Medicare Reimbursement for CPT 21501

CPT 21501 is a procedure code used in physician billing; the exact clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both the national rate and the rate adjusted for your locality, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$517.71	$327.66
ALASKA* (AK)	$593.49	$391.09
ALABAMA (AL)	$460.63	$294.34
ARKANSAS (AR)	$453.45	$290.20
ARIZONA (AZ)	$502.55	$318.39
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$661.85	$393.88
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$674.55	$400.49
OXNARD-THOUSAND OAKS-VENTURA (CA)	$576.48	$351.84
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$579.66	$354.83
NAPA (CA)	$626.84	$376.36
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$662.79	$394.82
VALLEJO (CA)	$625.49	$375.00
BAKERSFIELD (CA)	$543.93	$335.64
CHICO (CA)	$541.65	$333.36
FRESNO (CA)	$541.65	$333.36
HANFORD-CORCORAN (CA)	$541.65	$333.36
MADERA (CA)	$541.65	$333.36
MERCED (CA)	$541.65	$333.36
MODESTO (CA)	$541.65	$333.36
REDDING (CA)	$541.65	$333.36
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$550.57	$342.27
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$568.26	$347.23
SALINAS (CA)	$566.17	$345.90
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$678.40	$404.35
SANTA CRUZ-WATSONVILLE (CA)	$585.06	$354.15
SANTA ROSA-PETALUMA (CA)	$590.91	$357.53
STOCKTON (CA)	$541.65	$333.36
VISALIA (CA)	$541.65	$333.36
YUBA CITY (CA)	$541.65	$333.36
EL CENTRO (CA)	$541.79	$333.49
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$579.54	$352.24
SAN LUIS OBISPO-PASO ROBLES (CA)	$557.15	$340.68
SANTA MARIA-SANTA BARBARA (CA)	$568.30	$346.71
REST OF CALIFORNIA (CA)	$541.65	$333.36
COLORADO (CO)	$536.26	$334.05
CONNECTICUT (CT)	$553.88	$349.19
DC + MD/VA SUBURBS (DC)	$592.00	$368.11
DELAWARE (DE)	$511.24	$323.47
FORT LAUDERDALE (FL)	$544.80	$352.28
MIAMI (FL)	$574.88	$377.04
REST OF FLORIDA (FL)	$515.80	$334.11
ATLANTA (GA)	$529.44	$336.35
REST OF GEORGIA (GA)	$484.11	$314.59
HAWAII, GUAM (HI)	$555.42	$339.33
IOWA (IA)	$470.36	$296.47
IDAHO (ID)	$474.27	$299.43
EAST ST. LOUIS (IL)	$516.99	$342.15
SUBURBAN CHICAGO (IL)	$549.75	$354.57
CHICAGO (IL)	$556.32	$365.32
REST OF ILLINOIS (IL)	$501.97	$328.45
INDIANA (IN)	$477.16	$300.98
KANSAS (KS)	$469.37	$297.56
KENTUCKY (KY)	$475.35	$306.40
NEW ORLEANS (LA)	$500.22	$321.38
REST OF LOUISIANA (LA)	$475.10	$306.91
METROPOLITAN BOSTON (MA)	$589.89	$362.97
REST OF MASSACHUSETTS (MA)	$533.26	$333.14
BALTIMORE/SURR. CNTYS (MD)	$552.67	$348.74
REST OF MARYLAND (MD)	$521.06	$328.73
SOUTHERN MAINE (ME)	$504.24	$315.90
REST OF MAINE (ME)	$478.40	$303.56
DETROIT (MI)	$524.12	$340.72
REST OF MICHIGAN (MI)	$489.94	$316.42
MINNESOTA (MN)	$508.65	$313.09
METROPOLITAN ST. LOUIS (MO)	$500.47	$319.54
METROPOLITAN KANSAS CITY (MO)	$495.09	$316.63
REST OF MISSOURI (MO)	$467.26	$303.43
MISSISSIPPI (MS)	$460.38	$296.75
MONTANA** (MT)	$517.66	$327.61
NORTH CAROLINA (NC)	$483.56	$306.24
NORTH DAKOTA** (ND)	$501.25	$311.20
NEBRASKA (NE)	$472.72	$297.30
NEW HAMPSHIRE (NH)	$529.02	$331.18
NORTHERN NJ (NJ)	$585.43	$364.97
REST OF NEW JERSEY (NJ)	$558.74	$351.21
NEW MEXICO (NM)	$493.37	$319.10
NEVADA** (NV)	$513.44	$323.20
MANHATTAN (NY)	$600.64	$379.80
NYC SUBURBS/LONG ISLAND (NY)	$617.88	$391.91
POUGHKPSIE/N NYC SUBURBS (NY)	$563.61	$355.50
QUEENS (NY)	$603.85	$379.21
REST OF NEW YORK (NY)	$491.46	$310.91
OHIO (OH)	$486.58	$313.06
OKLAHOMA (OK)	$472.97	$303.25
PORTLAND (OR)	$552.69	$341.55
REST OF OREGON (OR)	$508.04	$318.75
METROPOLITAN PHILADELPHIA (PA)	$540.17	$342.33
REST OF PENNSYLVANIA (PA)	$486.64	$312.17
PUERTO RICO (PR)	$521.26	$329.12
RHODE ISLAND (RI)	$529.08	$332.75
SOUTH CAROLINA (SC)	$486.17	$310.56
SOUTH DAKOTA** (SD)	$499.31	$309.25
TENNESSEE (TN)	$472.08	$299.33
BRAZORIA (TX)	$509.41	$321.07
DALLAS (TX)	$513.50	$324.21
GALVESTON (TX)	$511.46	$322.74
HOUSTON (TX)	$526.65	$337.93
BEAUMONT (TX)	$483.31	$310.36
FORT WORTH (TX)	$510.26	$322.87
AUSTIN (TX)	$535.72	$334.64
REST OF TEXAS (TX)	$496.64	$316.29
UTAH (UT)	$493.26	$314.61
VIRGINIA (VA)	$503.44	$316.62
VIRGIN ISLANDS (VI)	$521.26	$329.12
VERMONT (VT)	$500.41	$312.26
SEATTLE (KING CNTY) (WA)	$600.93	$367.74
REST OF WASHINGTON (WA)	$531.87	$331.75
WISCONSIN (WI)	$483.39	$301.32
WEST VIRGINIA (WV)	$482.45	$317.30
WYOMING** (WY)	$510.51	$320.45

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 units per patient per day — Date of Service Edit: Clinical. 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 — that are each adjusted by locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar figure set by CMS) to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (staff, supplies, equipment) are typically higher when a service is performed in a physician's office versus a hospital or ASC. The national rate uses a GPCI value of 1.0 for comparison, while the locality-adjusted rate reflects where the service was actually performed.

RVUs — work 3.88, practice expense 10.79 (non-facility) / 5.1 (facility), malpractice 0.83 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate of the Medicare-allowed amount, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their annual Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Rates vary by locality based on GPCI values; always confirm the specific locality used for a claim.
Verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility rate lower than the non-facility rate?

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (hospital, ASC) — not the physician's office — is absorbing most of the overhead costs like equipment, supplies, and staff.

Why does the allowed amount differ from the national rate shown?

The national amount uses a neutral geographic adjustment (GPCI = 1.0), while the locality-specific amount adjusts for differences in local wages, rents, and malpractice costs.

Does this amount reflect what the patient will actually pay?

No. This is the Medicare-allowed amount before cost-sharing. The patient's out-of-pocket cost depends on deductible status, coinsurance, and any secondary insurance.

Can modifiers change this reimbursement amount?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services 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.