Medicare Reimbursement for CPT 21480

CPT 21480 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$172.01	$30.39
ALASKA* (AK)	$189.54	$38.71
ALABAMA (AL)	$151.63	$27.72
ARKANSAS (AR)	$149.05	$27.39
ARIZONA (AZ)	$166.80	$29.57
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$232.06	$32.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$236.97	$32.75
OXNARD-THOUSAND OAKS-VENTURA (CA)	$197.86	$30.46
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$198.44	$30.91
NAPA (CA)	$218.17	$31.52
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$232.20	$32.52
VALLEJO (CA)	$217.96	$31.31
BAKERSFIELD (CA)	$184.90	$29.68
CHICO (CA)	$184.54	$29.32
FRESNO (CA)	$184.54	$29.32
HANFORD-CORCORAN (CA)	$184.54	$29.32
MADERA (CA)	$184.54	$29.32
MERCED (CA)	$184.54	$29.32
MODESTO (CA)	$184.54	$29.32
REDDING (CA)	$184.54	$29.32
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$185.94	$30.72
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$194.83	$30.12
SALINAS (CA)	$194.14	$30.00
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$237.57	$33.35
SANTA CRUZ-WATSONVILLE (CA)	$202.23	$30.16
SANTA ROSA-PETALUMA (CA)	$204.33	$30.42
STOCKTON (CA)	$184.54	$29.32
VISALIA (CA)	$184.54	$29.32
YUBA CITY (CA)	$184.54	$29.32
EL CENTRO (CA)	$184.56	$29.35
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$199.62	$30.24
SAN LUIS OBISPO-PASO ROBLES (CA)	$190.90	$29.60
SANTA MARIA-SANTA BARBARA (CA)	$195.11	$29.99
REST OF CALIFORNIA (CA)	$184.54	$29.32
COLORADO (CO)	$180.77	$30.09
CONNECTICUT (CT)	$184.71	$32.19
DC + MD/VA SUBURBS (DC)	$199.91	$33.08
DELAWARE (DE)	$169.90	$29.98
FORT LAUDERDALE (FL)	$177.45	$33.99
MIAMI (FL)	$184.72	$37.29
REST OF FLORIDA (FL)	$167.69	$32.30
ATLANTA (GA)	$175.31	$31.43
REST OF GEORGIA (GA)	$156.87	$30.54
HAWAII, GUAM (HI)	$190.46	$29.44
IOWA (IA)	$156.82	$27.24
IDAHO (ID)	$157.89	$27.60
EAST ST. LOUIS (IL)	$164.58	$34.29
SUBURBAN CHICAGO (IL)	$179.50	$34.06
CHICAGO (IL)	$178.52	$36.19
REST OF ILLINOIS (IL)	$161.59	$32.29
INDIANA (IN)	$158.98	$27.70
KANSAS (KS)	$155.66	$27.63
KENTUCKY (KY)	$155.22	$29.32
NEW ORLEANS (LA)	$163.88	$30.61
REST OF LOUISIANA (LA)	$154.82	$29.48
METROPOLITAN BOSTON (MA)	$201.05	$31.96
REST OF MASSACHUSETTS (MA)	$179.29	$30.17
BALTIMORE/SURR. CNTYS (MD)	$184.16	$32.20
REST OF MARYLAND (MD)	$173.63	$30.31
SOUTHERN MAINE (ME)	$169.08	$28.74
REST OF MAINE (ME)	$158.54	$28.25
DETROIT (MI)	$169.81	$33.15
REST OF MICHIGAN (MI)	$159.70	$30.40
MINNESOTA (MN)	$173.25	$27.52
METROPOLITAN ST. LOUIS (MO)	$164.92	$30.10
METROPOLITAN KANSAS CITY (MO)	$162.89	$29.91
REST OF MISSOURI (MO)	$151.48	$29.41
MISSISSIPPI (MS)	$150.31	$28.38
MONTANA** (MT)	$172.01	$30.39
NORTH CAROLINA (NC)	$160.53	$28.40
NORTH DAKOTA** (ND)	$169.44	$27.82
NEBRASKA (NE)	$157.92	$27.21
NEW HAMPSHIRE (NH)	$177.54	$30.11
NORTHERN NJ (NJ)	$197.23	$32.95
REST OF NEW JERSEY (NJ)	$186.84	$32.19
NEW MEXICO (NM)	$160.61	$30.74
NEVADA** (NV)	$171.44	$29.68
MANHATTAN (NY)	$199.79	$35.23
NYC SUBURBS/LONG ISLAND (NY)	$204.96	$36.58
POUGHKPSIE/N NYC SUBURBS (NY)	$187.87	$32.80
QUEENS (NY)	$202.12	$34.73
REST OF NEW YORK (NY)	$163.33	$28.79
OHIO (OH)	$159.18	$29.88
OKLAHOMA (OK)	$155.21	$28.75
PORTLAND (OR)	$187.64	$30.30
REST OF OREGON (OR)	$170.13	$29.08
METROPOLITAN PHILADELPHIA (PA)	$179.27	$31.85
REST OF PENNSYLVANIA (PA)	$159.64	$29.64
PUERTO RICO (PR)	$173.58	$30.40
RHODE ISLAND (RI)	$176.80	$30.51
SOUTH CAROLINA (SC)	$160.12	$29.26
SOUTH DAKOTA** (SD)	$169.13	$27.51
TENNESSEE (TN)	$156.54	$27.81
BRAZORIA (TX)	$169.89	$29.54
DALLAS (TX)	$170.98	$29.93
GALVESTON (TX)	$170.39	$29.76
HOUSTON (TX)	$172.77	$32.14
BEAUMONT (TX)	$158.39	$29.52
FORT WORTH (TX)	$169.56	$29.92
AUSTIN (TX)	$180.14	$30.31
REST OF TEXAS (TX)	$164.05	$29.65
UTAH (UT)	$162.69	$29.57
VIRGINIA (VA)	$168.22	$29.01
VIRGIN ISLANDS (VI)	$173.58	$30.40
VERMONT (VT)	$168.39	$28.19
SEATTLE (KING CNTY) (WA)	$205.79	$32.03
REST OF WASHINGTON (WA)	$179.08	$29.95
WISCONSIN (WI)	$162.80	$27.12
WEST VIRGINIA (WV)	$154.50	$31.43
WYOMING** (WY)	$170.89	$29.27

