Medicare Reimbursement for CPT 21685

CPT 21685 is a surgical procedure code reported to Medicare for physician and outpatient billing. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and, where available, adjusted for local geographic cost differences, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$862.41	$862.41
ALASKA* (AK)	$1096.55	$1096.55
ALABAMA (AL)	$793.82	$793.82
ARKANSAS (AR)	$785.38	$785.38
ARIZONA (AZ)	$842.70	$842.70
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$986.41	$986.41
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1001.10	$1001.10
OXNARD-THOUSAND OAKS-VENTURA (CA)	$901.38	$901.38
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$911.17	$911.17
NAPA (CA)	$949.86	$949.86
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$988.93	$988.93
VALLEJO (CA)	$946.23	$946.23
BAKERSFIELD (CA)	$870.82	$870.82
CHICO (CA)	$864.42	$864.42
FRESNO (CA)	$864.42	$864.42
HANFORD-CORCORAN (CA)	$864.42	$864.42
MADERA (CA)	$864.42	$864.42
MERCED (CA)	$864.42	$864.42
MODESTO (CA)	$864.42	$864.42
REDDING (CA)	$864.42	$864.42
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$888.42	$888.42
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$893.37	$893.37
SALINAS (CA)	$889.72	$889.72
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1011.41	$1011.41
SANTA CRUZ-WATSONVILLE (CA)	$901.06	$901.06
SANTA ROSA-PETALUMA (CA)	$909.32	$909.32
STOCKTON (CA)	$864.42	$864.42
VISALIA (CA)	$864.42	$864.42
YUBA CITY (CA)	$864.42	$864.42
EL CENTRO (CA)	$864.79	$864.79
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$900.45	$900.45
SAN LUIS OBISPO-PASO ROBLES (CA)	$876.94	$876.94
SANTA MARIA-SANTA BARBARA (CA)	$890.27	$890.27
REST OF CALIFORNIA (CA)	$864.42	$864.42
COLORADO (CO)	$870.78	$870.78
CONNECTICUT (CT)	$910.35	$910.35
DC + MD/VA SUBURBS (DC)	$949.47	$949.47
DELAWARE (DE)	$853.91	$853.91
FORT LAUDERDALE (FL)	$926.11	$926.11
MIAMI (FL)	$987.73	$987.73
REST OF FLORIDA (FL)	$886.89	$886.89
ATLANTA (GA)	$883.47	$883.47
REST OF GEORGIA (GA)	$845.19	$845.19
HAWAII, GUAM (HI)	$871.10	$871.10
IOWA (IA)	$792.94	$792.94
IDAHO (ID)	$800.03	$800.03
EAST ST. LOUIS (IL)	$914.30	$914.30
SUBURBAN CHICAGO (IL)	$931.00	$931.00
CHICAGO (IL)	$963.37	$963.37
REST OF ILLINOIS (IL)	$878.82	$878.82
INDIANA (IN)	$803.04	$803.04
KANSAS (KS)	$797.67	$797.67
KENTUCKY (KY)	$823.78	$823.78
NEW ORLEANS (LA)	$855.31	$855.31
REST OF LOUISIANA (LA)	$825.80	$825.80
METROPOLITAN BOSTON (MA)	$931.14	$931.14
REST OF MASSACHUSETTS (MA)	$870.75	$870.75
BALTIMORE/SURR. CNTYS (MD)	$909.20	$909.20
REST OF MARYLAND (MD)	$864.80	$864.80
SOUTHERN MAINE (ME)	$832.43	$832.43
REST OF MAINE (ME)	$811.08	$811.08
DETROIT (MI)	$903.08	$903.08
REST OF MICHIGAN (MI)	$846.64	$846.64
MINNESOTA (MN)	$818.66	$818.66
METROPOLITAN ST. LOUIS (MO)	$848.58	$848.58
METROPOLITAN KANSAS CITY (MO)	$842.94	$842.94
REST OF MISSOURI (MO)	$820.29	$820.29
MISSISSIPPI (MS)	$802.57	$802.57
MONTANA** (MT)	$862.26	$862.26
NORTH CAROLINA (NC)	$816.13	$816.13
NORTH DAKOTA** (ND)	$818.37	$818.37
NEBRASKA (NE)	$793.86	$793.86
NEW HAMPSHIRE (NH)	$865.08	$865.08
NORTHERN NJ (NJ)	$945.37	$945.37
REST OF NEW JERSEY (NJ)	$916.28	$916.28
NEW MEXICO (NM)	$853.14	$853.14
NEVADA** (NV)	$850.32	$850.32
MANHATTAN (NY)	$984.85	$984.85
NYC SUBURBS/LONG ISLAND (NY)	$1012.81	$1012.81
POUGHKPSIE/N NYC SUBURBS (NY)	$928.02	$928.02
QUEENS (NY)	$980.00	$980.00
REST OF NEW YORK (NY)	$825.83	$825.83
OHIO (OH)	$837.67	$837.67
OKLAHOMA (OK)	$814.71	$814.71
PORTLAND (OR)	$883.71	$883.71
REST OF OREGON (OR)	$839.22	$839.22
METROPOLITAN PHILADELPHIA (PA)	$897.61	$897.61
REST OF PENNSYLVANIA (PA)	$834.45	$834.45
PUERTO RICO (PR)	$864.50	$864.50
RHODE ISLAND (RI)	$873.46	$873.46
SOUTH CAROLINA (SC)	$829.15	$829.15
SOUTH DAKOTA** (SD)	$813.18	$813.18
TENNESSEE (TN)	$801.58	$801.58
BRAZORIA (TX)	$847.45	$847.45
DALLAS (TX)	$855.19	$855.19
GALVESTON (TX)	$851.59	$851.59
HOUSTON (TX)	$892.23	$892.23
BEAUMONT (TX)	$830.93	$830.93
FORT WORTH (TX)	$853.24	$853.24
AUSTIN (TX)	$871.84	$871.84
REST OF TEXAS (TX)	$840.36	$840.36
UTAH (UT)	$837.37	$837.37
VIRGINIA (VA)	$835.66	$835.66
VIRGIN ISLANDS (VI)	$864.50	$864.50
VERMONT (VT)	$822.87	$822.87
SEATTLE (KING CNTY) (WA)	$939.81	$939.81
REST OF WASHINGTON (WA)	$866.59	$866.59
WISCONSIN (WI)	$798.87	$798.87
WEST VIRGINIA (WV)	$856.22	$856.22
WYOMING** (WY)	$843.13	$843.13

