Medicare Reimbursement for CPT 21556

CPT 21556 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS); because it is a CPT code, the official descriptor is not reproduced here due to AMA licensing. This page shows the PFS allowed amount, both at the national level and adjusted for your locality, and separately for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$491.33	$491.33
ALASKA* (AK)	$606.39	$606.39
ALABAMA (AL)	$445.82	$445.82
ARKANSAS (AR)	$440.23	$440.23
ARIZONA (AZ)	$478.24	$478.24
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$565.49	$565.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$574.00	$574.00
OXNARD-THOUSAND OAKS-VENTURA (CA)	$514.69	$514.69
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$520.15	$520.15
NAPA (CA)	$543.90	$543.90
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$567.17	$567.17
VALLEJO (CA)	$541.48	$541.48
BAKERSFIELD (CA)	$495.21	$495.21
CHICO (CA)	$491.10	$491.10
FRESNO (CA)	$491.10	$491.10
HANFORD-CORCORAN (CA)	$491.10	$491.10
MADERA (CA)	$491.10	$491.10
MERCED (CA)	$491.10	$491.10
MODESTO (CA)	$491.10	$491.10
REDDING (CA)	$491.10	$491.10
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$507.02	$507.02
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$508.73	$508.73
SALINAS (CA)	$506.71	$506.71
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$580.87	$580.87
SANTA CRUZ-WATSONVILLE (CA)	$514.99	$514.99
SANTA ROSA-PETALUMA (CA)	$519.74	$519.74
STOCKTON (CA)	$491.10	$491.10
VISALIA (CA)	$491.10	$491.10
YUBA CITY (CA)	$491.10	$491.10
EL CENTRO (CA)	$491.35	$491.35
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$513.88	$513.88
SAN LUIS OBISPO-PASO ROBLES (CA)	$499.37	$499.37
SANTA MARIA-SANTA BARBARA (CA)	$507.31	$507.31
REST OF CALIFORNIA (CA)	$491.10	$491.10
COLORADO (CO)	$495.81	$495.81
CONNECTICUT (CT)	$521.51	$521.51
DC + MD/VA SUBURBS (DC)	$544.63	$544.63
DELAWARE (DE)	$485.27	$485.27
FORT LAUDERDALE (FL)	$533.77	$533.77
MIAMI (FL)	$574.80	$574.80
REST OF FLORIDA (FL)	$507.73	$507.73
ATLANTA (GA)	$505.09	$505.09
REST OF GEORGIA (GA)	$480.04	$480.04
HAWAII, GUAM (HI)	$496.87	$496.87
IOWA (IA)	$445.17	$445.17
IDAHO (ID)	$449.88	$449.88
EAST ST. LOUIS (IL)	$526.06	$526.06
SUBURBAN CHICAGO (IL)	$536.43	$536.43
CHICAGO (IL)	$558.05	$558.05
REST OF ILLINOIS (IL)	$502.42	$502.42
INDIANA (IN)	$451.87	$451.87
KANSAS (KS)	$448.34	$448.34
KENTUCKY (KY)	$465.77	$465.77
NEW ORLEANS (LA)	$486.70	$486.70
REST OF LOUISIANA (LA)	$467.13	$467.13
METROPOLITAN BOSTON (MA)	$533.44	$533.44
REST OF MASSACHUSETTS (MA)	$495.48	$495.48
BALTIMORE/SURR. CNTYS (MD)	$521.08	$521.08
REST OF MARYLAND (MD)	$492.08	$492.08
SOUTHERN MAINE (ME)	$471.35	$471.35
REST OF MAINE (ME)	$457.25	$457.25
DETROIT (MI)	$518.50	$518.50
REST OF MICHIGAN (MI)	$480.97	$480.97
MINNESOTA (MN)	$462.11	$462.11
METROPOLITAN ST. LOUIS (MO)	$482.19	$482.19
METROPOLITAN KANSAS CITY (MO)	$478.45	$478.45
REST OF MISSOURI (MO)	$463.49	$463.49
MISSISSIPPI (MS)	$451.68	$451.68
MONTANA** (MT)	$491.23	$491.23
NORTH CAROLINA (NC)	$460.59	$460.59
NORTH DAKOTA** (ND)	$461.96	$461.96
NEBRASKA (NE)	$445.77	$445.77
NEW HAMPSHIRE (NH)	$493.04	$493.04
NORTHERN NJ (NJ)	$541.19	$541.19
REST OF NEW JERSEY (NJ)	$523.80	$523.80
NEW MEXICO (NM)	$485.30	$485.30
NEVADA** (NV)	$483.26	$483.26
MANHATTAN (NY)	$567.43	$567.43
NYC SUBURBS/LONG ISLAND (NY)	$586.02	$586.02
POUGHKPSIE/N NYC SUBURBS (NY)	$531.21	$531.21
QUEENS (NY)	$564.16	$564.16
REST OF NEW YORK (NY)	$467.03	$467.03
OHIO (OH)	$474.98	$474.98
OKLAHOMA (OK)	$459.72	$459.72
PORTLAND (OR)	$504.02	$504.02
REST OF OREGON (OR)	$475.88	$475.88
METROPOLITAN PHILADELPHIA (PA)	$513.25	$513.25
REST OF PENNSYLVANIA (PA)	$472.83	$472.83
PUERTO RICO (PR)	$492.70	$492.70
RHODE ISLAND (RI)	$497.08	$497.08
SOUTH CAROLINA (SC)	$469.29	$469.29
SOUTH DAKOTA** (SD)	$458.50	$458.50
TENNESSEE (TN)	$450.93	$450.93
BRAZORIA (TX)	$480.72	$480.72
DALLAS (TX)	$485.78	$485.78
GALVESTON (TX)	$483.47	$483.47
HOUSTON (TX)	$510.56	$510.56
BEAUMONT (TX)	$470.50	$470.50
FORT WORTH (TX)	$484.50	$484.50
AUSTIN (TX)	$497.35	$497.35
REST OF TEXAS (TX)	$476.72	$476.72
UTAH (UT)	$474.74	$474.74
VIRGINIA (VA)	$473.52	$473.52
VIRGIN ISLANDS (VI)	$492.70	$492.70
VERMONT (VT)	$464.98	$464.98
SEATTLE (KING CNTY) (WA)	$538.43	$538.43
REST OF WASHINGTON (WA)	$492.95	$492.95
WISCONSIN (WI)	$449.04	$449.04
WEST VIRGINIA (WV)	$487.43	$487.43
WYOMING** (WY)	$478.47	$478.47

