Medicare Reimbursement for CPT 21490

CPT 21490 is a physician procedure code; the official descriptor is not reproduced here due to AMA licensing. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjusted by locality, under non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$713.44	$713.44
ALASKA* (AK)	$918.60	$918.60
ALABAMA (AL)	$662.13	$662.13
ARKANSAS (AR)	$655.78	$655.78
ARIZONA (AZ)	$698.97	$698.97
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$825.70	$825.70
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$838.47	$838.47
OXNARD-THOUSAND OAKS-VENTURA (CA)	$751.44	$751.44
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$759.14	$759.14
NAPA (CA)	$793.79	$793.79
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$827.33	$827.33
VALLEJO (CA)	$791.43	$791.43
BAKERSFIELD (CA)	$726.03	$726.03
CHICO (CA)	$721.67	$721.67
FRESNO (CA)	$721.67	$721.67
HANFORD-CORCORAN (CA)	$721.67	$721.67
MADERA (CA)	$721.67	$721.67
MERCED (CA)	$721.67	$721.67
MODESTO (CA)	$721.67	$721.67
REDDING (CA)	$721.67	$721.67
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$737.34	$737.34
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$746.00	$746.00
SALINAS (CA)	$742.92	$742.92
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$845.15	$845.15
SANTA CRUZ-WATSONVILLE (CA)	$752.34	$752.34
SANTA ROSA-PETALUMA (CA)	$759.30	$759.30
STOCKTON (CA)	$721.67	$721.67
VISALIA (CA)	$721.67	$721.67
YUBA CITY (CA)	$721.67	$721.67
EL CENTRO (CA)	$721.91	$721.91
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$751.79	$751.79
SAN LUIS OBISPO-PASO ROBLES (CA)	$732.14	$732.14
SANTA MARIA-SANTA BARBARA (CA)	$743.36	$743.36
REST OF CALIFORNIA (CA)	$721.67	$721.67
COLORADO (CO)	$723.56	$723.56
CONNECTICUT (CT)	$750.73	$750.73
DC + MD/VA SUBURBS (DC)	$785.00	$785.00
DELAWARE (DE)	$707.77	$707.77
FORT LAUDERDALE (FL)	$755.47	$755.47
MIAMI (FL)	$796.97	$796.97
REST OF FLORIDA (FL)	$726.92	$726.92
ATLANTA (GA)	$728.27	$728.27
REST OF GEORGIA (GA)	$696.38	$696.38
HAWAII, GUAM (HI)	$726.55	$726.55
IOWA (IA)	$663.74	$663.74
IDAHO (ID)	$668.62	$668.62
EAST ST. LOUIS (IL)	$742.73	$742.73
SUBURBAN CHICAGO (IL)	$760.10	$760.10
CHICAGO (IL)	$779.90	$779.90
REST OF ILLINOIS (IL)	$719.34	$719.34
INDIANA (IN)	$670.95	$670.95
KANSAS (KS)	$666.21	$666.21
KENTUCKY (KY)	$682.33	$682.33
NEW ORLEANS (LA)	$705.62	$705.62
REST OF LOUISIANA (LA)	$683.42	$683.42
METROPOLITAN BOSTON (MA)	$772.69	$772.69
REST OF MASSACHUSETTS (MA)	$723.33	$723.33
BALTIMORE/SURR. CNTYS (MD)	$749.37	$749.37
REST OF MARYLAND (MD)	$716.64	$716.64
SOUTHERN MAINE (ME)	$693.50	$693.50
REST OF MAINE (ME)	$675.78	$675.78
DETROIT (MI)	$737.92	$737.92
REST OF MICHIGAN (MI)	$698.46	$698.46
MINNESOTA (MN)	$686.64	$686.64
METROPOLITAN ST. LOUIS (MO)	$701.85	$701.85
METROPOLITAN KANSAS CITY (MO)	$697.48	$697.48
REST OF MISSOURI (MO)	$678.59	$678.59
MISSISSIPPI (MS)	$667.04	$667.04
MONTANA** (MT)	$713.35	$713.35
NORTH CAROLINA (NC)	$679.77	$679.77
NORTH DAKOTA** (ND)	$684.87	$684.87
NEBRASKA (NE)	$664.78	$664.78
NEW HAMPSHIRE (NH)	$717.41	$717.41
