Medicare Reimbursement for CPT 21601

CPT 21601 is a surgical procedure code reported to Medicare and other payers. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted for locality, comparing non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1111.58	$1111.58
ALASKA* (AK)	$1359.55	$1359.55
ALABAMA (AL)	$999.21	$999.21
ARKANSAS (AR)	$985.50	$985.50
ARIZONA (AZ)	$1078.32	$1078.32
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1238.82	$1238.82
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1255.64	$1255.64
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1141.80	$1141.80
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1155.79	$1155.79
NAPA (CA)	$1197.25	$1197.25
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1243.86	$1243.86
VALLEJO (CA)	$1189.99	$1189.99
BAKERSFIELD (CA)	$1101.48	$1101.48
CHICO (CA)	$1089.49	$1089.49
FRESNO (CA)	$1089.49	$1089.49
HANFORD-CORCORAN (CA)	$1089.49	$1089.49
MADERA (CA)	$1089.49	$1089.49
MERCED (CA)	$1089.49	$1089.49
MODESTO (CA)	$1089.49	$1089.49
REDDING (CA)	$1089.49	$1089.49
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1137.08	$1137.08
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1126.23	$1126.23
SALINAS (CA)	$1121.80	$1121.80
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1276.26	$1276.26
SANTA CRUZ-WATSONVILLE (CA)	$1137.52	$1137.52
SANTA ROSA-PETALUMA (CA)	$1147.72	$1147.72
STOCKTON (CA)	$1089.49	$1089.49
VISALIA (CA)	$1089.49	$1089.49
YUBA CITY (CA)	$1089.49	$1089.49
EL CENTRO (CA)	$1090.23	$1090.23
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1136.32	$1136.32
SAN LUIS OBISPO-PASO ROBLES (CA)	$1106.01	$1106.01
SANTA MARIA-SANTA BARBARA (CA)	$1122.75	$1122.75
REST OF CALIFORNIA (CA)	$1089.49	$1089.49
COLORADO (CO)	$1110.64	$1110.64
CONNECTICUT (CT)	$1183.88	$1183.88
DC + MD/VA SUBURBS (DC)	$1227.99	$1227.99
DELAWARE (DE)	$1094.89	$1094.89
FORT LAUDERDALE (FL)	$1236.40	$1236.40
MIAMI (FL)	$1354.08	$1354.08
REST OF FLORIDA (FL)	$1169.28	$1169.28
ATLANTA (GA)	$1149.27	$1149.27
REST OF GEORGIA (GA)	$1098.57	$1098.57
HAWAII, GUAM (HI)	$1101.77	$1101.77
IOWA (IA)	$989.51	$989.51
IDAHO (ID)	$1002.70	$1002.70
EAST ST. LOUIS (IL)	$1231.23	$1231.23
SUBURBAN CHICAGO (IL)	$1240.49	$1240.49
CHICAGO (IL)	$1309.61	$1309.61
REST OF ILLINOIS (IL)	$1161.66	$1161.66
INDIANA (IN)	$1007.32	$1007.32
KANSAS (KS)	$1001.15	$1001.15
KENTUCKY (KY)	$1056.34	$1056.34
NEW ORLEANS (LA)	$1109.09	$1109.09
REST OF LOUISIANA (LA)	$1061.18	$1061.18
METROPOLITAN BOSTON (MA)	$1193.53	$1193.53
REST OF MASSACHUSETTS (MA)	$1111.10	$1111.10
BALTIMORE/SURR. CNTYS (MD)	$1184.04	$1184.04
REST OF MARYLAND (MD)	$1109.82	$1109.82
SOUTHERN MAINE (ME)	$1053.40	$1053.40
REST OF MAINE (ME)	$1024.80	$1024.80
DETROIT (MI)	$1199.87	$1199.87
REST OF MICHIGAN (MI)	$1097.30	$1097.30
MINNESOTA (MN)	$1018.32	$1018.32
METROPOLITAN ST. LOUIS (MO)	$1093.44	$1093.44
METROPOLITAN KANSAS CITY (MO)	$1084.74	$1084.74
REST OF MISSOURI (MO)	$1054.72	$1054.72
MISSISSIPPI (MS)	$1019.48	$1019.48
MONTANA** (MT)	$1111.29	$1111.29
NORTH CAROLINA (NC)	$1032.31	$1032.31
NORTH DAKOTA** (ND)	$1023.49	$1023.49
NEBRASKA (NE)	$989.76	$989.76
NEW HAMPSHIRE (NH)	$1108.79	$1108.79
NORTHERN NJ (NJ)	$1219.61	$1219.61
REST OF NEW JERSEY (NJ)	$1184.47	$1184.47
NEW MEXICO (NM)	$1109.51	$1109.51
NEVADA** (NV)	$1087.20	$1087.20
MANHATTAN (NY)	$1297.78	$1297.78
NYC SUBURBS/LONG ISLAND (NY)	$1348.34	$1348.34
POUGHKPSIE/N NYC SUBURBS (NY)	$1205.28	$1205.28
QUEENS (NY)	$1284.11	$1284.11
REST OF NEW YORK (NY)	$1048.33	$1048.33
OHIO (OH)	$1079.35	$1079.35
OKLAHOMA (OK)	$1037.41	$1037.41
PORTLAND (OR)	$1125.52	$1125.52
REST OF OREGON (OR)	$1066.00	$1066.00
METROPOLITAN PHILADELPHIA (PA)	$1166.38	$1166.38
REST OF PENNSYLVANIA (PA)	$1071.93	$1071.93
PUERTO RICO (PR)	$1113.58	$1113.58
RHODE ISLAND (RI)	$1119.25	$1119.25
SOUTH CAROLINA (SC)	$1060.14	$1060.14
SOUTH DAKOTA** (SD)	$1013.11	$1013.11
TENNESSEE (TN)	$1007.97	$1007.97
BRAZORIA (TX)	$1080.13	$1080.13
DALLAS (TX)	$1094.20	$1094.20
GALVESTON (TX)	$1088.02	$1088.02
HOUSTON (TX)	$1169.29	$1169.29
BEAUMONT (TX)	$1066.48	$1066.48
FORT WORTH (TX)	$1092.29	$1092.29
AUSTIN (TX)	$1118.11	$1118.11
REST OF TEXAS (TX)	$1077.61	$1077.61
UTAH (UT)	$1073.41	$1073.41
VIRGINIA (VA)	$1061.45	$1061.45
VIRGIN ISLANDS (VI)	$1113.58	$1113.58
VERMONT (VT)	$1034.48	$1034.48
SEATTLE (KING CNTY) (WA)	$1200.59	$1200.59
REST OF WASHINGTON (WA)	$1104.03	$1104.03
WISCONSIN (WI)	$992.83	$992.83
WEST VIRGINIA (WV)	$1125.18	$1125.18
WYOMING** (WY)	$1073.02	$1073.02

