Medicare Reimbursement for CPT 21558

CPT 21558 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount at the national level and, where available, adjusted for local cost differences, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1221.47	$1221.47
ALASKA* (AK)	$1529.31	$1529.31
ALABAMA (AL)	$1110.19	$1110.19
ARKANSAS (AR)	$1096.63	$1096.63
ARIZONA (AZ)	$1188.41	$1188.41
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1352.86	$1352.86
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1370.98	$1370.98
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1251.53	$1251.53
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1267.20	$1267.20
NAPA (CA)	$1308.95	$1308.95
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1357.97	$1357.97
VALLEJO (CA)	$1301.58	$1301.58
BAKERSFIELD (CA)	$1211.42	$1211.42
CHICO (CA)	$1199.04	$1199.04
FRESNO (CA)	$1199.04	$1199.04
HANFORD-CORCORAN (CA)	$1199.04	$1199.04
MADERA (CA)	$1199.04	$1199.04
MERCED (CA)	$1199.04	$1199.04
MODESTO (CA)	$1199.04	$1199.04
REDDING (CA)	$1199.04	$1199.04
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1247.39	$1247.39
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1237.08	$1237.08
SALINAS (CA)	$1232.09	$1232.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1391.87	$1391.87
SANTA CRUZ-WATSONVILLE (CA)	$1245.70	$1245.70
SANTA ROSA-PETALUMA (CA)	$1256.81	$1256.81
STOCKTON (CA)	$1199.04	$1199.04
VISALIA (CA)	$1199.04	$1199.04
YUBA CITY (CA)	$1199.04	$1199.04
EL CENTRO (CA)	$1199.80	$1199.80
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1245.92	$1245.92
SAN LUIS OBISPO-PASO ROBLES (CA)	$1214.89	$1214.89
SANTA MARIA-SANTA BARBARA (CA)	$1232.56	$1232.56
REST OF CALIFORNIA (CA)	$1199.04	$1199.04
COLORADO (CO)	$1220.57	$1220.57
CONNECTICUT (CT)	$1295.46	$1295.46
DC + MD/VA SUBURBS (DC)	$1341.98	$1341.98
DELAWARE (DE)	$1205.38	$1205.38
FORT LAUDERDALE (FL)	$1347.71	$1347.71
MIAMI (FL)	$1466.39	$1466.39
REST OF FLORIDA (FL)	$1280.86	$1280.86
ATLANTA (GA)	$1259.68	$1259.68
REST OF GEORGIA (GA)	$1210.54	$1210.54
HAWAII, GUAM (HI)	$1208.67	$1208.67
IOWA (IA)	$1099.52	$1099.52
IDAHO (ID)	$1112.79	$1112.79
EAST ST. LOUIS (IL)	$1344.41	$1344.41
SUBURBAN CHICAGO (IL)	$1352.37	$1352.37
CHICAGO (IL)	$1422.88	$1422.88
REST OF ILLINOIS (IL)	$1274.04	$1274.04
INDIANA (IN)	$1117.32	$1117.32
KANSAS (KS)	$1111.55	$1111.55
KENTUCKY (KY)	$1167.80	$1167.80
NEW ORLEANS (LA)	$1220.18	$1220.18
REST OF LOUISIANA (LA)	$1172.79	$1172.79
METROPOLITAN BOSTON (MA)	$1305.22	$1305.22
REST OF MASSACHUSETTS (MA)	$1221.73	$1221.73
BALTIMORE/SURR. CNTYS (MD)	$1295.23	$1295.23
REST OF MARYLAND (MD)	$1220.59	$1220.59
SOUTHERN MAINE (ME)	$1162.69	$1162.69
REST OF MAINE (ME)	$1135.18	$1135.18
DETROIT (MI)	$1311.69	$1311.69
REST OF MICHIGAN (MI)	$1208.81	$1208.81
MINNESOTA (MN)	$1126.34	$1126.34
METROPOLITAN ST. LOUIS (MO)	$1204.09	$1204.09
METROPOLITAN KANSAS CITY (MO)	$1195.54	$1195.54
REST OF MISSOURI (MO)	$1166.72	$1166.72
MISSISSIPPI (MS)	$1131.03	$1131.03
MONTANA** (MT)	$1221.17	$1221.17
NORTH CAROLINA (NC)	$1142.53	$1142.53
NORTH DAKOTA** (ND)	$1132.19	$1132.19
NEBRASKA (NE)	$1099.61	$1099.61
NEW HAMPSHIRE (NH)	$1217.79	$1217.79