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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 PFS payment is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by a Geographic Practice Cost Index (GPCI) specific to the Medicare locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual conversion factor to produce a national or locality-specific allowed amount. Non-facility and facility rates differ primarily in the practice-expense RVU, reflecting whether the practice or the facility bears the overhead costs; for this code, the practice-expense RVU is the same in both settings, so the non-facility and facility amounts are identical. The conversion factor and RVU values are updated annually and can shift payment year over year even without any coding change.

RVUs — work 7.47, practice expense 5.76 (non-facility) / 5.76 (facility), malpractice 1.48 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment; actual claims processing may differ.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary insurance is responsible for the rest.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-adjusted amounts depend on correct GPCI assignment; always confirm the specific locality used for a claim.
Verify current rates and any local coverage determinations with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

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

Each Medicare locality has its own GPCI values for work, practice expense, and malpractice, which adjust the national RVUs to reflect local cost differences before the conversion factor is applied.

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

The practice-expense RVU — the main driver of the difference between settings — is identical for non-facility and facility for this code, so the calculated PFS amounts come out the same.

Does this amount reflect what Medicare will actually pay?

It reflects the PFS allowed amount before the standard 80/20 split, deductible status, modifiers, and any sequestration or budget-neutrality adjustments are applied, so actual payment may differ.

Where can I find the official descriptor for this CPT code?

CPT code descriptors are copyrighted by the American Medical Association; consult your AMA CPT codebook or licensed coding software 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.