Medicare Reimbursement for CPT 21616

CPT 21616 is a procedure code billed under Medicare Part B; the exact clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for your locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$666.01	$666.01
ALASKA* (AK)	$834.78	$834.78
ALABAMA (AL)	$601.79	$601.79
ARKANSAS (AR)	$594.05	$594.05
ARIZONA (AZ)	$646.25	$646.25
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$704.97	$704.97
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$712.92	$712.92
OXNARD-THOUSAND OAKS-VENTURA (CA)	$664.60	$664.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$674.45	$674.45
NAPA (CA)	$686.96	$686.96
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$708.56	$708.56
VALLEJO (CA)	$681.78	$681.78
BAKERSFIELD (CA)	$646.74	$646.74
CHICO (CA)	$638.20	$638.20
FRESNO (CA)	$638.20	$638.20
HANFORD-CORCORAN (CA)	$638.20	$638.20
MADERA (CA)	$638.20	$638.20
MERCED (CA)	$638.20	$638.20
MODESTO (CA)	$638.20	$638.20
REDDING (CA)	$638.20	$638.20
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$672.08	$672.08
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$655.92	$655.92
SALINAS (CA)	$653.27	$653.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$727.59	$727.59
SANTA CRUZ-WATSONVILLE (CA)	$657.39	$657.39
SANTA ROSA-PETALUMA (CA)	$663.02	$663.02
STOCKTON (CA)	$638.20	$638.20
VISALIA (CA)	$638.20	$638.20
YUBA CITY (CA)	$638.20	$638.20
EL CENTRO (CA)	$638.73	$638.73
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$658.94	$658.94
SAN LUIS OBISPO-PASO ROBLES (CA)	$644.54	$644.54
SANTA MARIA-SANTA BARBARA (CA)	$653.06	$653.06
REST OF CALIFORNIA (CA)	$638.20	$638.20
COLORADO (CO)	$657.28	$657.28
CONNECTICUT (CT)	$707.78	$707.78
DC + MD/VA SUBURBS (DC)	$726.47	$726.47
DELAWARE (DE)	$655.65	$655.65
FORT LAUDERDALE (FL)	$753.21	$753.21
MIAMI (FL)	$833.43	$833.43
REST OF FLORIDA (FL)	$712.62	$712.62
ATLANTA (GA)	$690.83	$690.83
REST OF GEORGIA (GA)	$670.37	$670.37
HAWAII, GUAM (HI)	$641.76	$641.76
IOWA (IA)	$589.85	$589.85
IDAHO (ID)	$598.61	$598.61
EAST ST. LOUIS (IL)	$761.25	$761.25
SUBURBAN CHICAGO (IL)	$754.37	$754.37
CHICAGO (IL)	$806.33	$806.33
REST OF ILLINOIS (IL)	$712.62	$712.62
INDIANA (IN)	$601.01	$601.01
KANSAS (KS)	$599.52	$599.52
KENTUCKY (KY)	$640.69	$640.69
NEW ORLEANS (LA)	$671.68	$671.68
REST OF LOUISIANA (LA)	$644.64	$644.64
METROPOLITAN BOSTON (MA)	$699.92	$699.92
REST OF MASSACHUSETTS (MA)	$659.01	$659.01
BALTIMORE/SURR. CNTYS (MD)	$708.39	$708.39
REST OF MARYLAND (MD)	$663.26	$663.26
SOUTHERN MAINE (ME)	$625.74	$625.74
REST OF MAINE (ME)	$614.33	$614.33
DETROIT (MI)	$733.26	$733.26
REST OF MICHIGAN (MI)	$666.81	$666.81
MINNESOTA (MN)	$595.98	$595.98
METROPOLITAN ST. LOUIS (MO)	$659.15	$659.15
METROPOLITAN KANSAS CITY (MO)	$654.60	$654.60
REST OF MISSOURI (MO)	$642.94	$642.94
MISSISSIPPI (MS)	$617.99	$617.99
MONTANA** (MT)	$665.80	$665.80
NORTH CAROLINA (NC)	$618.04	$618.04
NORTH DAKOTA** (ND)	$603.32	$603.32
NEBRASKA (NE)	$589.02	$589.02
NEW HAMPSHIRE (NH)	$658.86	$658.86
NORTHERN NJ (NJ)	$722.79	$722.79
REST OF NEW JERSEY (NJ)	$706.33	$706.33
NEW MEXICO (NM)	$675.00	$675.00
NEVADA** (NV)	$648.53	$648.53
MANHATTAN (NY)	$778.17	$778.17
NYC SUBURBS/LONG ISLAND (NY)	$810.75	$810.75
POUGHKPSIE/N NYC SUBURBS (NY)	$720.76	$720.76
QUEENS (NY)	$765.92	$765.92
REST OF NEW YORK (NY)	$627.30	$627.30
OHIO (OH)	$654.04	$654.04
OKLAHOMA (OK)	$626.72	$626.72
PORTLAND (OR)	$661.95	$661.95
REST OF OREGON (OR)	$634.08	$634.08
METROPOLITAN PHILADELPHIA (PA)	$699.86	$699.86
REST OF PENNSYLVANIA (PA)	$648.13	$648.13
PUERTO RICO (PR)	$666.05	$666.05
RHODE ISLAND (RI)	$667.33	$667.33
SOUTH CAROLINA (SC)	$638.99	$638.99
SOUTH DAKOTA** (SD)	$595.93	$595.93
TENNESSEE (TN)	$603.74	$603.74
BRAZORIA (TX)	$644.77	$644.77
DALLAS (TX)	$654.16	$654.16
GALVESTON (TX)	$650.13	$650.13
HOUSTON (TX)	$707.97	$707.97
BEAUMONT (TX)	$645.26	$645.26
FORT WORTH (TX)	$654.05	$654.05
AUSTIN (TX)	$663.35	$663.35
REST OF TEXAS (TX)	$648.26	$648.26
UTAH (UT)	$646.41	$646.41
VIRGINIA (VA)	$632.48	$632.48
VIRGIN ISLANDS (VI)	$666.05	$666.05
VERMONT (VT)	$612.40	$612.40
SEATTLE (KING CNTY) (WA)	$700.79	$700.79
REST OF WASHINGTON (WA)	$653.97	$653.97
WISCONSIN (WI)	$586.79	$586.79
WEST VIRGINIA (WV)	$692.21	$692.21
WYOMING** (WY)	$638.57	$638.57

