Medicare Reimbursement for CPT 21554

CPT 21554 is a physician procedure code reported to Medicare for payment under the Physician Fee Schedule (PFS). This page shows the estimated Medicare PFS allowed amount for this code nationally and by locality, broken out by non-facility and facility settings. Because the CPT descriptor is proprietary to the AMA, it is not reproduced here — please consult your CPT codebook or encoder for the official code description.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$680.71	$680.71
ALASKA* (AK)	$841.57	$841.57
ALABAMA (AL)	$616.25	$616.25
ARKANSAS (AR)	$608.37	$608.37
ARIZONA (AZ)	$661.82	$661.82
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$767.01	$767.01
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$777.85	$777.85
OXNARD-THOUSAND OAKS-VENTURA (CA)	$704.17	$704.17
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$712.39	$712.39
NAPA (CA)	$740.10	$740.10
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$769.73	$769.73
VALLEJO (CA)	$736.19	$736.19
BAKERSFIELD (CA)	$679.28	$679.28
CHICO (CA)	$672.73	$672.73
FRESNO (CA)	$672.73	$672.73
HANFORD-CORCORAN (CA)	$672.73	$672.73
MADERA (CA)	$672.73	$672.73
MERCED (CA)	$672.73	$672.73
MODESTO (CA)	$672.73	$672.73
REDDING (CA)	$672.73	$672.73
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$698.39	$698.39
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$695.59	$695.59
SALINAS (CA)	$692.82	$692.82
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$788.94	$788.94
SANTA CRUZ-WATSONVILLE (CA)	$702.55	$702.55
SANTA ROSA-PETALUMA (CA)	$708.92	$708.92
STOCKTON (CA)	$672.73	$672.73
VISALIA (CA)	$672.73	$672.73
YUBA CITY (CA)	$672.73	$672.73
EL CENTRO (CA)	$673.12	$673.12
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$701.76	$701.76
SAN LUIS OBISPO-PASO ROBLES (CA)	$682.98	$682.98
SANTA MARIA-SANTA BARBARA (CA)	$693.41	$693.41
REST OF CALIFORNIA (CA)	$672.73	$672.73
COLORADO (CO)	$682.84	$682.84
CONNECTICUT (CT)	$723.09	$723.09
DC + MD/VA SUBURBS (DC)	$751.75	$751.75
DELAWARE (DE)	$671.60	$671.60
FORT LAUDERDALE (FL)	$748.31	$748.31
MIAMI (FL)	$812.55	$812.55
REST OF FLORIDA (FL)	$710.37	$710.37
ATLANTA (GA)	$701.66	$701.66
REST OF GEORGIA (GA)	$670.28	$670.28
HAWAII, GUAM (HI)	$679.77	$679.77
IOWA (IA)	$612.30	$612.30
IDAHO (ID)	$619.56	$619.56
EAST ST. LOUIS (IL)	$742.58	$742.58
SUBURBAN CHICAGO (IL)	$751.31	$751.31
CHICAGO (IL)	$787.82	$787.82
REST OF ILLINOIS (IL)	$704.91	$704.91
INDIANA (IN)	$622.27	$622.27
KANSAS (KS)	$618.22	$618.22
KENTUCKY (KY)	$647.45	$647.45
NEW ORLEANS (LA)	$677.50	$677.50
REST OF LOUISIANA (LA)	$649.93	$649.93
METROPOLITAN BOSTON (MA)	$733.05	$733.05
REST OF MASSACHUSETTS (MA)	$682.94	$682.94
BALTIMORE/SURR. CNTYS (MD)	$722.84	$722.84
REST OF MARYLAND (MD)	$680.65	$680.65
SOUTHERN MAINE (ME)	$649.11	$649.11
REST OF MAINE (ME)	$631.46	$631.46
DETROIT (MI)	$727.13	$727.13
REST OF MICHIGAN (MI)	$670.26	$670.26
MINNESOTA (MN)	$631.43	$631.43
METROPOLITAN ST. LOUIS (MO)	$669.42	$669.42
METROPOLITAN KANSAS CITY (MO)	$664.33	$664.33
REST OF MISSOURI (MO)	$645.72	$645.72
MISSISSIPPI (MS)	$626.73	$626.73
MONTANA** (MT)	$680.55	$680.55
NORTH CAROLINA (NC)	$635.91	$635.91
NORTH DAKOTA** (ND)	$633.29	$633.29
NEBRASKA (NE)	$612.69	$612.69
NEW HAMPSHIRE (NH)	$680.51	$680.51
NORTHERN NJ (NJ)	$747.13	$747.13
REST OF NEW JERSEY (NJ)	$724.89	$724.89
NEW MEXICO (NM)	$676.96	$676.96
NEVADA** (NV)	$667.62	$667.62
MANHATTAN (NY)	$789.32	$789.32
NYC SUBURBS/LONG ISLAND (NY)	$817.39	$817.39
POUGHKPSIE/N NYC SUBURBS (NY)	$736.44	$736.44
QUEENS (NY)	$782.59	$782.59
REST OF NEW YORK (NY)	$645.08	$645.08
OHIO (OH)	$660.60	$660.60
OKLAHOMA (OK)	$637.39	$637.39
PORTLAND (OR)	$692.54	$692.54
REST OF OREGON (OR)	$656.05	$656.05
METROPOLITAN PHILADELPHIA (PA)	$712.42	$712.42
REST OF PENNSYLVANIA (PA)	$656.76	$656.76
PUERTO RICO (PR)	$682.14	$682.14
RHODE ISLAND (RI)	$686.84	$686.84
SOUTH CAROLINA (SC)	$650.61	$650.61
SOUTH DAKOTA** (SD)	$627.70	$627.70
TENNESSEE (TN)	$622.05	$622.05
BRAZORIA (TX)	$663.90	$663.90
DALLAS (TX)	$671.68	$671.68
GALVESTON (TX)	$668.21	$668.21
HOUSTON (TX)	$711.96	$711.96
BEAUMONT (TX)	$653.58	$653.58
FORT WORTH (TX)	$670.34	$670.34
AUSTIN (TX)	$686.17	$686.17
REST OF TEXAS (TX)	$660.80	$660.80
UTAH (UT)	$658.26	$658.26
VIRGINIA (VA)	$653.19	$653.19
VIRGIN ISLANDS (VI)	$682.14	$682.14
VERMONT (VT)	$638.89	$638.89
SEATTLE (KING CNTY) (WA)	$738.36	$738.36
REST OF WASHINGTON (WA)	$678.98	$678.98
WISCONSIN (WI)	$615.45	$615.45
WEST VIRGINIA (WV)	$683.88	$683.88
WYOMING** (WY)	$659.96	$659.96

