Medicare Reimbursement for CPT 21555

CPT 21555 is a procedure code billed under Medicare Part B. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount, nationally and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$462.60	$297.60
ALASKA* (AK)	$534.68	$358.95
ALABAMA (AL)	$412.43	$268.05
ARKANSAS (AR)	$406.13	$264.40
ARIZONA (AZ)	$449.16	$289.28
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$584.68	$352.03
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$595.65	$357.72
OXNARD-THOUSAND OAKS-VENTURA (CA)	$511.63	$316.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$514.74	$319.54
NAPA (CA)	$554.65	$337.18
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$585.61	$352.96
VALLEJO (CA)	$553.31	$335.84
BAKERSFIELD (CA)	$483.75	$302.91
CHICO (CA)	$481.49	$300.65
FRESNO (CA)	$481.49	$300.65
HANFORD-CORCORAN (CA)	$481.49	$300.65
MADERA (CA)	$481.49	$300.65
MERCED (CA)	$481.49	$300.65
MODESTO (CA)	$481.49	$300.65
REDDING (CA)	$481.49	$300.65
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$490.30	$309.46
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$504.46	$312.56
SALINAS (CA)	$502.59	$311.35
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$599.45	$361.52
SANTA CRUZ-WATSONVILLE (CA)	$518.45	$317.98
SANTA ROSA-PETALUMA (CA)	$523.60	$320.97
STOCKTON (CA)	$481.49	$300.65
VISALIA (CA)	$481.49	$300.65
YUBA CITY (CA)	$481.49	$300.65
EL CENTRO (CA)	$481.63	$300.79
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$513.96	$316.62
SAN LUIS OBISPO-PASO ROBLES (CA)	$494.66	$306.72
SANTA MARIA-SANTA BARBARA (CA)	$504.35	$311.96
REST OF CALIFORNIA (CA)	$481.49	$300.65
COLORADO (CO)	$477.75	$302.19
CONNECTICUT (CT)	$494.52	$316.81
DC + MD/VA SUBURBS (DC)	$527.18	$332.81
DELAWARE (DE)	$456.81	$293.78
FORT LAUDERDALE (FL)	$488.71	$321.57
MIAMI (FL)	$517.04	$345.27
REST OF FLORIDA (FL)	$462.90	$305.16
ATLANTA (GA)	$473.39	$305.75
REST OF GEORGIA (GA)	$434.78	$287.60
HAWAII, GUAM (HI)	$493.03	$305.43
IOWA (IA)	$420.05	$269.08
IDAHO (ID)	$423.67	$271.87
EAST ST. LOUIS (IL)	$465.87	$314.07
SUBURBAN CHICAGO (IL)	$492.92	$323.46
CHICAGO (IL)	$500.50	$334.68
REST OF ILLINOIS (IL)	$451.38	$300.73
INDIANA (IN)	$426.17	$273.21
KANSAS (KS)	$419.61	$270.45
KENTUCKY (KY)	$426.28	$279.59
NEW ORLEANS (LA)	$448.26	$292.99
REST OF LOUISIANA (LA)	$426.23	$280.20
METROPOLITAN BOSTON (MA)	$524.30	$327.28
REST OF MASSACHUSETTS (MA)	$475.34	$301.59
BALTIMORE/SURR. CNTYS (MD)	$493.52	$316.47
REST OF MARYLAND (MD)	$465.32	$298.34
SOUTHERN MAINE (ME)	$449.74	$286.22
REST OF MAINE (ME)	$427.75	$275.95
DETROIT (MI)	$470.67	$311.45
REST OF MICHIGAN (MI)	$439.49	$288.84
MINNESOTA (MN)	$452.20	$282.42
METROPOLITAN ST. LOUIS (MO)	$447.96	$290.88
METROPOLITAN KANSAS CITY (MO)	$443.29	$288.35
REST OF MISSOURI (MO)	$419.62	$277.39
MISSISSIPPI (MS)	$412.88	$270.81
MONTANA** (MT)	$462.55	$297.55
NORTH CAROLINA (NC)	$432.19	$278.25
NORTH DAKOTA** (ND)	$446.33	$281.33
NEBRASKA (NE)	$421.98	$269.69
NEW HAMPSHIRE (NH)	$471.74	$299.97
NORTHERN NJ (NJ)	$521.59	$330.19
REST OF NEW JERSEY (NJ)	$498.59	$318.41
NEW MEXICO (NM)	$442.69	$291.38
NEVADA** (NV)	$458.33	$293.17
MANHATTAN (NY)	$536.52	$344.79
NYC SUBURBS/LONG ISLAND (NY)	$552.21	$356.03
POUGHKPSIE/N NYC SUBURBS (NY)	$503.25	$322.58
QUEENS (NY)	$538.70	$343.67
REST OF NEW YORK (NY)	$439.15	$282.40
OHIO (OH)	$436.17	$285.53
OKLAHOMA (OK)	$423.72	$276.38
PORTLAND (OR)	$491.65	$308.34
REST OF OREGON (OR)	$453.24	$288.90
METROPOLITAN PHILADELPHIA (PA)	$482.77	$311.00
REST OF PENNSYLVANIA (PA)	$435.98	$284.51
PUERTO RICO (PR)	$465.56	$298.75
RHODE ISLAND (RI)	$472.20	$301.76
SOUTH CAROLINA (SC)	$435.22	$282.76
SOUTH DAKOTA** (SD)	$444.42	$279.42
TENNESSEE (TN)	$422.05	$272.06
BRAZORIA (TX)	$454.85	$291.34
DALLAS (TX)	$458.65	$294.31
GALVESTON (TX)	$456.78	$292.93
HOUSTON (TX)	$471.79	$307.94
BEAUMONT (TX)	$433.09	$282.94
FORT WORTH (TX)	$455.94	$293.25
AUSTIN (TX)	$477.50	$302.93
REST OF TEXAS (TX)	$444.33	$287.74
UTAH (UT)	$441.43	$286.33
VIRGINIA (VA)	$449.34	$287.15
VIRGIN ISLANDS (VI)	$465.56	$298.75
VERMONT (VT)	$446.01	$282.66
SEATTLE (KING CNTY) (WA)	$533.56	$331.11
REST OF WASHINGTON (WA)	$473.97	$300.22
WISCONSIN (WI)	$430.79	$272.72
WEST VIRGINIA (WV)	$434.28	$290.90
WYOMING** (WY)	$455.48	$290.48