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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: Policy. 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 Geographic Practice Cost Indices (GPCIs) specific to the service locality. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Because practice expense RVUs differ depending on whether the service is performed in a non-facility (e.g., office) or facility (e.g., hospital) setting, the resulting payment amounts can differ between the two. These figures are recalculated each year as RVUs, GPCIs, and the conversion factor are updated.

RVUs — work 12.37, practice expense 4.41 (non-facility) / 4.41 (facility), malpractice 3.16 — × 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 the Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service codes, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Local Medicare Administrative Contractor (MAC) policies and coverage determinations may affect whether and how this code is reimbursed.
Always verify current-year rates and locality-specific amounts directly with your MAC before billing.

Frequently asked

Why does CPT 21616 pay differently in different states?

The RVUs for this code are adjusted using locality-specific GPCIs, which account for regional differences in wages, rents, and malpractice costs. This causes the same code to have different allowed amounts across localities.

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

When the practice expense RVUs are identical for both settings, the resulting non-facility and facility payment amounts will be the same, since the other RVU components (work and malpractice) do not vary by setting.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-allowed amount before cost-sharing. The actual Medicare payment is typically 80% of this amount after the deductible is met, and secondary payers or patients cover the rest.

Will this amount change next year?

Yes. The conversion factor, RVUs, and GPCIs are updated annually (and sometimes mid-year), so the allowed amount for CPT 21616 can change from year to year.

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.