Medicare Reimbursement for CPT 21705

CPT 21705 is a surgical procedure code reported to Medicare and other payers; the specific clinical descriptor is omitted here because CPT language is licensed by the AMA. 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)	$494.33	$494.33
ALASKA* (AK)	$624.39	$624.39
ALABAMA (AL)	$447.32	$447.32
ARKANSAS (AR)	$441.68	$441.68
ARIZONA (AZ)	$479.66	$479.66
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$513.68	$513.68
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$519.04	$519.04
OXNARD-THOUSAND OAKS-VENTURA (CA)	$488.26	$488.26
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$495.94	$495.94
NAPA (CA)	$502.07	$502.07
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$516.49	$516.49
VALLEJO (CA)	$498.02	$498.02
BAKERSFIELD (CA)	$476.58	$476.58
CHICO (CA)	$469.89	$469.89
FRESNO (CA)	$469.89	$469.89
HANFORD-CORCORAN (CA)	$469.89	$469.89
MADERA (CA)	$469.89	$469.89
MERCED (CA)	$469.89	$469.89
MODESTO (CA)	$469.89	$469.89
REDDING (CA)	$469.89	$469.89
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$496.47	$496.47
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$481.95	$481.95
SALINAS (CA)	$479.98	$479.98
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$530.55	$530.55
SANTA CRUZ-WATSONVILLE (CA)	$481.71	$481.71
SANTA ROSA-PETALUMA (CA)	$485.77	$485.77
STOCKTON (CA)	$469.89	$469.89
VISALIA (CA)	$469.89	$469.89
YUBA CITY (CA)	$469.89	$469.89
EL CENTRO (CA)	$470.30	$470.30
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$483.43	$483.43
SAN LUIS OBISPO-PASO ROBLES (CA)	$473.69	$473.69
SANTA MARIA-SANTA BARBARA (CA)	$479.63	$479.63
REST OF CALIFORNIA (CA)	$469.89	$469.89
COLORADO (CO)	$485.73	$485.73
CONNECTICUT (CT)	$525.00	$525.00
DC + MD/VA SUBURBS (DC)	$536.89	$536.89
DELAWARE (DE)	$486.52	$486.52
FORT LAUDERDALE (FL)	$562.41	$562.41
MIAMI (FL)	$624.62	$624.62
REST OF FLORIDA (FL)	$532.10	$532.10
ATLANTA (GA)	$513.37	$513.37
REST OF GEORGIA (GA)	$500.68	$500.68
HAWAII, GUAM (HI)	$471.59	$471.59
IOWA (IA)	$436.86	$436.86
IDAHO (ID)	$443.60	$443.60
EAST ST. LOUIS (IL)	$571.25	$571.25
SUBURBAN CHICAGO (IL)	$562.93	$562.93
CHICAGO (IL)	$604.31	$604.31
REST OF ILLINOIS (IL)	$533.27	$533.27
INDIANA (IN)	$445.30	$445.30
KANSAS (KS)	$444.75	$444.75
KENTUCKY (KY)	$477.47	$477.47
NEW ORLEANS (LA)	$500.38	$500.38
REST OF LOUISIANA (LA)	$480.68	$480.68
METROPOLITAN BOSTON (MA)	$515.64	$515.64
REST OF MASSACHUSETTS (MA)	$487.38	$487.38
BALTIMORE/SURR. CNTYS (MD)	$525.59	$525.59
REST OF MARYLAND (MD)	$491.83	$491.83
SOUTHERN MAINE (ME)	$462.97	$462.97
REST OF MAINE (ME)	$455.94	$455.94
DETROIT (MI)	$548.06	$548.06
REST OF MICHIGAN (MI)	$497.32	$497.32
MINNESOTA (MN)	$438.58	$438.58
METROPOLITAN ST. LOUIS (MO)	$490.25	$490.25
METROPOLITAN KANSAS CITY (MO)	$487.03	$487.03
REST OF MISSOURI (MO)	$479.96	$479.96
MISSISSIPPI (MS)	$460.41	$460.41
MONTANA** (MT)	$494.17	$494.17
NORTH CAROLINA (NC)	$458.50	$458.50
NORTH DAKOTA** (ND)	$445.13	$445.13
NEBRASKA (NE)	$435.99	$435.99
NEW HAMPSHIRE (NH)	$487.61	$487.61
NORTHERN NJ (NJ)	$534.48	$534.48
REST OF NEW JERSEY (NJ)	$523.43	$523.43
NEW MEXICO (NM)	$503.64	$503.64
NEVADA** (NV)	$480.59	$480.59
MANHATTAN (NY)	$577.88	$577.88
NYC SUBURBS/LONG ISLAND (NY)	$602.72	$602.72
POUGHKPSIE/N NYC SUBURBS (NY)	$534.67	$534.67
QUEENS (NY)	$567.73	$567.73
REST OF NEW YORK (NY)	$465.31	$465.31
OHIO (OH)	$487.30	$487.30
OKLAHOMA (OK)	$466.39	$466.39
PORTLAND (OR)	$488.12	$488.12
REST OF OREGON (OR)	$469.38	$469.38
METROPOLITAN PHILADELPHIA (PA)	$519.76	$519.76
REST OF PENNSYLVANIA (PA)	$482.52	$482.52
PUERTO RICO (PR)	$494.06	$494.06
RHODE ISLAND (RI)	$494.44	$494.44
SOUTH CAROLINA (SC)	$475.18	$475.18
SOUTH DAKOTA** (SD)	$439.33	$439.33
TENNESSEE (TN)	$447.93	$447.93
BRAZORIA (TX)	$477.90	$477.90
DALLAS (TX)	$485.12	$485.12
GALVESTON (TX)	$482.05	$482.05
HOUSTON (TX)	$527.44	$527.44
BEAUMONT (TX)	$480.49	$480.49
FORT WORTH (TX)	$485.32	$485.32
AUSTIN (TX)	$490.67	$490.67
REST OF TEXAS (TX)	$481.78	$481.78
UTAH (UT)	$480.57	$480.57
VIRGINIA (VA)	$468.48	$468.48
VIRGIN ISLANDS (VI)	$494.06	$494.06
VERMONT (VT)	$452.53	$452.53
SEATTLE (KING CNTY) (WA)	$515.42	$515.42
REST OF WASHINGTON (WA)	$483.43	$483.43
WISCONSIN (WI)	$433.29	$433.29
WEST VIRGINIA (WV)	$518.44	$518.44
WYOMING** (WY)	$472.80	$472.80

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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 for a code is built from three Relative Value Units (RVUs): 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, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs, reflecting the different overhead a clinician bears, which is why the two amounts can differ. These RVU and GPCI values, along with the conversion factor, are updated annually and are subject to budget-neutrality adjustments by CMS.

RVUs — work 9.67, practice expense 2.65 (non-facility) / 2.65 (facility), malpractice 2.48 — × 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's deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary based on locality, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and mid-year or annual policy changes.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The practice-expense RVU component is lower in the facility setting because the facility (e.g., hospital) is separately reimbursed for overhead costs, while the non-facility rate assumes the billing physician bears those costs directly.

Why might my locality's payment differ from the national amount shown?

Medicare applies locality-specific GPCIs to the work, practice-expense, and malpractice RVUs before multiplying by the conversion factor, so costs of practicing medicine in different geographic areas raise or lower the final allowed amount.

Does this amount reflect what Medicare actually pays?

It reflects the estimated Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible, with the remaining 20% owed by the beneficiary or secondary insurance.

Can modifiers change this estimate?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the final payment relative to the base PFS amount shown here.

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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.