Medicare Reimbursement for CPT 21454

CPT 21454 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 estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and, where available, by locality, with separate figures for non-facility and facility settings. These figures reflect 2026 PFS inputs and are intended as a reference, not a payment guarantee.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$450.58	$450.58
ALASKA* (AK)	$570.11	$570.11
ALABAMA (AL)	$415.77	$415.77
ARKANSAS (AR)	$411.44	$411.44
ARIZONA (AZ)	$440.95	$440.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$532.79	$532.79
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$541.49	$541.49
OXNARD-THOUSAND OAKS-VENTURA (CA)	$480.34	$480.34
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$484.76	$484.76
NAPA (CA)	$510.52	$510.52
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$533.73	$533.73
VALLEJO (CA)	$509.18	$509.18
BAKERSFIELD (CA)	$462.03	$462.03
CHICO (CA)	$459.55	$459.55
FRESNO (CA)	$459.55	$459.55
HANFORD-CORCORAN (CA)	$459.55	$459.55
MADERA (CA)	$459.55	$459.55
MERCED (CA)	$459.55	$459.55
MODESTO (CA)	$459.55	$459.55
REDDING (CA)	$459.55	$459.55
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$468.47	$468.47
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$476.39	$476.39
SALINAS (CA)	$474.46	$474.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$545.30	$545.30
SANTA CRUZ-WATSONVILLE (CA)	$482.33	$482.33
SANTA ROSA-PETALUMA (CA)	$486.87	$486.87
STOCKTON (CA)	$459.55	$459.55
VISALIA (CA)	$459.55	$459.55
YUBA CITY (CA)	$459.55	$459.55
EL CENTRO (CA)	$459.69	$459.69
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$481.17	$481.17
SAN LUIS OBISPO-PASO ROBLES (CA)	$467.44	$467.44
SANTA MARIA-SANTA BARBARA (CA)	$475.02	$475.02
REST OF CALIFORNIA (CA)	$459.55	$459.55
COLORADO (CO)	$459.19	$459.19
CONNECTICUT (CT)	$475.25	$475.25
DC + MD/VA SUBURBS (DC)	$499.26	$499.26
DELAWARE (DE)	$446.81	$446.81
FORT LAUDERDALE (FL)	$475.09	$475.09
MIAMI (FL)	$499.97	$499.97
REST OF FLORIDA (FL)	$456.29	$456.29
ATLANTA (GA)	$459.74	$459.74
REST OF GEORGIA (GA)	$436.03	$436.03
HAWAII, GUAM (HI)	$464.17	$464.17
IOWA (IA)	$418.48	$418.48
IDAHO (ID)	$421.47	$421.47
EAST ST. LOUIS (IL)	$463.68	$463.68
SUBURBAN CHICAGO (IL)	$478.35	$478.35
CHICAGO (IL)	$488.64	$488.64
REST OF ILLINOIS (IL)	$450.04	$450.04
INDIANA (IN)	$423.11	$423.11
KANSAS (KS)	$419.39	$419.39
KENTUCKY (KY)	$427.90	$427.90
NEW ORLEANS (LA)	$443.48	$443.48
REST OF LOUISIANA (LA)	$428.34	$428.34
METROPOLITAN BOSTON (MA)	$492.97	$492.97
REST OF MASSACHUSETTS (MA)	$458.57	$458.57
BALTIMORE/SURR. CNTYS (MD)	$474.29	$474.29
REST OF MARYLAND (MD)	$452.93	$452.93
SOUTHERN MAINE (ME)	$438.82	$438.82
REST OF MAINE (ME)	$425.56	$425.56
DETROIT (MI)	$462.95	$462.95
REST OF MICHIGAN (MI)	$438.16	$438.16
MINNESOTA (MN)	$436.61	$436.61
METROPOLITAN ST. LOUIS (MO)	$441.83	$441.83
METROPOLITAN KANSAS CITY (MO)	$438.76	$438.76
REST OF MISSOURI (MO)	$424.56	$424.56
MISSISSIPPI (MS)	$417.94	$417.94
MONTANA** (MT)	$450.52	$450.52
NORTH CAROLINA (NC)	$428.40	$428.40
NORTH DAKOTA** (ND)	$434.31	$434.31
NEBRASKA (NE)	$419.42	$419.42
NEW HAMPSHIRE (NH)	$454.67	$454.67
NORTHERN NJ (NJ)	$496.89	$496.89
REST OF NEW JERSEY (NJ)	$479.70	$479.70
NEW MEXICO (NM)	$440.86	$440.86