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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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost-of-living and practice-cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often use different practice-expense RVUs, since overhead costs differ when the procedure is performed in a hospital or ambulatory surgical center versus a physician's office.

RVUs — work 17.34, practice expense 11.5 (non-facility) / 11.5 (facility), malpractice 4.44 — × 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 patient meets their annual deductible; the remaining 20% is patient responsibility (or secondary insurance).
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts can vary by Medicare Administrative Contractor (MAC) and specific locality; always verify with your MAC's published fee schedule.
This figure reflects Medicare Part B physician fee schedule pricing and may not apply to other payers or Medicare Advantage plans.

Frequently asked

Why is the facility amount different from the non-facility amount?

The practice-expense RVU component differs because overhead costs (staff, supplies, equipment) are typically lower when a procedure is performed in a facility like a hospital, since the facility bears some of those costs separately.

Does this amount reflect what the patient will actually pay?

No. This is the Medicare-allowed amount before cost-sharing. The patient (or secondary insurance) is generally responsible for 20% after the deductible is met, and actual billed or collected amounts can vary.

Why might my MAC's fee schedule show a different number?

Locality-specific GPCIs, annual budget-neutrality adjustments, sequestration, and timing of CMS updates can cause small variances between national estimates and your local MAC's published amounts.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the final payment relative to the base PFS amount shown here.

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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.