Look up another code or locality →

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) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (equipment, staff, supplies) are typically higher when the physician's own office absorbs those costs versus when the procedure is performed in a hospital or facility. The resulting non-facility and facility amounts can differ substantially for the same code depending on where the service is rendered.

RVUs — work 0.59, practice expense 4.43 (non-facility) / 0.19 (facility), malpractice 0.13 — × 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 deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary based on the specific locality, applicable modifiers, claim adjustments, sequestration, and annual budget-neutrality adjustments to the fee schedule.
Always verify current rates and coverage policies with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

The non-facility rate includes higher practice-expense RVUs because it assumes the billing physician's office bears the overhead costs (staff, equipment, supplies). The facility rate assumes those overhead costs are borne by the hospital or ambulatory surgical center, so the physician payment is lower.

Does this amount change by location?

Yes. Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs for each locality, so the final allowed amount can vary from the national average depending on where the service is performed.

What does the conversion factor do?

The conversion factor is a dollar multiplier applied to the sum of the GPCI-adjusted RVUs to calculate the final Medicare allowed amount. It is updated annually and applies uniformly across all PFS codes for that year.

Will Medicare pay this full amount?

No. Medicare generally pays 80% of the allowed amount after the annual Part B deductible is met; the remaining 20% is typically the patient's or secondary payer's responsibility, subject to modifiers and other claim-specific adjustments.

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.