Medicare Reimbursement for CPT 21602

CPT 21602 is a procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, reflecting both non-facility and facility payment settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1529.09	$1529.09
ALASKA* (AK)	$1851.74	$1851.74
ALABAMA (AL)	$1373.50	$1373.50
ARKANSAS (AR)	$1354.39	$1354.39
ARIZONA (AZ)	$1484.06	$1484.06
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1753.64	$1753.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1779.64	$1779.64
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1596.93	$1596.93
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1614.23	$1614.23
NAPA (CA)	$1687.37	$1687.37
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1759.67	$1759.67
VALLEJO (CA)	$1678.68	$1678.68
BAKERSFIELD (CA)	$1533.86	$1533.86
CHICO (CA)	$1519.46	$1519.46
FRESNO (CA)	$1519.46	$1519.46
HANFORD-CORCORAN (CA)	$1519.46	$1519.46
MADERA (CA)	$1519.46	$1519.46
MERCED (CA)	$1519.46	$1519.46
MODESTO (CA)	$1519.46	$1519.46
REDDING (CA)	$1519.46	$1519.46
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1576.41	$1576.41
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1575.34	$1575.34
SALINAS (CA)	$1569.21	$1569.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1804.30	$1804.30
SANTA CRUZ-WATSONVILLE (CA)	$1597.20	$1597.20
SANTA ROSA-PETALUMA (CA)	$1611.88	$1611.88
STOCKTON (CA)	$1519.46	$1519.46
VISALIA (CA)	$1519.46	$1519.46
YUBA CITY (CA)	$1519.46	$1519.46
EL CENTRO (CA)	$1520.35	$1520.35
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1592.82	$1592.82
SAN LUIS OBISPO-PASO ROBLES (CA)	$1546.51	$1546.51
SANTA MARIA-SANTA BARBARA (CA)	$1571.44	$1571.44
REST OF CALIFORNIA (CA)	$1519.46	$1519.46
COLORADO (CO)	$1539.18	$1539.18
CONNECTICUT (CT)	$1629.22	$1629.22
DC + MD/VA SUBURBS (DC)	$1700.12	$1700.12
DELAWARE (DE)	$1507.25	$1507.25
FORT LAUDERDALE (FL)	$1680.58	$1680.58
MIAMI (FL)	$1826.06	$1826.06
REST OF FLORIDA (FL)	$1590.63	$1590.63
ATLANTA (GA)	$1576.97	$1576.97
REST OF GEORGIA (GA)	$1495.22	$1495.22
HAWAII, GUAM (HI)	$1540.59	$1540.59
IOWA (IA)	$1368.69	$1368.69
IDAHO (ID)	$1385.31	$1385.31
EAST ST. LOUIS (IL)	$1658.62	$1658.62
SUBURBAN CHICAGO (IL)	$1688.06	$1688.06
CHICAGO (IL)	$1766.98	$1766.98
REST OF ILLINOIS (IL)	$1574.23	$1574.23
INDIANA (IN)	$1392.02	$1392.02
KANSAS (KS)	$1380.75	$1380.75
KENTUCKY (KY)	$1444.21	$1444.21
NEW ORLEANS (LA)	$1516.11	$1516.11
REST OF LOUISIANA (LA)	$1449.32	$1449.32
METROPOLITAN BOSTON (MA)	$1661.23	$1661.23
REST OF MASSACHUSETTS (MA)	$1537.99	$1537.99
BALTIMORE/SURR. CNTYS (MD)	$1628.60	$1628.60
REST OF MARYLAND (MD)	$1529.33	$1529.33
SOUTHERN MAINE (ME)	$1457.99	$1457.99
REST OF MAINE (ME)	$1411.74	$1411.74
DETROIT (MI)	$1628.75	$1628.75
REST OF MICHIGAN (MI)	$1497.25	$1497.25
MINNESOTA (MN)	$1422.47	$1422.47
METROPOLITAN ST. LOUIS (MO)	$1499.26	$1499.26
METROPOLITAN KANSAS CITY (MO)	$1486.65	$1486.65
REST OF MISSOURI (MO)	$1437.69	$1437.69
MISSISSIPPI (MS)	$1395.38	$1395.38
MONTANA** (MT)	$1528.74	$1528.74
NORTH CAROLINA (NC)	$1422.93	$1422.93
NORTH DAKOTA** (ND)	$1423.74	$1423.74
NEBRASKA (NE)	$1370.35	$1370.35
NEW HAMPSHIRE (NH)	$1532.71	$1532.71
NORTHERN NJ (NJ)	$1687.32	$1687.32
REST OF NEW JERSEY (NJ)	$1633.07	$1633.07
NEW MEXICO (NM)	$1512.54	$1512.54
NEVADA** (NV)	$1500.10	$1500.10
MANHATTAN (NY)	$1781.17	$1781.17
NYC SUBURBS/LONG ISLAND (NY)	$1846.22	$1846.22
POUGHKPSIE/N NYC SUBURBS (NY)	$1658.61	$1658.61
QUEENS (NY)	$1768.21	$1768.21
REST OF NEW YORK (NY)	$1444.97	$1444.97
OHIO (OH)	$1475.79	$1475.79
OKLAHOMA (OK)	$1422.25	$1422.25
PORTLAND (OR)	$1565.07	$1565.07
REST OF OREGON (OR)	$1473.90	$1473.90
METROPOLITAN PHILADELPHIA (PA)	$1602.12	$1602.12
REST OF PENNSYLVANIA (PA)	$1467.77	$1467.77
PUERTO RICO (PR)	$1533.35	$1533.35
RHODE ISLAND (RI)	$1544.43	$1544.43
SOUTH CAROLINA (SC)	$1454.69	$1454.69
SOUTH DAKOTA** (SD)	$1411.33	$1411.33
TENNESSEE (TN)	$1389.74	$1389.74
BRAZORIA (TX)	$1490.20	$1490.20
DALLAS (TX)	$1507.90	$1507.90
GALVESTON (TX)	$1499.97	$1499.97
HOUSTON (TX)	$1597.16	$1597.16
BEAUMONT (TX)	$1459.90	$1459.90
FORT WORTH (TX)	$1503.91	$1503.91
AUSTIN (TX)	$1546.80	$1546.80
REST OF TEXAS (TX)	$1479.81	$1479.81
UTAH (UT)	$1473.27	$1473.27
VIRGINIA (VA)	$1466.26	$1466.26
VIRGIN ISLANDS (VI)	$1533.35	$1533.35
VERMONT (VT)	$1435.19	$1435.19
SEATTLE (KING CNTY) (WA)	$1675.55	$1675.55
REST OF WASHINGTON (WA)	$1529.43	$1529.43
WISCONSIN (WI)	$1379.95	$1379.95
WEST VIRGINIA (WV)	$1523.14	$1523.14
WYOMING** (WY)	$1482.98	$1482.98

