Medicare Reimbursement for CPT 21461

CPT 21461 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 by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1791.29	$970.30
ALASKA* (AK)	$2017.16	$1142.80
ALABAMA (AL)	$1591.77	$873.40
ARKANSAS (AR)	$1566.43	$861.20
ARIZONA (AZ)	$1740.22	$944.67
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2387.09	$1229.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2436.63	$1252.75
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2046.14	$1075.73
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2053.32	$1082.09
NAPA (CA)	$2248.14	$1166.07
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2388.57	$1230.97
VALLEJO (CA)	$2246.00	$1163.93
BAKERSFIELD (CA)	$1918.59	$1018.78
CHICO (CA)	$1914.79	$1014.98
FRESNO (CA)	$1914.79	$1014.98
HANFORD-CORCORAN (CA)	$1914.79	$1014.98
MADERA (CA)	$1914.79	$1014.98
MERCED (CA)	$1914.79	$1014.98
MODESTO (CA)	$1914.79	$1014.98
REDDING (CA)	$1914.79	$1014.98
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1928.97	$1029.16
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2017.32	$1062.50
SALINAS (CA)	$2010.03	$1058.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2442.71	$1258.84
SANTA CRUZ-WATSONVILLE (CA)	$2087.87	$1090.36
SANTA ROSA-PETALUMA (CA)	$2109.38	$1101.20
STOCKTON (CA)	$1914.79	$1014.98
VISALIA (CA)	$1914.79	$1014.98
YUBA CITY (CA)	$1914.79	$1014.98
EL CENTRO (CA)	$1915.01	$1015.20
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2063.42	$1081.51
SAN LUIS OBISPO-PASO ROBLES (CA)	$1976.90	$1041.78
SANTA MARIA-SANTA BARBARA (CA)	$2019.23	$1061.95
REST OF CALIFORNIA (CA)	$1914.79	$1014.98
COLORADO (CO)	$1877.78	$1004.24
CONNECTICUT (CT)	$1917.75	$1033.54
DC + MD/VA SUBURBS (DC)	$2069.69	$1102.56
DELAWARE (DE)	$1771.06	$959.91
FORT LAUDERDALE (FL)	$1845.42	$1013.75
MIAMI (FL)	$1917.41	$1062.75
REST OF FLORIDA (FL)	$1749.75	$964.88
ATLANTA (GA)	$1824.10	$989.97
REST OF GEORGIA (GA)	$1643.71	$911.38
HAWAII, GUAM (HI)	$1970.73	$1037.26
IOWA (IA)	$1642.14	$890.93
IDAHO (ID)	$1652.69	$897.38
EAST ST. LOUIS (IL)	$1720.12	$964.80
SUBURBAN CHICAGO (IL)	$1866.19	$1023.03
CHICAGO (IL)	$1857.30	$1032.20
REST OF ILLINOIS (IL)	$1690.27	$940.71
INDIANA (IN)	$1663.37	$902.31
KANSAS (KS)	$1630.94	$888.76
KENTUCKY (KY)	$1627.26	$897.40
NEW ORLEANS (LA)	$1712.03	$939.47
REST OF LOUISIANA (LA)	$1623.36	$896.78
METROPOLITAN BOSTON (MA)	$2079.10	$1098.83
REST OF MASSACHUSETTS (MA)	$1863.81	$999.30
BALTIMORE/SURR. CNTYS (MD)	$1911.94	$1031.02
REST OF MARYLAND (MD)	$1808.07	$977.22
SOUTHERN MAINE (ME)	$1762.15	$948.54
REST OF MAINE (ME)	$1659.21	$903.90
DETROIT (MI)	$1770.76	$978.50
REST OF MICHIGAN (MI)	$1671.28	$921.72
MINNESOTA (MN)	$1802.37	$957.57
METROPOLITAN ST. LOUIS (MO)	$1722.05	$940.47
METROPOLITAN KANSAS CITY (MO)	$1702.18	$931.27
REST OF MISSOURI (MO)	$1590.85	$883.15
MISSISSIPPI (MS)	$1579.12	$872.24
MONTANA** (MT)	$1791.20	$970.21
NORTH CAROLINA (NC)	$1678.73	$912.74
NORTH DAKOTA** (ND)	$1765.30	$944.31
NEBRASKA (NE)	$1652.87	$895.09
NEW HAMPSHIRE (NH)	$1845.04	$990.38
NORTHERN NJ (NJ)	$2044.45	$1092.10
REST OF NEW JERSEY (NJ)	$1940.54	$1044.01
NEW MEXICO (NM)	$1680.21	$927.36
NEVADA** (NV)	$1785.43	$963.61
