Medicare Reimbursement for CPT 21462

CPT 21462 is a physician procedure code; the AMA descriptor is not reproduced here due to licensing. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, nationally and adjusted for your locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2034.78	$1106.57
ALASKA* (AK)	$2295.30	$1306.76
ALABAMA (AL)	$1808.62	$996.43
ARKANSAS (AR)	$1779.91	$982.58
ARIZONA (AZ)	$1976.74	$1077.30
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2703.18	$1394.40
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2758.98	$1420.50
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2319.86	$1222.72
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2328.35	$1230.27
NAPA (CA)	$2546.90	$1323.51
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2705.01	$1396.23
VALLEJO (CA)	$2544.26	$1320.88
BAKERSFIELD (CA)	$2176.34	$1159.02
CHICO (CA)	$2171.69	$1154.38
FRESNO (CA)	$2171.69	$1154.38
HANFORD-CORCORAN (CA)	$2171.69	$1154.38
MADERA (CA)	$2171.69	$1154.38
MERCED (CA)	$2171.69	$1154.38
MODESTO (CA)	$2171.69	$1154.38
REDDING (CA)	$2171.69	$1154.38
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2189.10	$1171.78
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2287.22	$1207.71
SALINAS (CA)	$2278.94	$1203.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2766.45	$1427.97
SANTA CRUZ-WATSONVILLE (CA)	$2366.22	$1238.44
SANTA ROSA-PETALUMA (CA)	$2390.54	$1250.70
STOCKTON (CA)	$2171.69	$1154.38
VISALIA (CA)	$2171.69	$1154.38
YUBA CITY (CA)	$2171.69	$1154.38
EL CENTRO (CA)	$2171.96	$1154.64
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2338.94	$1228.80
SAN LUIS OBISPO-PASO ROBLES (CA)	$2241.47	$1184.23
SANTA MARIA-SANTA BARBARA (CA)	$2289.22	$1206.93
REST OF CALIFORNIA (CA)	$2171.69	$1154.38
COLORADO (CO)	$2131.15	$1143.54
CONNECTICUT (CT)	$2178.18	$1178.50
DC + MD/VA SUBURBS (DC)	$2349.04	$1255.61
DELAWARE (DE)	$2011.67	$1094.60
FORT LAUDERDALE (FL)	$2099.33	$1159.05
MIAMI (FL)	$2183.53	$1217.27
REST OF FLORIDA (FL)	$1990.44	$1103.07
ATLANTA (GA)	$2072.63	$1129.57
REST OF GEORGIA (GA)	$1869.87	$1041.90
HAWAII, GUAM (HI)	$2234.44	$1179.07
IOWA (IA)	$1864.43	$1015.12
IDAHO (ID)	$1876.63	$1022.68
EAST ST. LOUIS (IL)	$1959.50	$1105.55
SUBURBAN CHICAGO (IL)	$2122.62	$1169.34
CHICAGO (IL)	$2115.04	$1182.19
REST OF ILLINOIS (IL)	$1923.89	$1076.43
INDIANA (IN)	$1888.69	$1028.24
KANSAS (KS)	$1852.34	$1013.24
KENTUCKY (KY)	$1850.10	$1024.92
NEW ORLEANS (LA)	$1946.36	$1072.92
REST OF LOUISIANA (LA)	$1845.92	$1024.46
METROPOLITAN BOSTON (MA)	$2358.35	$1250.07
REST OF MASSACHUSETTS (MA)	$2115.60	$1138.19
BALTIMORE/SURR. CNTYS (MD)	$2171.71	$1175.74
REST OF MARYLAND (MD)	$2053.43	$1114.08
SOUTHERN MAINE (ME)	$2000.34	$1080.48
REST OF MAINE (ME)	$1884.65	$1030.69
DETROIT (MI)	$2014.88	$1119.16
REST OF MICHIGAN (MI)	$1900.55	$1053.10
MINNESOTA (MN)	$2043.98	$1088.85
METROPOLITAN ST. LOUIS (MO)	$1957.00	$1073.35
METROPOLITAN KANSAS CITY (MO)	$1934.57	$1062.98
REST OF MISSOURI (MO)	$1809.46	$1009.35
MISSISSIPPI (MS)	$1795.20	$996.01
MONTANA** (MT)	$2034.68	$1106.46
NORTH CAROLINA (NC)	$1906.65	$1040.63
NORTH DAKOTA** (ND)	$2002.84	$1074.63