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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

The Medicare PFS amount is 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 Indices (GPCIs) for the specific locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, because overhead costs differ depending on where the service is rendered, which is why the two amounts differ.

RVUs — work 3.86, practice expense 9.17 (non-facility) / 4.23 (facility), malpractice 0.82 — × 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 remainder.
Actual payment varies by locality GPCIs, applicable modifiers, claims-based adjustments, sequestration, and annual budget-neutrality changes to RVUs or the conversion factor.
Always verify current rates and coverage policy with your local Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount for this code?

The practice-expense RVU is lower in the facility setting because the facility (e.g., hospital) typically absorbs certain overhead and resource costs that the physician's own practice would otherwise bear in a non-facility setting.

Why does the Medicare payment for this code vary by location?

Each locality has its own GPCI values for work, practice expense, and malpractice, reflecting local cost-of-living and practice-cost differences. These GPCIs adjust the RVUs before the conversion factor is applied, producing different allowed amounts across regions.

Is the amount shown here what Medicare will actually pay?

No. The figure shown is the estimated Medicare-allowed amount before the standard 80/20 cost-sharing split, deductible status, modifiers, and any claim-specific adjustments are applied.

Where can I find the official descriptor for CPT 21555?

CPT code descriptors are copyrighted by the American Medical Association (AMA). Refer to your licensed CPT codebook or AMA resources for the official language of this code.

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.