Medicare Reimbursement for CPT 21497

CPT 21497 is a procedure code billed under Medicare Part B; the exact 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, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$717.12	$561.80
ALASKA* (AK)	$820.82	$655.41
ALABAMA (AL)	$641.19	$505.29
ARKANSAS (AR)	$631.55	$498.13
ARIZONA (AZ)	$697.68	$547.18
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$947.13	$728.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$966.51	$742.55
OXNARD-THOUSAND OAKS-VENTURA (CA)	$815.05	$631.47
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$818.24	$634.51
NAPA (CA)	$893.14	$688.43
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$947.70	$728.70
VALLEJO (CA)	$892.32	$687.61
BAKERSFIELD (CA)	$766.20	$595.98
CHICO (CA)	$764.68	$594.46
FRESNO (CA)	$764.68	$594.46
HANFORD-CORCORAN (CA)	$764.68	$594.46
MADERA (CA)	$764.68	$594.46
MERCED (CA)	$764.68	$594.46
MODESTO (CA)	$764.68	$594.46
REDDING (CA)	$764.68	$594.46
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$770.13	$599.90
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$804.36	$623.73
SALINAS (CA)	$801.41	$621.40
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$968.83	$744.87
SANTA CRUZ-WATSONVILLE (CA)	$830.67	$641.96
SANTA ROSA-PETALUMA (CA)	$839.17	$648.45
STOCKTON (CA)	$764.68	$594.46
VISALIA (CA)	$764.68	$594.46
YUBA CITY (CA)	$764.68	$594.46
EL CENTRO (CA)	$764.77	$594.54
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$821.69	$635.93
SAN LUIS OBISPO-PASO ROBLES (CA)	$788.31	$611.40
SANTA MARIA-SANTA BARBARA (CA)	$804.80	$623.71
REST OF CALIFORNIA (CA)	$764.68	$594.46
COLORADO (CO)	$750.44	$585.18
CONNECTICUT (CT)	$765.95	$598.68
DC + MD/VA SUBURBS (DC)	$824.96	$642.00
DELAWARE (DE)	$709.59	$556.14
FORT LAUDERDALE (FL)	$737.75	$580.42
MIAMI (FL)	$765.18	$603.50
REST OF FLORIDA (FL)	$701.34	$552.86
ATLANTA (GA)	$729.72	$571.92
REST OF GEORGIA (GA)	$660.98	$522.44
HAWAII, GUAM (HI)	$785.36	$608.77
IOWA (IA)	$660.34	$518.23
IDAHO (ID)	$664.36	$521.47
EAST ST. LOUIS (IL)	$690.10	$547.21
SUBURBAN CHICAGO (IL)	$745.90	$586.39
CHICAGO (IL)	$742.55	$586.46
REST OF ILLINOIS (IL)	$678.72	$536.92
INDIANA (IN)	$668.42	$524.45
KANSAS (KS)	$656.09	$515.68
KENTUCKY (KY)	$654.71	$516.64
NEW ORLEANS (LA)	$686.97	$540.82
REST OF LOUISIANA (LA)	$653.23	$515.78
METROPOLITAN BOSTON (MA)	$828.06	$642.62
REST OF MASSACHUSETTS (MA)	$745.26	$581.72
BALTIMORE/SURR. CNTYS (MD)	$763.60	$596.95
REST OF MARYLAND (MD)	$723.85	$566.67
SOUTHERN MAINE (ME)	$706.01	$552.09
REST OF MAINE (ME)	$666.85	$523.96
DETROIT (MI)	$709.34	$559.47
REST OF MICHIGAN (MI)	$671.47	$529.67
MINNESOTA (MN)	$721.29	$561.48
METROPOLITAN ST. LOUIS (MO)	$690.78	$542.92
METROPOLITAN KANSAS CITY (MO)	$683.22	$537.38
REST OF MISSOURI (MO)	$640.86	$506.98
MISSISSIPPI (MS)	$636.39	$502.66
MONTANA** (MT)	$717.08	$561.77
NORTH CAROLINA (NC)	$674.28	$529.37
NORTH DAKOTA** (ND)	$707.20	$551.88
NEBRASKA (NE)	$664.42	$521.07
NEW HAMPSHIRE (NH)	$737.56	$575.87
NORTHERN NJ (NJ)	$815.68	$635.51
REST OF NEW JERSEY (NJ)	$775.33	$605.72
NEW MEXICO (NM)	$674.87	$532.45
NEVADA** (NV)	$714.88	$559.41
MANHATTAN (NY)	$825.58	$645.10
NYC SUBURBS/LONG ISLAND (NY)	$844.94	$660.27
POUGHKPSIE/N NYC SUBURBS (NY)	$779.62	$609.55
QUEENS (NY)	$834.16	$650.58
REST OF NEW YORK (NY)	$684.69	$537.14
OHIO (OH)	$669.45	$527.65
OKLAHOMA (OK)	$654.60	$515.91
PORTLAND (OR)	$776.25	$603.69
REST OF OREGON (OR)	$709.96	$555.27
METROPOLITAN PHILADELPHIA (PA)	$745.59	$583.90
REST OF PENNSYLVANIA (PA)	$671.14	$528.57
PUERTO RICO (PR)	$722.91	$565.89
RHODE ISLAND (RI)	$736.31	$575.87
SOUTH CAROLINA (SC)	$672.85	$529.34
SOUTH DAKOTA** (SD)	$706.03	$550.71
TENNESSEE (TN)	$659.39	$518.20
BRAZORIA (TX)	$709.71	$555.79
DALLAS (TX)	$713.91	$559.21
GALVESTON (TX)	$711.61	$557.38
HOUSTON (TX)	$720.76	$566.53
BEAUMONT (TX)	$666.48	$525.15
FORT WORTH (TX)	$708.63	$555.49
AUSTIN (TX)	$747.38	$583.06
REST OF TEXAS (TX)	$687.48	$540.08
UTAH (UT)	$682.45	$536.45
VIRGINIA (VA)	$702.87	$550.19
VIRGIN ISLANDS (VI)	$722.91	$565.89
VERMONT (VT)	$703.37	$549.61
SEATTLE (KING CNTY) (WA)	$846.33	$655.76
REST OF WASHINGTON (WA)	$744.21	$580.66
WISCONSIN (WI)	$682.48	$533.69
WEST VIRGINIA (WV)	$652.34	$517.37
WYOMING** (WY)	$712.78	$557.46

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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 PFS amounts are built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. These locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why the two allowed amounts for this code are not the same. The conversion factor and RVU values are updated annually, so allowed amounts can change year to year even if the code itself is unchanged.

RVUs — work 4.52, practice expense 16.45 (non-facility) / 11.8 (facility), malpractice 0.5 — × 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 the annual Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the actual paid amount.
Locality-adjusted amounts depend on the GPCI values for the specific Medicare locality and may differ from the national figures shown here.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is absorbing certain overhead costs, such as equipment and clinical staff time, rather than the billing physician's office.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-allowed amount before the standard 80/20 coinsurance split, deductible status, sequestration, and any applicable modifiers or adjustments are applied.

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

Medicare adjusts payments by locality using GPCIs, so the same code can have different allowed amounts depending on where the service was performed.

Can I use this figure to predict patient responsibility?

Only as a rough estimate. Patient responsibility depends on deductible status, secondary insurance, and any modifiers applied to the specific claim.

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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.