Medicare Reimbursement for CPT 21627

CPT 21627 is a physician procedure code (the specific descriptor is not shown here due to AMA licensing restrictions). This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$555.46	$555.46
ALASKA* (AK)	$665.83	$665.83
ALABAMA (AL)	$498.21	$498.21
ARKANSAS (AR)	$491.14	$491.14
ARIZONA (AZ)	$539.19	$539.19
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$652.35	$652.35
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$662.68	$662.68
OXNARD-THOUSAND OAKS-VENTURA (CA)	$588.19	$588.19
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$593.87	$593.87
NAPA (CA)	$625.46	$625.46
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$654.28	$654.28
VALLEJO (CA)	$622.67	$622.67
BAKERSFIELD (CA)	$562.82	$562.82
CHICO (CA)	$558.20	$558.20
FRESNO (CA)	$558.20	$558.20
HANFORD-CORCORAN (CA)	$558.20	$558.20
MADERA (CA)	$558.20	$558.20
MERCED (CA)	$558.20	$558.20
MODESTO (CA)	$558.20	$558.20
REDDING (CA)	$558.20	$558.20
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$576.43	$576.43
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$580.19	$580.19
SALINAS (CA)	$577.96	$577.96
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$670.57	$670.57
SANTA CRUZ-WATSONVILLE (CA)	$590.19	$590.19
SANTA ROSA-PETALUMA (CA)	$595.72	$595.72
STOCKTON (CA)	$558.20	$558.20
VISALIA (CA)	$558.20	$558.20
YUBA CITY (CA)	$558.20	$558.20
EL CENTRO (CA)	$558.48	$558.48
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$587.71	$587.71
SAN LUIS OBISPO-PASO ROBLES (CA)	$569.41	$569.41
SANTA MARIA-SANTA BARBARA (CA)	$579.07	$579.07
REST OF CALIFORNIA (CA)	$558.20	$558.20
COLORADO (CO)	$562.57	$562.57
CONNECTICUT (CT)	$592.22	$592.22
DC + MD/VA SUBURBS (DC)	$621.15	$621.15
DELAWARE (DE)	$547.78	$547.78
FORT LAUDERDALE (FL)	$604.73	$604.73
MIAMI (FL)	$652.97	$652.97
REST OF FLORIDA (FL)	$572.54	$572.54
ATLANTA (GA)	$571.76	$571.76
REST OF GEORGIA (GA)	$538.19	$538.19
HAWAII, GUAM (HI)	$567.29	$567.29
IOWA (IA)	$499.04	$499.04
IDAHO (ID)	$504.66	$504.66
EAST ST. LOUIS (IL)	$592.16	$592.16
SUBURBAN CHICAGO (IL)	$608.00	$608.00
CHICAGO (IL)	$631.96	$631.96
REST OF ILLINOIS (IL)	$564.73	$564.73
INDIANA (IN)	$507.23	$507.23
KANSAS (KS)	$502.25	$502.25
KENTUCKY (KY)	$521.67	$521.67
NEW ORLEANS (LA)	$547.79	$547.79
REST OF LOUISIANA (LA)	$523.07	$523.07
METROPOLITAN BOSTON (MA)	$609.57	$609.57
REST OF MASSACHUSETTS (MA)	$561.56	$561.56
BALTIMORE/SURR. CNTYS (MD)	$591.76	$591.76
REST OF MARYLAND (MD)	$556.31	$556.31
SOUTHERN MAINE (ME)	$532.16	$532.16
REST OF MAINE (ME)	$513.12	$513.12
DETROIT (MI)	$585.28	$585.28
REST OF MICHIGAN (MI)	$540.09	$540.09
MINNESOTA (MN)	$523.05	$523.05
METROPOLITAN ST. LOUIS (MO)	$543.05	$543.05
METROPOLITAN KANSAS CITY (MO)	$538.24	$538.24
REST OF MISSOURI (MO)	$517.98	$517.98
MISSISSIPPI (MS)	$504.38	$504.38
MONTANA** (MT)	$555.34	$555.34
NORTH CAROLINA (NC)	$517.48	$517.48
NORTH DAKOTA** (ND)	$521.73	$521.73
NEBRASKA (NE)	$500.05	$500.05
NEW HAMPSHIRE (NH)	$559.05	$559.05
NORTHERN NJ (NJ)	$616.04	$616.04
REST OF NEW JERSEY (NJ)	$594.48	$594.48
NEW MEXICO (NM)	$545.22	$545.22
NEVADA** (NV)	$546.24	$546.24
MANHATTAN (NY)	$646.21	$646.21
NYC SUBURBS/LONG ISLAND (NY)	$668.64	$668.64
POUGHKPSIE/N NYC SUBURBS (NY)	$602.86	$602.86
QUEENS (NY)	$643.25	$643.25
REST OF NEW YORK (NY)	$525.55	$525.55
OHIO (OH)	$533.22	$533.22
OKLAHOMA (OK)	$514.88	$514.88
PORTLAND (OR)	$573.68	$573.68
REST OF OREGON (OR)	$537.55	$537.55
METROPOLITAN PHILADELPHIA (PA)	$581.39	$581.39
REST OF PENNSYLVANIA (PA)	$530.94	$530.94
PUERTO RICO (PR)	$557.47	$557.47
RHODE ISLAND (RI)	$562.45	$562.45
SOUTH CAROLINA (SC)	$527.11	$527.11
SOUTH DAKOTA** (SD)	$517.75	$517.75
TENNESSEE (TN)	$505.43	$505.43
BRAZORIA (TX)	$542.52	$542.52
DALLAS (TX)	$548.49	$548.49
GALVESTON (TX)	$545.77	$545.77
HOUSTON (TX)	$576.88	$576.88
BEAUMONT (TX)	$527.95	$527.95
FORT WORTH (TX)	$546.62	$546.62
AUSTIN (TX)	$564.59	$564.59
REST OF TEXAS (TX)	$536.65	$536.65
UTAH (UT)	$534.01	$534.01
VIRGINIA (VA)	$534.33	$534.33
VIRGIN ISLANDS (VI)	$557.47	$557.47
VERMONT (VT)	$524.80	$524.80
SEATTLE (KING CNTY) (WA)	$616.17	$616.17
REST OF WASHINGTON (WA)	$558.80	$558.80
WISCONSIN (WI)	$505.21	$505.21
WEST VIRGINIA (WV)	$545.76	$545.76
WYOMING** (WY)	$540.69	$540.69