NEVADA** (NV)	$446.19	$446.19
MANHATTAN (NY)	$511.68	$511.68
NYC SUBURBS/LONG ISLAND (NY)	$524.06	$524.06
POUGHKPSIE/N NYC SUBURBS (NY)	$484.54	$484.54
QUEENS (NY)	$511.41	$511.41
REST OF NEW YORK (NY)	$433.28	$433.28
OHIO (OH)	$434.84	$434.84
OKLAHOMA (OK)	$424.85	$424.85
PORTLAND (OR)	$467.76	$467.76
REST OF OREGON (OR)	$441.71	$441.71
METROPOLITAN PHILADELPHIA (PA)	$467.70	$467.70
REST OF PENNSYLVANIA (PA)	$434.04	$434.04
PUERTO RICO (PR)	$452.18	$452.18
RHODE ISLAND (RI)	$458.23	$458.23
SOUTH CAROLINA (SC)	$432.53	$432.53
SOUTH DAKOTA** (SD)	$432.39	$432.39
TENNESSEE (TN)	$421.21	$421.21
BRAZORIA (TX)	$444.82	$444.82
DALLAS (TX)	$448.11	$448.11
GALVESTON (TX)	$446.50	$446.50
HOUSTON (TX)	$461.51	$461.51
BEAUMONT (TX)	$432.13	$432.13
FORT WORTH (TX)	$446.64	$446.64
AUSTIN (TX)	$458.57	$458.57
REST OF TEXAS (TX)	$438.57	$438.57
UTAH (UT)	$436.78	$436.78
VIRGINIA (VA)	$439.41	$439.41
VIRGIN ISLANDS (VI)	$452.18	$452.18
VERMONT (VT)	$435.21	$435.21
SEATTLE (KING CNTY) (WA)	$499.18	$499.18
REST OF WASHINGTON (WA)	$456.87	$456.87
WISCONSIN (WI)	$423.92	$423.92
WEST VIRGINIA (WV)	$438.36	$438.36
WYOMING** (WY)	$443.46	$443.46

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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) assigned to a 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, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility and facility rates differ because the practice-expense RVU is typically lower in facility settings, where the facility itself bears more of the overhead cost. Because GPCIs vary by locality, the same code can have different allowed amounts in different parts of the country.

RVUs — work 7.18, practice expense 5.49 (non-facility) / 5.49 (facility), malpractice 0.82 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate based on the national Physician Fee Schedule formula and may not reflect the exact amount paid by your MAC.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, place-of-service rules, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final payment.
Locality-specific GPCIs and conversion factor updates are set annually by CMS and may differ from the figures shown.
Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The practice-expense RVU component is generally reduced in the facility setting because the facility (e.g., hospital) absorbs certain overhead costs, so the fee schedule allows less to the billing physician in that setting.

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

CMS applies Geographic Practice Cost Indices (GPCIs) to adjust work, practice expense, and malpractice RVUs for regional cost-of-living and labor cost differences, which can raise or lower the amount compared to the national average.

Is this the amount Medicare will actually pay?

No. This is an estimated allowed amount under the PFS formula. Actual payment depends on factors like deductible status, modifiers, secondary insurance, and MAC-specific adjustments.

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

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page refers to the code generically rather than reproducing the official descriptor.

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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.