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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) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, reflecting differences in local costs. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs can differ between non-facility (e.g., office) and facility (e.g., hospital) settings, though for this code the practice-expense RVU is the same in both settings, so the national amounts shown are equal.

RVUs — work 14.88, practice expense 8.72 (non-facility) / 8.72 (facility), malpractice 2.22 — × 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 their deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment varies by locality, applicable modifiers, claim-specific adjustments, and annual sequestration or budget-neutrality changes.
Always verify the current allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why do non-facility and facility amounts differ for some codes?

Non-facility (e.g., office) settings often have higher practice-expense RVUs because the billing physician covers overhead that a facility would otherwise absorb. For CPT 21685, these RVUs are the same in both settings, so the national amounts match.

Why might my actual payment differ from the national amount shown here?

The national figure uses a standard conversion factor and unadjusted inputs; actual payment is recalculated using your specific locality's GPCIs, any applicable modifiers, and current-year sequestration or budget-neutrality adjustments.

Does this page tell me what the patient owes?

No. This page reflects the Medicare-allowed amount estimate. Patient responsibility depends on deductible status, coinsurance, and any secondary coverage.

Where can I find the official rate for my locality?

Check the CMS Physician Fee Schedule Look-Up Tool or contact your Medicare Administrative Contractor (MAC) for the authoritative, locality-specific rate.

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.