Medicare Reimbursement for CPT 21603

CPT 21603 is a physician procedure code reimbursed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount nationally and by locality, broken out for non-facility and facility settings. Because work, practice expense, and malpractice RVUs are identical for this code in both settings, the non-facility and facility amounts are the same.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1672.05	$1672.05
ALASKA* (AK)	$2031.18	$2031.18
ALABAMA (AL)	$1501.72	$1501.72
ARKANSAS (AR)	$1480.85	$1480.85
ARIZONA (AZ)	$1622.30	$1622.30
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1896.08	$1896.08
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1923.26	$1923.26
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1734.75	$1734.75
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1754.51	$1754.51
NAPA (CA)	$1827.55	$1827.55
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1903.09	$1903.09
VALLEJO (CA)	$1817.44	$1817.44
BAKERSFIELD (CA)	$1668.93	$1668.93
CHICO (CA)	$1652.22	$1652.22
FRESNO (CA)	$1652.22	$1652.22
HANFORD-CORCORAN (CA)	$1652.22	$1652.22
MADERA (CA)	$1652.22	$1652.22
MERCED (CA)	$1652.22	$1652.22
MODESTO (CA)	$1652.22	$1652.22
REDDING (CA)	$1652.22	$1652.22
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1718.47	$1718.47
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1711.07	$1711.07
SALINAS (CA)	$1704.39	$1704.39
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1951.95	$1951.95
SANTA CRUZ-WATSONVILLE (CA)	$1732.37	$1732.37
SANTA ROSA-PETALUMA (CA)	$1748.14	$1748.14
STOCKTON (CA)	$1652.22	$1652.22
VISALIA (CA)	$1652.22	$1652.22
YUBA CITY (CA)	$1652.22	$1652.22
EL CENTRO (CA)	$1653.25	$1653.25
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1728.71	$1728.71
SAN LUIS OBISPO-PASO ROBLES (CA)	$1680.00	$1680.00
SANTA MARIA-SANTA BARBARA (CA)	$1706.45	$1706.45
REST OF CALIFORNIA (CA)	$1652.22	$1652.22
COLORADO (CO)	$1678.02	$1678.02
CONNECTICUT (CT)	$1781.53	$1781.53
DC + MD/VA SUBURBS (DC)	$1854.62	$1854.62
DELAWARE (DE)	$1647.55	$1647.55
FORT LAUDERDALE (FL)	$1847.23	$1847.23
MIAMI (FL)	$2014.15	$2014.15
REST OF FLORIDA (FL)	$1747.45	$1747.45
ATLANTA (GA)	$1726.33	$1726.33
REST OF GEORGIA (GA)	$1641.92	$1641.92
HAWAII, GUAM (HI)	$1673.65	$1673.65
IOWA (IA)	$1492.67	$1492.67
IDAHO (ID)	$1511.59	$1511.59
EAST ST. LOUIS (IL)	$1829.68	$1829.68
SUBURBAN CHICAGO (IL)	$1854.58	$1854.58
CHICAGO (IL)	$1948.33	$1948.33
REST OF ILLINOIS (IL)	$1732.06	$1732.06
INDIANA (IN)	$1518.79	$1518.79
KANSAS (KS)	$1507.65	$1507.65
KENTUCKY (KY)	$1582.80	$1582.80
NEW ORLEANS (LA)	$1662.01	$1662.01
REST OF LOUISIANA (LA)	$1589.09	$1589.09
METROPOLITAN BOSTON (MA)	$1808.27	$1808.27
REST OF MASSACHUSETTS (MA)	$1677.50	$1677.50
BALTIMORE/SURR. CNTYS (MD)	$1781.24	$1781.24
REST OF MARYLAND (MD)	$1671.07	$1671.07
SOUTHERN MAINE (ME)	$1590.07	$1590.07
REST OF MAINE (ME)	$1542.35	$1542.35
DETROIT (MI)	$1791.04	$1791.04
REST OF MICHIGAN (MI)	$1642.48	$1642.48
MINNESOTA (MN)	$1545.46	$1545.46
METROPOLITAN ST. LOUIS (MO)	$1641.46	$1641.46
METROPOLITAN KANSAS CITY (MO)	$1627.90	$1627.90
REST OF MISSOURI (MO)	$1577.54	$1577.54
MISSISSIPPI (MS)	$1528.38	$1528.38
MONTANA** (MT)	$1671.64	$1671.64
NORTH CAROLINA (NC)	$1554.25	$1554.25
NORTH DAKOTA** (ND)	$1549.44	$1549.44
NEBRASKA (NE)	$1493.92	$1493.92
NEW HAMPSHIRE (NH)	$1672.73	$1672.73
NORTHERN NJ (NJ)	$1841.08	$1841.08
REST OF NEW JERSEY (NJ)	$1784.29	$1784.29
NEW MEXICO (NM)	$1659.92	$1659.92
NEVADA** (NV)	$1638.22	$1638.22
MANHATTAN (NY)	$1950.12	$1950.12
NYC SUBURBS/LONG ISLAND (NY)	$2023.50	$2023.50
POUGHKPSIE/N NYC SUBURBS (NY)	$1813.65	$1813.65
QUEENS (NY)	$1933.31	$1933.31
REST OF NEW YORK (NY)	$1578.44	$1578.44
OHIO (OH)	$1617.50	$1617.50
OKLAHOMA (OK)	$1556.90	$1556.90
PORTLAND (OR)	$1704.02	$1704.02
REST OF OREGON (OR)	$1608.16	$1608.16
METROPOLITAN PHILADELPHIA (PA)	$1753.13	$1753.13
REST OF PENNSYLVANIA (PA)	$1607.73	$1607.73
PUERTO RICO (PR)	$1676.06	$1676.06
RHODE ISLAND (RI)	$1686.65	$1686.65
SOUTH CAROLINA (SC)	$1591.99	$1591.99
SOUTH DAKOTA** (SD)	$1534.99	$1534.99
TENNESSEE (TN)	$1517.69	$1517.69
BRAZORIA (TX)	$1627.38	$1627.38
DALLAS (TX)	$1647.53	$1647.53
GALVESTON (TX)	$1638.58	$1638.58
HOUSTON (TX)	$1751.70	$1751.70
BEAUMONT (TX)	$1599.26	$1599.26
FORT WORTH (TX)	$1643.75	$1643.75
AUSTIN (TX)	$1687.62	$1687.62
REST OF TEXAS (TX)	$1619.08	$1619.08
UTAH (UT)	$1612.24	$1612.24
VIRGINIA (VA)	$1600.38	$1600.38
VIRGIN ISLANDS (VI)	$1676.06	$1676.06
VERMONT (VT)	$1563.62	$1563.62
SEATTLE (KING CNTY) (WA)	$1821.89	$1821.89
REST OF WASHINGTON (WA)	$1667.61	$1667.61
WISCONSIN (WI)	$1502.08	$1502.08
WEST VIRGINIA (WV)	$1676.39	$1676.39
WYOMING** (WY)	$1618.38	$1618.38

