Medicare Reimbursement for CPT 21630

CPT 21630 is a surgical procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code at the national level and adjusted by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1170.70	$1170.70
ALASKA* (AK)	$1458.92	$1458.92
ALABAMA (AL)	$1066.63	$1066.63
ARKANSAS (AR)	$1053.83	$1053.83
ARIZONA (AZ)	$1140.68	$1140.68
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1339.78	$1339.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1359.67	$1359.67
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1222.79	$1222.79
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1236.09	$1236.09
NAPA (CA)	$1289.83	$1289.83
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1343.72	$1343.72
VALLEJO (CA)	$1284.15	$1284.15
BAKERSFIELD (CA)	$1178.55	$1178.55
CHICO (CA)	$1168.84	$1168.84
FRESNO (CA)	$1168.84	$1168.84
HANFORD-CORCORAN (CA)	$1168.84	$1168.84
MADERA (CA)	$1168.84	$1168.84
MERCED (CA)	$1168.84	$1168.84
MODESTO (CA)	$1168.84	$1168.84
REDDING (CA)	$1168.84	$1168.84
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1206.21	$1206.21
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1209.53	$1209.53
SALINAS (CA)	$1204.69	$1204.69
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1375.78	$1375.78
SANTA CRUZ-WATSONVILLE (CA)	$1222.53	$1222.53
SANTA ROSA-PETALUMA (CA)	$1233.75	$1233.75
STOCKTON (CA)	$1168.84	$1168.84
VISALIA (CA)	$1168.84	$1168.84
YUBA CITY (CA)	$1168.84	$1168.84
EL CENTRO (CA)	$1169.42	$1169.42
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1220.68	$1220.68
SAN LUIS OBISPO-PASO ROBLES (CA)	$1187.34	$1187.34
SANTA MARIA-SANTA BARBARA (CA)	$1205.83	$1205.83
REST OF CALIFORNIA (CA)	$1168.84	$1168.84
COLORADO (CO)	$1180.35	$1180.35
CONNECTICUT (CT)	$1240.66	$1240.66
DC + MD/VA SUBURBS (DC)	$1294.10	$1294.10
DELAWARE (DE)	$1156.96	$1156.96
FORT LAUDERDALE (FL)	$1269.94	$1269.94
MIAMI (FL)	$1365.55	$1365.55
REST OF FLORIDA (FL)	$1210.07	$1210.07
ATLANTA (GA)	$1202.75	$1202.75
REST OF GEORGIA (GA)	$1146.49	$1146.49
HAWAII, GUAM (HI)	$1180.85	$1180.85
IOWA (IA)	$1064.25	$1064.25
IDAHO (ID)	$1075.21	$1075.21
EAST ST. LOUIS (IL)	$1253.81	$1253.81
SUBURBAN CHICAGO (IL)	$1276.16	$1276.16
CHICAGO (IL)	$1327.32	$1327.32
REST OF ILLINOIS (IL)	$1198.53	$1198.53
INDIANA (IN)	$1079.72	$1079.72
KANSAS (KS)	$1071.92	$1071.92
KENTUCKY (KY)	$1113.10	$1113.10
NEW ORLEANS (LA)	$1161.08	$1161.08
REST OF LOUISIANA (LA)	$1116.36	$1116.36
METROPOLITAN BOSTON (MA)	$1267.02	$1267.02
REST OF MASSACHUSETTS (MA)	$1179.97	$1179.97
BALTIMORE/SURR. CNTYS (MD)	$1239.57	$1239.57
REST OF MARYLAND (MD)	$1172.61	$1172.61
SOUTHERN MAINE (ME)	$1124.06	$1124.06
REST OF MAINE (ME)	$1092.47	$1092.47
DETROIT (MI)	$1235.15	$1235.15
REST OF MICHIGAN (MI)	$1148.23	$1148.23
MINNESOTA (MN)	$1101.58	$1101.58
METROPOLITAN ST. LOUIS (MO)	$1150.28	$1150.28
METROPOLITAN KANSAS CITY (MO)	$1141.79	$1141.79
REST OF MISSOURI (MO)	$1108.32	$1108.32
MISSISSIPPI (MS)	$1080.65	$1080.65
MONTANA** (MT)	$1170.47	$1170.47
NORTH CAROLINA (NC)	$1100.04	$1100.04
NORTH DAKOTA** (ND)	$1101.86	$1101.86
NEBRASKA (NE)	$1065.49	$1065.49
NEW HAMPSHIRE (NH)	$1173.85	$1173.85
NORTHERN NJ (NJ)	$1286.76	$1286.76