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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 — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the dollar amount. Non-facility and facility rates can differ because the practice-expense RVU often changes depending on whether the service is performed in a physician office (non-facility) or a hospital/ASC setting (facility), reflecting differences in overhead costs borne by the provider.

RVUs — work 7.12, practice expense 7.81 (non-facility) / 7.81 (facility), malpractice 1.7 — × 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 annual deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, place-of-service codes, multiple-procedure reductions, and sequestration can change the actual paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts change each year.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

The practice-expense RVU component can differ because non-facility settings (like a physician office) typically bear more overhead cost for supplies, equipment, and staff than when the same service is performed in a facility, where the facility itself absorbs many of those costs.

Why might the amount shown differ from what my MAC actually pays?

The posted amount reflects national RVUs adjusted by locality GPCIs and the current conversion factor, but actual payment can be affected by modifiers, secondary payer rules, claim-specific adjustments, and any sequestration or budget-neutrality changes applied at the time of processing.

Does this amount include the patient's share?

No. The figure represents the Medicare-allowed amount. Medicare generally pays 80% of this amount after the deductible is met, with the remaining 20% typically owed by the patient or a secondary payer.

Can I use this estimate to predict my exact reimbursement?

No. This is a reference estimate based on national RVU and conversion factor data. Actual reimbursement depends on your specific locality, claim details, and any applicable modifiers or adjustments, so you should confirm with your MAC or billing software.

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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.