Medicare Reimbursement for CPT 21552

CPT code 21552 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$429.20	$429.20
ALASKA* (AK)	$523.32	$523.32
ALABAMA (AL)	$386.50	$386.50
ARKANSAS (AR)	$381.26	$381.26
ARIZONA (AZ)	$416.79	$416.79
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$489.22	$489.22
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$496.36	$496.36
OXNARD-THOUSAND OAKS-VENTURA (CA)	$446.75	$446.75
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$451.72	$451.72
NAPA (CA)	$471.19	$471.19
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$490.93	$490.93
VALLEJO (CA)	$468.74	$468.74
BAKERSFIELD (CA)	$429.73	$429.73
CHICO (CA)	$425.65	$425.65
FRESNO (CA)	$425.65	$425.65
HANFORD-CORCORAN (CA)	$425.65	$425.65
MADERA (CA)	$425.65	$425.65
MERCED (CA)	$425.65	$425.65
MODESTO (CA)	$425.65	$425.65
REDDING (CA)	$425.65	$425.65
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$441.74	$441.74
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$440.90	$440.90
SALINAS (CA)	$439.17	$439.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$503.32	$503.32
SANTA CRUZ-WATSONVILLE (CA)	$446.44	$446.44
SANTA ROSA-PETALUMA (CA)	$450.53	$450.53
STOCKTON (CA)	$425.65	$425.65
VISALIA (CA)	$425.65	$425.65
YUBA CITY (CA)	$425.65	$425.65
EL CENTRO (CA)	$425.90	$425.90
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$445.46	$445.46
SAN LUIS OBISPO-PASO ROBLES (CA)	$432.86	$432.86
SANTA MARIA-SANTA BARBARA (CA)	$439.71	$439.71
REST OF CALIFORNIA (CA)	$425.65	$425.65
COLORADO (CO)	$431.50	$431.50
CONNECTICUT (CT)	$456.86	$456.86
DC + MD/VA SUBURBS (DC)	$476.13	$476.13
DELAWARE (DE)	$423.19	$423.19
FORT LAUDERDALE (FL)	$471.86	$471.86
MIAMI (FL)	$512.68	$512.68
REST OF FLORIDA (FL)	$447.02	$447.02
ATLANTA (GA)	$442.59	$442.59
REST OF GEORGIA (GA)	$420.71	$420.71
HAWAII, GUAM (HI)	$431.08	$431.08
IOWA (IA)	$384.74	$384.74
IDAHO (ID)	$389.38	$389.38
EAST ST. LOUIS (IL)	$466.59	$466.59
SUBURBAN CHICAGO (IL)	$473.89	$473.89
CHICAGO (IL)	$496.40	$496.40
REST OF ILLINOIS (IL)	$442.82	$442.82
INDIANA (IN)	$391.21	$391.21
KANSAS (KS)	$388.25	$388.25
KENTUCKY (KY)	$406.33	$406.33
NEW ORLEANS (LA)	$426.12	$426.12
REST OF LOUISIANA (LA)	$407.81	$407.81
METROPOLITAN BOSTON (MA)	$464.89	$464.89
REST OF MASSACHUSETTS (MA)	$431.30	$431.30
BALTIMORE/SURR. CNTYS (MD)	$456.70	$456.70
REST OF MARYLAND (MD)	$429.22	$429.22
SOUTHERN MAINE (ME)	$409.21	$409.21
REST OF MAINE (ME)	$396.85	$396.85
DETROIT (MI)	$457.70	$457.70
REST OF MICHIGAN (MI)	$421.08	$421.08
MINNESOTA (MN)	$398.79	$398.79
METROPOLITAN ST. LOUIS (MO)	$421.25	$421.25
METROPOLITAN KANSAS CITY (MO)	$417.82	$417.82
REST OF MISSOURI (MO)	$404.76	$404.76
MISSISSIPPI (MS)	$392.82	$392.82
MONTANA** (MT)	$429.10	$429.10
NORTH CAROLINA (NC)	$399.88	$399.88
NORTH DAKOTA** (ND)	$399.44	$399.44
NEBRASKA (NE)	$385.13	$385.13
NEW HAMPSHIRE (NH)	$429.81	$429.81
NORTHERN NJ (NJ)	$472.76	$472.76
REST OF NEW JERSEY (NJ)	$457.94	$457.94
NEW MEXICO (NM)	$425.36	$425.36
NEVADA** (NV)	$421.00	$421.00
MANHATTAN (NY)	$499.26	$499.26
NYC SUBURBS/LONG ISLAND (NY)	$517.36	$517.36
POUGHKPSIE/N NYC SUBURBS (NY)	$465.17	$465.17
QUEENS (NY)	$495.39	$495.39
REST OF NEW YORK (NY)	$405.94	$405.94
OHIO (OH)	$415.01	$415.01
OKLAHOMA (OK)	$400.09	$400.09
PORTLAND (OR)	$438.37	$438.37
REST OF OREGON (OR)	$413.65	$413.65
METROPOLITAN PHILADELPHIA (PA)	$449.55	$449.55
REST OF PENNSYLVANIA (PA)	$412.70	$412.70
PUERTO RICO (PR)	$430.29	$430.29
RHODE ISLAND (RI)	$433.34	$433.34
SOUTH CAROLINA (SC)	$408.94	$408.94
SOUTH DAKOTA** (SD)	$395.93	$395.93
TENNESSEE (TN)	$390.75	$390.75
BRAZORIA (TX)	$418.36	$418.36
DALLAS (TX)	$423.32	$423.32
GALVESTON (TX)	$421.10	$421.10
HOUSTON (TX)	$448.56	$448.56
BEAUMONT (TX)	$410.55	$410.55
FORT WORTH (TX)	$422.29	$422.29
AUSTIN (TX)	$433.64	$433.64
REST OF TEXAS (TX)	$415.79	$415.79
UTAH (UT)	$414.03	$414.03
VIRGINIA (VA)	$411.62	$411.62
VIRGIN ISLANDS (VI)	$430.29	$430.29
VERMONT (VT)	$402.77	$402.77
SEATTLE (KING CNTY) (WA)	$468.67	$468.67
REST OF WASHINGTON (WA)	$428.86	$428.86
WISCONSIN (WI)	$387.49	$387.49
WEST VIRGINIA (WV)	$428.83	$428.83
WYOMING** (WY)	$416.18	$416.18

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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 — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. These geographically adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings to reflect different overhead costs, though for some codes these values are the same. The conversion factor and RVU values are updated annually and can shift the allowed amount even if the code itself doesn't change.

RVUs — work 6.33, practice expense 5.02 (non-facility) / 5.02 (facility), malpractice 1.5 — × 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 annual Part B deductible is met; the patient or secondary payer is responsible for the rest.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean the actual allowed amount can vary meaningfully from the national figure.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the amount shown differ from what I see in my MAC's fee schedule lookup tool?

Differences can result from locality-specific GPCIs, more recent quarterly updates, applied modifiers, or whether the correction cycle for that year's rates has been finalized.

Why are the non-facility and facility amounts the same for this code?

When the practice expense RVU is identical in both settings, the resulting PFS allowed amounts will match, since work and malpractice RVUs don't vary by site of service.

Does this amount reflect what Medicare will actually pay?

No — this is the allowed amount before patient cost-sharing. Medicare generally pays 80%, with patients or secondary insurance covering the remainder after any applicable deductible.

Can modifiers change this amount?

Yes. Modifiers such as bilateral, multiple procedure, or reduced-service indicators can increase or decrease the final payment relative to the base PFS amount shown here.

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.