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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 PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for a given locality to reflect local cost differences. The geographically adjusted RVUs are summed and multiplied by the annual conversion factor to produce the allowed amount. Non-facility and facility rates can differ because practice-expense RVUs vary depending on whether the service is furnished in a physician office versus a hospital or other facility setting. For this code, the non-facility and facility practice-expense RVUs are the same, so the national allowed amounts shown are identical in both settings; locality-adjusted amounts may still vary slightly due to GPCI differences.

RVUs — work 21.64, practice expense 18.83 (non-facility) / 18.83 (facility), malpractice 5.31 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national RVUs, GPCIs, and the conversion factor — not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the beneficiary or secondary payer is responsible for the remainder.
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 locality; always verify current-year rates with your MAC or official CMS files before billing.

Frequently asked

Why does the facility amount equal the non-facility amount for this code?

When the practice-expense RVUs are the same for both settings, the calculated PFS amounts come out equal, though this isn't the case for all codes.

Does this amount reflect what Medicare will actually pay?

No — it reflects the PFS allowed amount before deductible and coinsurance. Medicare generally pays 80% of this amount after the deductible, and factors like sequestration or modifiers can further adjust the payment.

Why might the amount differ by locality?

Each locality has its own GPCI values for work, practice expense, and malpractice costs, which adjust the RVUs to reflect regional cost-of-living and practice cost differences.

Where can I find the official rate for my area?

Use the CMS Physician Fee Schedule Look-Up Tool or contact your Medicare Administrative Contractor (MAC) for the current, locality-specific amount.

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.