Medicare Reimbursement for CPT 21610

CPT 21610 is a procedure code reported to Medicare for physician and outpatient billing. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for local costs, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1217.13	$1217.13
ALASKA* (AK)	$1409.14	$1409.14
ALABAMA (AL)	$1062.14	$1062.14
ARKANSAS (AR)	$1043.30	$1043.30
ARIZONA (AZ)	$1170.74	$1170.74
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1337.47	$1337.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1354.49	$1354.49
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1236.57	$1236.57
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1252.76	$1252.76
NAPA (CA)	$1294.87	$1294.87
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1344.91	$1344.91
VALLEJO (CA)	$1284.15	$1284.15
BAKERSFIELD (CA)	$1187.54	$1187.54
CHICO (CA)	$1170.53	$1170.53
FRESNO (CA)	$1170.53	$1170.53
HANFORD-CORCORAN (CA)	$1170.53	$1170.53
MADERA (CA)	$1170.53	$1170.53
MERCED (CA)	$1170.53	$1170.53
MODESTO (CA)	$1170.53	$1170.53
REDDING (CA)	$1170.53	$1170.53
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1240.40	$1240.40
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1212.56	$1212.56
SALINAS (CA)	$1208.04	$1208.04
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1384.90	$1384.90
SANTA CRUZ-WATSONVILLE (CA)	$1229.76	$1229.76
SANTA ROSA-PETALUMA (CA)	$1240.67	$1240.67
STOCKTON (CA)	$1170.53	$1170.53
VISALIA (CA)	$1170.53	$1170.53
YUBA CITY (CA)	$1170.53	$1170.53
EL CENTRO (CA)	$1171.63	$1171.63
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1226.61	$1226.61
SAN LUIS OBISPO-PASO ROBLES (CA)	$1191.19	$1191.19
SANTA MARIA-SANTA BARBARA (CA)	$1209.85	$1209.85
REST OF CALIFORNIA (CA)	$1170.53	$1170.53
COLORADO (CO)	$1206.17	$1206.17
CONNECTICUT (CT)	$1310.42	$1310.42
DC + MD/VA SUBURBS (DC)	$1355.32	$1355.32
DELAWARE (DE)	$1191.86	$1191.86
FORT LAUDERDALE (FL)	$1400.14	$1400.14
MIAMI (FL)	$1571.33	$1571.33
REST OF FLORIDA (FL)	$1306.04	$1306.04
ATLANTA (GA)	$1270.34	$1270.34
REST OF GEORGIA (GA)	$1207.26	$1207.26
HAWAII, GUAM (HI)	$1190.83	$1190.83
IOWA (IA)	$1044.38	$1044.38
IDAHO (ID)	$1063.41	$1063.41
EAST ST. LOUIS (IL)	$1400.54	$1400.54
SUBURBAN CHICAGO (IL)	$1402.62	$1402.62
CHICAGO (IL)	$1506.47	$1506.47
REST OF ILLINOIS (IL)	$1298.51	$1298.51
INDIANA (IN)	$1069.62	$1069.62
KANSAS (KS)	$1062.51	$1062.51
KENTUCKY (KY)	$1145.22	$1145.22
NEW ORLEANS (LA)	$1218.54	$1218.54
REST OF LOUISIANA (LA)	$1152.71	$1152.71
METROPOLITAN BOSTON (MA)	$1307.48	$1307.48
REST OF MASSACHUSETTS (MA)	$1206.46	$1206.46
BALTIMORE/SURR. CNTYS (MD)	$1312.33	$1312.33
REST OF MARYLAND (MD)	$1210.13	$1210.13
SOUTHERN MAINE (ME)	$1132.08	$1132.08
REST OF MAINE (ME)	$1096.01	$1096.01
DETROIT (MI)	$1350.40	$1350.40
REST OF MICHIGAN (MI)	$1203.56	$1203.56
MINNESOTA (MN)	$1077.04	$1077.04
METROPOLITAN ST. LOUIS (MO)	$1194.51	$1194.51
METROPOLITAN KANSAS CITY (MO)	$1182.80	$1182.80
REST OF MISSOURI (MO)	$1145.16	$1145.16
MISSISSIPPI (MS)	$1093.27	$1093.27
MONTANA** (MT)	$1216.69	$1216.69
NORTH CAROLINA (NC)	$1105.97	$1105.97
NORTH DAKOTA** (ND)	$1087.18	$1087.18
NEBRASKA (NE)	$1044.07	$1044.07
NEW HAMPSHIRE (NH)	$1209.47	$1209.47
NORTHERN NJ (NJ)	$1341.49	$1341.49