NEBRASKA (NE)	$1876.39	$1019.65
NEW HAMPSHIRE (NH)	$2094.59	$1128.32
NORTHERN NJ (NJ)	$2320.64	$1243.91
REST OF NEW JERSEY (NJ)	$2203.62	$1190.01
NEW MEXICO (NM)	$1910.91	$1059.75
NEVADA** (NV)	$2027.42	$1098.29
MANHATTAN (NY)	$2352.10	$1273.51
NYC SUBURBS/LONG ISLAND (NY)	$2410.48	$1306.84
POUGHKPSIE/N NYC SUBURBS (NY)	$2216.35	$1199.96
QUEENS (NY)	$2376.80	$1279.66
REST OF NEW YORK (NY)	$1937.68	$1055.88
OHIO (OH)	$1894.05	$1046.59
OKLAHOMA (OK)	$1849.17	$1020.28
PORTLAND (OR)	$2206.86	$1175.62
REST OF OREGON (OR)	$2012.32	$1087.82
METROPOLITAN PHILADELPHIA (PA)	$2118.14	$1151.87
REST OF PENNSYLVANIA (PA)	$1898.77	$1046.67
PUERTO RICO (PR)	$2051.82	$1113.40
RHODE ISLAND (RI)	$2089.33	$1130.49
SOUTH CAROLINA (SC)	$1903.40	$1045.73
SOUTH DAKOTA** (SD)	$1999.08	$1070.86
TENNESSEE (TN)	$1862.23	$1018.48
BRAZORIA (TX)	$2011.22	$1091.36
DALLAS (TX)	$2023.88	$1099.38
GALVESTON (TX)	$2017.04	$1095.33
HOUSTON (TX)	$2046.51	$1124.80
BEAUMONT (TX)	$1884.93	$1040.26
FORT WORTH (TX)	$2008.35	$1093.14
AUSTIN (TX)	$2123.48	$1141.43
REST OF TEXAS (TX)	$1946.81	$1065.94
UTAH (UT)	$1931.94	$1059.42
VIRGINIA (VA)	$1991.39	$1078.96
VIRGIN ISLANDS (VI)	$2051.82	$1113.40
VERMONT (VT)	$1991.99	$1073.06
SEATTLE (KING CNTY) (WA)	$2411.20	$1272.28
REST OF WASHINGTON (WA)	$2112.59	$1135.18
WISCONSIN (WI)	$1929.42	$1040.19
WEST VIRGINIA (WV)	$1845.40	$1038.78
WYOMING** (WY)	$2020.80	$1092.59

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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 amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two allowed amounts differ.

RVUs — work 10.73, practice expense 48.58 (non-facility) / 20.79 (facility), malpractice 1.61 — × 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 deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, place-of-service rules, multiple-procedure reductions, and sequestration can change the actual amount paid.
Conversion factors and RVUs are updated annually and may be revised for budget neutrality.
Always confirm current rates and locality-specific adjustments with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The practice expense RVU is lower in the facility setting because the facility (e.g., hospital) absorbs certain overhead costs separately, while non-facility settings like a physician's office bear those costs directly.

Why does the reimbursement amount vary by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust for regional differences in labor, rent, and malpractice insurance costs, so the same code can pay differently depending on where the service is billed.

Does this page reflect what my practice will actually be paid?

No. This is a reference estimate based on standard PFS methodology. Actual payment depends on your specific MAC, contract terms, applied modifiers, and any sequestration or policy adjustments in effect.

Where can I find the official CPT descriptor for this code?

CPT code descriptors are copyrighted by the American Medical Association. Consult your CPT codebook or AMA-licensed coding software for the official description.

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.