Medicare Reimbursement for CPT 21720

CPT 21720 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$574.50	$574.50
ALASKA* (AK)	$653.21	$653.21
ALABAMA (AL)	$501.75	$501.75
ARKANSAS (AR)	$492.80	$492.80
ARIZONA (AZ)	$553.56	$553.56
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$672.19	$672.19
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$682.59	$682.59
OXNARD-THOUSAND OAKS-VENTURA (CA)	$605.50	$605.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$611.53	$611.53
NAPA (CA)	$644.59	$644.59
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$674.89	$674.89
VALLEJO (CA)	$640.69	$640.69
BAKERSFIELD (CA)	$576.38	$576.38
CHICO (CA)	$570.20	$570.20
FRESNO (CA)	$570.20	$570.20
HANFORD-CORCORAN (CA)	$570.20	$570.20
MADERA (CA)	$570.20	$570.20
MERCED (CA)	$570.20	$570.20
MODESTO (CA)	$570.20	$570.20
REDDING (CA)	$570.20	$570.20
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$595.58	$595.58
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$594.29	$594.29
SALINAS (CA)	$592.12	$592.12
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$693.64	$693.64
SANTA CRUZ-WATSONVILLE (CA)	$607.36	$607.36
SANTA ROSA-PETALUMA (CA)	$613.04	$613.04
STOCKTON (CA)	$570.20	$570.20
VISALIA (CA)	$570.20	$570.20
YUBA CITY (CA)	$570.20	$570.20
EL CENTRO (CA)	$570.59	$570.59
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$603.73	$603.73
SAN LUIS OBISPO-PASO ROBLES (CA)	$583.35	$583.35
SANTA MARIA-SANTA BARBARA (CA)	$593.69	$593.69
REST OF CALIFORNIA (CA)	$570.20	$570.20
COLORADO (CO)	$578.94	$578.94
CONNECTICUT (CT)	$618.53	$618.53
DC + MD/VA SUBURBS (DC)	$648.15	$648.15
DELAWARE (DE)	$563.74	$563.74
FORT LAUDERDALE (FL)	$642.70	$642.70
MIAMI (FL)	$708.59	$708.59
REST OF FLORIDA (FL)	$601.02	$601.02
ATLANTA (GA)	$595.94	$595.94
REST OF GEORGIA (GA)	$556.72	$556.72
HAWAII, GUAM (HI)	$582.94	$582.94
IOWA (IA)	$500.55	$500.55
IDAHO (ID)	$508.13	$508.13
EAST ST. LOUIS (IL)	$630.63	$630.63
SUBURBAN CHICAGO (IL)	$645.45	$645.45
CHICAGO (IL)	$680.29	$680.29
REST OF ILLINOIS (IL)	$592.63	$592.63
INDIANA (IN)	$511.30	$511.30
KANSAS (KS)	$505.69	$505.69
KENTUCKY (KY)	$533.78	$533.78
NEW ORLEANS (LA)	$567.26	$567.26
REST OF LOUISIANA (LA)	$535.97	$535.97
METROPOLITAN BOSTON (MA)	$632.86	$632.86
REST OF MASSACHUSETTS (MA)	$577.60	$577.60
BALTIMORE/SURR. CNTYS (MD)	$618.69	$618.69
REST OF MARYLAND (MD)	$573.54	$573.54
SOUTHERN MAINE (ME)	$542.41	$542.41
REST OF MAINE (ME)	$519.97	$519.97
DETROIT (MI)	$618.32	$618.32
REST OF MICHIGAN (MI)	$558.13	$558.13
MINNESOTA (MN)	$527.40	$527.40
METROPOLITAN ST. LOUIS (MO)	$559.97	$559.97
METROPOLITAN KANSAS CITY (MO)	$554.00	$554.00
REST OF MISSOURI (MO)	$530.21	$530.21
MISSISSIPPI (MS)	$511.22	$511.22
MONTANA** (MT)	$574.34	$574.34
NORTH CAROLINA (NC)	$525.30	$525.30
NORTH DAKOTA** (ND)	$527.28	$527.28
NEBRASKA (NE)	$501.49	$501.49
NEW HAMPSHIRE (NH)	$577.10	$577.10
NORTHERN NJ (NJ)	$640.76	$640.76
REST OF NEW JERSEY (NJ)	$617.92	$617.92
NEW MEXICO (NM)	$565.08	$565.08
NEVADA** (NV)	$561.53	$561.53
MANHATTAN (NY)	$682.74	$682.74
NYC SUBURBS/LONG ISLAND (NY)	$712.55	$712.55
POUGHKPSIE/N NYC SUBURBS (NY)	$628.76	$628.76
QUEENS (NY)	$677.41	$677.41
REST OF NEW YORK (NY)	$535.59	$535.59
OHIO (OH)	$548.51	$548.51
OKLAHOMA (OK)	$524.03	$524.03
PORTLAND (OR)	$591.13	$591.13
REST OF OREGON (OR)	$549.66	$549.66
METROPOLITAN PHILADELPHIA (PA)	$605.78	$605.78
REST OF PENNSYLVANIA (PA)	$545.04	$545.04
PUERTO RICO (PR)	$576.67	$576.67
RHODE ISLAND (RI)	$579.60	$579.60
SOUTH CAROLINA (SC)	$539.32	$539.32
SOUTH DAKOTA** (SD)	$521.71	$521.71
TENNESSEE (TN)	$509.85	$509.85
BRAZORIA (TX)	$555.77	$555.77
DALLAS (TX)	$563.68	$563.68
GALVESTON (TX)	$560.19	$560.19
HOUSTON (TX)	$603.76	$603.76
BEAUMONT (TX)	$541.32	$541.32
FORT WORTH (TX)	$561.66	$561.66
AUSTIN (TX)	$583.56	$583.56
REST OF TEXAS (TX)	$551.18	$551.18
UTAH (UT)	$548.03	$548.03
VIRGINIA (VA)	$545.92	$545.92
VIRGIN ISLANDS (VI)	$576.67	$576.67
VERMONT (VT)	$532.17	$532.17
SEATTLE (KING CNTY) (WA)	$638.85	$638.85
REST OF WASHINGTON (WA)	$574.17	$574.17
WISCONSIN (WI)	$506.64	$506.64
WEST VIRGINIA (WV)	$568.68	$568.68
WYOMING** (WY)	$553.83	$553.83

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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: Clinical. 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 Indices (GPCIs) specific to a locality. These locality-adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which is why the two settings can show different allowed amounts. The conversion factor and RVU values are updated annually and can change due to legislative or budget-neutrality adjustments.

RVUs — work 5.66, practice expense 9.16 (non-facility) / 9.16 (facility), malpractice 2.38 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount 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 payer is responsible for the remainder.
Modifiers, place-of-service codes, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean actual payment can differ from the national amount shown here.
Always confirm the current, locality-specific rate 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 calculated differently depending on whether the service is performed in a facility (like a hospital, where the facility bears overhead costs) versus a non-facility setting (like a private office, where the billing provider bears those costs).

Why might my local Medicare payment differ from the national amount shown?

The national amount uses an average GPCI value, while actual payments are adjusted using the GPCIs specific to the provider's locality, which can raise or lower the final amount.

Does this amount include the patient's share?

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

Can modifiers change this amount?

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