REST OF NEW JERSEY (NJ)	$1303.26	$1303.26
NEW MEXICO (NM)	$1221.24	$1221.24
NEVADA** (NV)	$1181.07	$1181.07
MANHATTAN (NY)	$1456.30	$1456.30
NYC SUBURBS/LONG ISLAND (NY)	$1528.55	$1528.55
POUGHKPSIE/N NYC SUBURBS (NY)	$1332.01	$1332.01
QUEENS (NY)	$1434.40	$1434.40
REST OF NEW YORK (NY)	$1128.14	$1128.14
OHIO (OH)	$1177.09	$1177.09
OKLAHOMA (OK)	$1116.95	$1116.95
PORTLAND (OR)	$1222.72	$1222.72
REST OF OREGON (OR)	$1150.23	$1150.23
METROPOLITAN PHILADELPHIA (PA)	$1288.37	$1288.37
REST OF PENNSYLVANIA (PA)	$1165.71	$1165.71
PUERTO RICO (PR)	$1219.13	$1219.13
RHODE ISLAND (RI)	$1219.19	$1219.19
SOUTH CAROLINA (SC)	$1147.81	$1147.81
SOUTH DAKOTA** (SD)	$1071.86	$1071.86
TENNESSEE (TN)	$1072.13	$1072.13
BRAZORIA (TX)	$1168.82	$1168.82
DALLAS (TX)	$1188.80	$1188.80
GALVESTON (TX)	$1180.28	$1180.28
HOUSTON (TX)	$1300.17	$1300.17
BEAUMONT (TX)	$1158.37	$1158.37
FORT WORTH (TX)	$1186.84	$1186.84
AUSTIN (TX)	$1221.08	$1221.08
REST OF TEXAS (TX)	$1171.41	$1171.41
UTAH (UT)	$1166.00	$1166.00
VIRGINIA (VA)	$1144.64	$1144.64
VIRGIN ISLANDS (VI)	$1219.13	$1219.13
VERMONT (VT)	$1104.25	$1104.25
SEATTLE (KING CNTY) (WA)	$1312.02	$1312.02
REST OF WASHINGTON (WA)	$1197.03	$1197.03
WISCONSIN (WI)	$1045.56	$1045.56
WEST VIRGINIA (WV)	$1248.50	$1248.50
WYOMING** (WY)	$1160.25	$1160.25

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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 — that reflect the relative resources needed to furnish a service. Each RVU component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is performed, since costs vary across the country. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings because the resources a physician must supply differ in each setting.

RVUs — work 15.51, practice expense 14.38 (non-facility) / 14.38 (facility), malpractice 6.55 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can change the amount actually paid.
Annual budget-neutrality adjustments and conversion factor updates can shift fees from year to year.
Local Medicare Administrative Contractor (MAC) coverage and payment policies may affect whether and how this code is reimbursed; verify current figures with your MAC.

Frequently asked

Why does the fee differ between non-facility and facility settings?

The practice-expense RVU is higher in non-facility settings because the physician's office bears the overhead costs (staff, equipment, supplies) that a facility would otherwise absorb.

Will my locality's payment match the national amount shown here?

Not necessarily. The national amount uses a standard geographic adjustment, while actual payment is recalculated using the GPCIs for the specific locality where the service is performed.

Does this figure represent what the provider will actually collect?

No. This is the Medicare-allowed amount before cost-sharing. Actual collections depend on the patient's deductible status, coinsurance, secondary coverage, and any applicable adjustments.

Why might the amount change next year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality requirements can shift relative payments across codes.

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.