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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

The Medicare PFS amount is built from three Relative Value Units (RVUs) — work, practice expense (PE), and malpractice (MP) — assigned to the code each year. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific Medicare locality where the service is performed, reflecting local cost differences. The locality-adjusted RVUs are summed and multiplied by the annual Conversion Factor (CF) to produce the dollar allowed amount. Non-facility and facility rates can differ when PE RVUs differ between the two settings, though for some codes — like this one — they are the same.

RVUs — work 24.54, practice expense 19.34 (non-facility) / 19.34 (facility), malpractice 6.18 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by Medicare Administrative Contractor (MAC), locality GPCI updates, applied modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always confirm current rates and coverage rules with your local MAC before billing or appealing a claim.

Frequently asked

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

When the practice expense RVU is identical in both settings, the calculated allowed amount is the same whether the service is billed in a non-facility (e.g., office) or facility (e.g., hospital) setting.

Does this amount reflect what my practice will actually be paid?

No. It's a national or locality-level estimate based on standard RVUs and the conversion factor. Your actual payment depends on your specific locality, any modifiers applied, and other adjustments such as sequestration.

Why do GPCIs matter for this calculation?

GPCIs adjust the work, practice expense, and malpractice RVUs to reflect cost-of-living and practice cost differences across different Medicare localities, so the same code can have different allowed amounts in different areas.

What if I disagree with a denial or payment amount for this code?

Contact your Medicare Administrative Contractor (MAC) to review the claim; verify that the correct locality, modifiers, and place of service were applied before submitting an appeal.

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.