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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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by a locality-specific Geographic Practice Cost Index (GPCI) to reflect regional 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 because overhead costs differ, though for some codes — as shown here — the non-facility and facility PE RVUs and resulting allowed amounts are the same. The conversion factor is updated annually and amounts are subject to nationwide budget-neutrality adjustments.

RVUs — work 10.85, practice expense 7.14 (non-facility) / 7.14 (facility), malpractice 2.39 — × 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 remainder.
Actual payment can vary by locality GPCI, applicable modifiers, claim-level adjustments, and sequestration.
Annual conversion factor changes and budget-neutrality adjustments can shift amounts from year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The practice expense RVUs used in the facility and non-facility calculations are identical for this code, so the resulting allowed amounts match. This is not the case for every code.

Why does the allowed amount vary by locality?

Each Medicare locality has its own Geographic Practice Cost Indices (GPCIs) for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost-of-practice differences before the conversion factor is applied.

Does this amount reflect what Medicare will actually pay?

No — it reflects the estimated allowed amount under the PFS formula. Actual payment depends on the patient's deductible status, applicable modifiers, secondary insurance, and claim-specific adjustments.

Where can I find the official CPT code description?

CPT descriptors are copyrighted by the American Medical Association. Refer to your licensed CPT codebook, encoder software, or AMA resources 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.