TN)	$1026.11	$818.14
BRAZORIA (TX)	$1107.28	$880.54
DALLAS (TX)	$1114.41	$886.53
GALVESTON (TX)	$1110.60	$883.40
HOUSTON (TX)	$1128.53	$901.34
BEAUMONT (TX)	$1039.82	$831.61
FORT WORTH (TX)	$1106.12	$880.52
AUSTIN (TX)	$1167.86	$925.80
REST OF TEXAS (TX)	$1072.97	$855.84
UTAH (UT)	$1064.96	$849.89
VIRGINIA (VA)	$1096.16	$871.25
VIRGIN ISLANDS (VI)	$1129.70	$898.39
VERMONT (VT)	$1095.71	$869.20
SEATTLE (KING CNTY) (WA)	$1323.31	$1042.57
REST OF WASHINGTON (WA)	$1161.79	$920.87
WISCONSIN (WI)	$1061.33	$842.15
WEST VIRGINIA (WV)	$1020.51	$821.68
WYOMING** (WY)	$1112.09	$883.29

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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 payment is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility settings differ because practice-expense RVUs are lower when the service is performed in a facility (since the facility, not the physician's practice, bears certain overhead costs). The resulting total represents the full allowed amount before any patient cost-sharing is applied.

RVUs — work 6.47, practice expense 26.1 (non-facility) / 19.25 (facility), malpractice 0.98 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement can differ.
Medicare typically pays 80% of the allowed amount after the patient's Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Amounts shown are national/locality estimates and do not account for modifiers, site-of-service adjustments, sequestration, or mid-year budget-neutrality changes.
Final payment is determined by your local Medicare Administrative Contractor (MAC) and may vary from these figures.
RVUs and conversion factors are updated annually and can change the final payment amount in future years.

Frequently asked

Why is the facility amount lower than the non-facility amount?

In a facility setting, the facility (e.g., hospital) absorbs certain overhead and equipment costs, so the practice-expense RVU — and therefore the total payment to the billing physician — is lower than when the same service is performed in a non-facility setting like a private office.

Does this figure reflect what Medicare will actually pay?

No. This is the Medicare Physician Fee Schedule allowed amount estimate. Medicare generally pays 80% of this amount after the deductible is met, and the actual payment can be affected by modifiers, sequestration, and locality-specific adjustments.

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

Medicare adjusts RVUs using Geographic Practice Cost Indices (GPCIs) that reflect regional differences in wages, rents, and malpractice costs. Localities with higher costs of practice typically see higher adjusted payment amounts, and lower-cost areas see lower amounts.

Can I use this number for claim appeals or billing disputes?

This page is for informational reference only. For claim-specific issues, denials, or appeals, verify the applicable fee schedule amount and policy directly with your Medicare Administrative Contractor (MAC).

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.