NORTHERN NJ (NJ)	$782.25	$782.25
REST OF NEW JERSEY (NJ)	$757.38	$757.38
NEW MEXICO (NM)	$702.90	$702.90
NEVADA** (NV)	$705.65	$705.65
MANHATTAN (NY)	$808.07	$808.07
NYC SUBURBS/LONG ISLAND (NY)	$827.68	$827.68
POUGHKPSIE/N NYC SUBURBS (NY)	$765.66	$765.66
QUEENS (NY)	$806.02	$806.02
REST OF NEW YORK (NY)	$686.98	$686.98
OHIO (OH)	$692.64	$692.64
OKLAHOMA (OK)	$676.66	$676.66
PORTLAND (OR)	$734.91	$734.91
REST OF OREGON (OR)	$698.18	$698.18
METROPOLITAN PHILADELPHIA (PA)	$740.30	$740.30
REST OF PENNSYLVANIA (PA)	$690.83	$690.83
PUERTO RICO (PR)	$715.40	$715.40
RHODE ISLAND (RI)	$724.30	$724.30
SOUTH CAROLINA (SC)	$687.72	$687.72
SOUTH DAKOTA** (SD)	$681.51	$681.51
TENNESSEE (TN)	$669.02	$669.02
BRAZORIA (TX)	$704.05	$704.05
DALLAS (TX)	$709.44	$709.44
GALVESTON (TX)	$706.84	$706.84
HOUSTON (TX)	$733.20	$733.20
BEAUMONT (TX)	$688.11	$688.11
FORT WORTH (TX)	$707.63	$707.63
AUSTIN (TX)	$722.93	$722.93
REST OF TEXAS (TX)	$696.36	$696.36
UTAH (UT)	$693.93	$693.93
VIRGINIA (VA)	$695.16	$695.16
VIRGIN ISLANDS (VI)	$715.40	$715.40
VERMONT (VT)	$687.25	$687.25
SEATTLE (KING CNTY) (WA)	$781.01	$781.01
REST OF WASHINGTON (WA)	$720.34	$720.34
WISCONSIN (WI)	$669.93	$669.93
WEST VIRGINIA (WV)	$702.28	$702.28
WYOMING** (WY)	$700.94	$700.94

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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) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, since overhead costs differ; for this code, those values are equal, so the non-facility and facility amounts are the same here. The resulting figure is the Medicare-allowed amount before any adjustments like sequestration or modifiers are applied.

RVUs — work 12.63, practice expense 7.29 (non-facility) / 7.29 (facility), malpractice 1.44 — × 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 Part B deductible is met; the beneficiary or secondary payer is responsible for the rest.
Actual payment can vary by locality, applicable modifiers, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount the same as the non-facility amount for this code?

When the practice-expense RVU is identical for both settings, the calculated allowed amount comes out the same, since work and malpractice RVUs don't change by setting.

Does this amount reflect what Medicare actually pays?

No — this is the PFS allowed amount estimate. Medicare generally pays 80% of this amount after the deductible is met, and the final payment can be affected by modifiers, sequestration, or locality-specific adjustments.

Why do amounts differ by locality?

The Geographic Practice Cost Index (GPCI) adjusts the RVUs to reflect regional differences in wages, rent, and malpractice costs, so the same code can have different allowed amounts in different areas.

Where can I find the official descriptor for CPT 21490?

CPT code descriptors are copyrighted by the American Medical Association. Refer to your AMA CPT codebook or licensed coding software for the official language.

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.