NORTHERN NJ (NJ)	$1334.91	$1334.91
REST OF NEW JERSEY (NJ)	$1298.05	$1298.05
NEW MEXICO (NM)	$1221.10	$1221.10
NEVADA** (NV)	$1196.74	$1196.74
MANHATTAN (NY)	$1414.21	$1414.21
NYC SUBURBS/LONG ISLAND (NY)	$1464.89	$1464.89
POUGHKPSIE/N NYC SUBURBS (NY)	$1319.66	$1319.66
QUEENS (NY)	$1399.93	$1399.93
REST OF NEW YORK (NY)	$1158.41	$1158.41
OHIO (OH)	$1190.62	$1190.62
OKLAHOMA (OK)	$1148.53	$1148.53
PORTLAND (OR)	$1235.13	$1235.13
REST OF OREGON (OR)	$1175.36	$1175.36
METROPOLITAN PHILADELPHIA (PA)	$1278.23	$1278.23
REST OF PENNSYLVANIA (PA)	$1182.99	$1182.99
PUERTO RICO (PR)	$1223.27	$1223.27
RHODE ISLAND (RI)	$1230.75	$1230.75
SOUTH CAROLINA (SC)	$1170.93	$1170.93
SOUTH DAKOTA** (SD)	$1121.67	$1121.67
TENNESSEE (TN)	$1118.35	$1118.35
BRAZORIA (TX)	$1190.71	$1190.71
DALLAS (TX)	$1204.98	$1204.98
GALVESTON (TX)	$1198.66	$1198.66
HOUSTON (TX)	$1281.03	$1281.03
BEAUMONT (TX)	$1177.64	$1177.64
FORT WORTH (TX)	$1203.25	$1203.25
AUSTIN (TX)	$1227.11	$1227.11
REST OF TEXAS (TX)	$1188.10	$1188.10
UTAH (UT)	$1184.04	$1184.04
VIRGINIA (VA)	$1171.02	$1171.02
VIRGIN ISLANDS (VI)	$1223.27	$1223.27
VERMONT (VT)	$1143.54	$1143.54
SEATTLE (KING CNTY) (WA)	$1312.73	$1312.73
REST OF WASHINGTON (WA)	$1214.21	$1214.21
WISCONSIN (WI)	$1101.99	$1101.99
WEST VIRGINIA (WV)	$1237.99	$1237.99
WYOMING** (WY)	$1182.39	$1182.39

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit 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) — physician work, practice expense, and malpractice — assigned to each procedure code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Medicare 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 these values may be the same. The resulting national and locality-adjusted amounts represent the Medicare-allowed rate before any additional adjustments.

RVUs — work 21.04, practice expense 11.03 (non-facility) / 11.03 (facility), malpractice 4.5 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the remainder is patient or secondary-payer responsibility.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts can change year to year.
Always verify the current rate and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount the same as the non-facility amount for this code?

For some procedure codes, CMS assigns the same practice-expense RVU to both settings, resulting in equal allowed amounts. This can occur when the code is typically performed only in one setting or when overhead costs are treated as equivalent.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-allowed amount before the standard 80/20 split, deductible, and any modifier or sequestration adjustments are applied.

Will this amount change during the year?

The conversion factor and RVUs are typically set annually, but CMS can issue corrections, and some values are subject to budget-neutrality adjustments across the payment system.

How do I find the amount for my specific location?

Use the locality-adjusted figures shown on this page, which apply the GPCIs for that area, or check your MAC's published fee schedule for confirmation.

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.