REST OF NEW JERSEY (NJ)	$1246.51	$1246.51
NEW MEXICO (NM)	$1158.29	$1158.29
NEVADA** (NV)	$1151.78	$1151.78
MANHATTAN (NY)	$1348.29	$1348.29
NYC SUBURBS/LONG ISLAND (NY)	$1391.31	$1391.31
POUGHKPSIE/N NYC SUBURBS (NY)	$1264.02	$1264.02
QUEENS (NY)	$1340.20	$1340.20
REST OF NEW YORK (NY)	$1114.77	$1114.77
OHIO (OH)	$1134.20	$1134.20
OKLAHOMA (OK)	$1098.82	$1098.82
PORTLAND (OR)	$1198.78	$1198.78
REST OF OREGON (OR)	$1134.56	$1134.56
METROPOLITAN PHILADELPHIA (PA)	$1221.95	$1221.95
REST OF PENNSYLVANIA (PA)	$1129.05	$1129.05
PUERTO RICO (PR)	$1173.70	$1173.70
RHODE ISLAND (RI)	$1184.25	$1184.25
SOUTH CAROLINA (SC)	$1120.62	$1120.62
SOUTH DAKOTA** (SD)	$1093.74	$1093.74
TENNESSEE (TN)	$1077.89	$1077.89
BRAZORIA (TX)	$1146.33	$1146.33
DALLAS (TX)	$1158.14	$1158.14
GALVESTON (TX)	$1152.75	$1152.75
HOUSTON (TX)	$1216.27	$1216.27
BEAUMONT (TX)	$1123.75	$1123.75
FORT WORTH (TX)	$1155.35	$1155.35
AUSTIN (TX)	$1183.69	$1183.69
REST OF TEXAS (TX)	$1137.52	$1137.52
UTAH (UT)	$1133.07	$1133.07
VIRGINIA (VA)	$1129.31	$1129.31
VIRGIN ISLANDS (VI)	$1173.70	$1173.70
VERMONT (VT)	$1109.14	$1109.14
SEATTLE (KING CNTY) (WA)	$1278.38	$1278.38
REST OF WASHINGTON (WA)	$1173.92	$1173.92
WISCONSIN (WI)	$1072.43	$1072.43
WEST VIRGINIA (WV)	$1164.30	$1164.30
WYOMING** (WY)	$1140.57	$1140.57

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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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed. These locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs (and sometimes the resulting payment) can differ between non-facility settings (e.g., an office) and facility settings (e.g., a hospital), reflecting different overhead assumptions. For this code, the facility and non-facility amounts shown are the same, which can occur when CMS assigns identical practice-expense inputs in both settings.

RVUs — work 18.7, practice expense 12.88 (non-facility) / 12.88 (facility), malpractice 3.47 — × 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 the annual deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality adjustments to the conversion factor.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

CMS sets separate practice-expense RVUs for facility and non-facility settings based on where the service is typically furnished. When the inputs are identical for both settings, the resulting allowed amounts match.

Why does the allowed amount change by locality?

Each locality has its own Geographic Practice Cost Index (GPCI) values for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost differences before the conversion factor is applied.

Does this amount reflect what the patient will owe?

No. This is the Medicare-allowed amount before cost-sharing. Patients typically owe 20% coinsurance after the deductible is met, unless a secondary payer or supplemental plan covers it.

Will modifiers or place-of-service codes change this estimate?

Yes. Modifiers, multiple-procedure reductions, and the reported place of service can all affect the final paid amount beyond what is shown here.

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.