MANHATTAN (NY)	$2070.31	$1116.31
NYC SUBURBS/LONG ISLAND (NY)	$2121.16	$1145.00
POUGHKPSIE/N NYC SUBURBS (NY)	$1951.33	$1052.34
QUEENS (NY)	$2092.89	$1122.48
REST OF NEW YORK (NY)	$1706.08	$926.14
OHIO (OH)	$1665.99	$916.42
OKLAHOMA (OK)	$1627.00	$893.85
PORTLAND (OR)	$1945.25	$1033.13
REST OF OREGON (OR)	$1772.52	$954.81
METROPOLITAN PHILADELPHIA (PA)	$1864.41	$1009.75
REST OF PENNSYLVANIA (PA)	$1670.45	$916.78
PUERTO RICO (PR)	$1806.52	$976.50
RHODE ISLAND (RI)	$1839.99	$991.90
SOUTH CAROLINA (SC)	$1674.96	$916.37
SOUTH DAKOTA** (SD)	$1762.24	$941.24
TENNESSEE (TN)	$1639.60	$893.32
BRAZORIA (TX)	$1771.09	$957.49
DALLAS (TX)	$1782.03	$964.32
GALVESTON (TX)	$1776.08	$960.83
HOUSTON (TX)	$1800.06	$984.81
BEAUMONT (TX)	$1658.20	$911.10
FORT WORTH (TX)	$1768.16	$958.66
AUSTIN (TX)	$1870.68	$1002.06
REST OF TEXAS (TX)	$1713.39	$934.27
UTAH (UT)	$1700.17	$928.44
VIRGINIA (VA)	$1753.87	$946.84
VIRGIN ISLANDS (VI)	$1806.52	$976.50
VERMONT (VT)	$1755.23	$942.45
SEATTLE (KING CNTY) (WA)	$2126.29	$1118.93
REST OF WASHINGTON (WA)	$1861.32	$996.81
WISCONSIN (WI)	$1700.35	$913.84
WEST VIRGINIA (WV)	$1620.95	$907.51
WYOMING** (WY)	$1779.91	$958.92

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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 PFS amounts are 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 furnished, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher in non-facility (e.g., office) settings, reflecting overhead costs not incurred when a service is performed in a hospital or other facility. These figures are national/locality estimates before application of any modifiers or additional adjustments.

RVUs — work 9.08, practice expense 43.24 (non-facility) / 18.66 (facility), malpractice 1.31 — × 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 Part B deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality GPCIs, applicable modifiers, place of service, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the non-facility amount higher than the facility amount for this code?

The non-facility rate includes a higher practice-expense RVU because it accounts for overhead costs (staff, supplies, equipment) that the billing practice incurs when the service is performed outside a facility. In a facility setting, the facility itself bills separately for overhead, so the physician's practice-expense RVU is lower.

Does this amount include the Medicare conversion factor already applied?

Yes, the displayed PFS amounts reflect the RVUs multiplied by the applicable year's conversion factor and adjusted by locality GPCIs; no additional calculation is needed to see the estimated allowed amount.

Will the same amount apply in every state or region?

No. Because GPCIs vary by locality, the final allowed amount can differ from the national figure. Check the locality-specific amount shown on this page for a more accurate local estimate.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple procedures can increase or decrease the final paid amount relative to the base PFS rate shown here.

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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.