Medicare Reimbursement for CPT 21725

This page covers CPT code 21725, a physician procedure code reported under Medicare Part B. It shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and, where available, adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$515.38	$515.38
ALASKA* (AK)	$625.32	$625.32
ALABAMA (AL)	$464.95	$464.95
ARKANSAS (AR)	$458.72	$458.72
ARIZONA (AZ)	$501.07	$501.07
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$604.23	$604.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$613.78	$613.78
OXNARD-THOUSAND OAKS-VENTURA (CA)	$545.48	$545.48
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$550.79	$550.79
NAPA (CA)	$579.52	$579.52
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$605.91	$605.91
VALLEJO (CA)	$577.10	$577.10
BAKERSFIELD (CA)	$522.75	$522.75
CHICO (CA)	$518.67	$518.67
FRESNO (CA)	$518.67	$518.67
HANFORD-CORCORAN (CA)	$518.67	$518.67
MADERA (CA)	$518.67	$518.67
MERCED (CA)	$518.67	$518.67
MODESTO (CA)	$518.67	$518.67
REDDING (CA)	$518.67	$518.67
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$534.58	$534.58
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$538.65	$538.65
SALINAS (CA)	$536.55	$536.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$620.65	$620.65
SANTA CRUZ-WATSONVILLE (CA)	$547.19	$547.19
SANTA ROSA-PETALUMA (CA)	$552.31	$552.31
STOCKTON (CA)	$518.67	$518.67
VISALIA (CA)	$518.67	$518.67
YUBA CITY (CA)	$518.67	$518.67
EL CENTRO (CA)	$518.92	$518.92
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$545.19	$545.19
SAN LUIS OBISPO-PASO ROBLES (CA)	$528.64	$528.64
SANTA MARIA-SANTA BARBARA (CA)	$537.47	$537.47
REST OF CALIFORNIA (CA)	$518.67	$518.67
COLORADO (CO)	$522.20	$522.20
CONNECTICUT (CT)	$548.29	$548.29
DC + MD/VA SUBURBS (DC)	$574.87	$574.87
DELAWARE (DE)	$508.77	$508.77
FORT LAUDERDALE (FL)	$558.33	$558.33
MIAMI (FL)	$600.46	$600.46
REST OF FLORIDA (FL)	$530.04	$530.04
ATLANTA (GA)	$529.72	$529.72
REST OF GEORGIA (GA)	$499.83	$499.83
HAWAII, GUAM (HI)	$526.32	$526.32
IOWA (IA)	$465.86	$465.86
IDAHO (ID)	$470.78	$470.78
EAST ST. LOUIS (IL)	$546.96	$546.96
SUBURBAN CHICAGO (IL)	$561.44	$561.44
CHICAGO (IL)	$582.19	$582.19
REST OF ILLINOIS (IL)	$523.04	$523.04
INDIANA (IN)	$473.05	$473.05
KANSAS (KS)	$468.60	$468.60
KENTUCKY (KY)	$485.44	$485.44
NEW ORLEANS (LA)	$508.42	$508.42
REST OF LOUISIANA (LA)	$486.64	$486.64
METROPOLITAN BOSTON (MA)	$564.51	$564.51
REST OF MASSACHUSETTS (MA)	$521.37	$521.37
BALTIMORE/SURR. CNTYS (MD)	$547.76	$547.76
REST OF MARYLAND (MD)	$516.45	$516.45
SOUTHERN MAINE (ME)	$495.05	$495.05
REST OF MAINE (ME)	$478.15	$478.15
DETROIT (MI)	$541.17	$541.17
REST OF MICHIGAN (MI)	$501.59	$501.59
MINNESOTA (MN)	$487.30	$487.30
METROPOLITAN ST. LOUIS (MO)	$504.35	$504.35
METROPOLITAN KANSAS CITY (MO)	$500.10	$500.10
REST OF MISSOURI (MO)	$482.10	$482.10
MISSISSIPPI (MS)	$470.25	$470.25
MONTANA** (MT)	$515.28	$515.28
NORTH CAROLINA (NC)	$482.00	$482.00
NORTH DAKOTA** (ND)	$486.01	$486.01
NEBRASKA (NE)	$466.78	$466.78
NEW HAMPSHIRE (NH)	$518.70	$518.70
NORTHERN NJ (NJ)	$570.58	$570.58
REST OF NEW JERSEY (NJ)	$550.86	$550.86
NEW MEXICO (NM)	$506.07	$506.07
NEVADA** (NV)	$507.35	$507.35
MANHATTAN (NY)	$596.88	$596.88
NYC SUBURBS/LONG ISLAND (NY)	$616.54	$616.54
POUGHKPSIE/N NYC SUBURBS (NY)	$558.31	$558.31
QUEENS (NY)	$594.40	$594.40
REST OF NEW YORK (NY)	$489.10	$489.10
OHIO (OH)	$495.60	$495.60
OKLAHOMA (OK)	$479.55	$479.55
PORTLAND (OR)	$532.20	$532.20
REST OF OREGON (OR)	$499.77	$499.77
METROPOLITAN PHILADELPHIA (PA)	$538.63	$538.63
REST OF PENNSYLVANIA (PA)	$493.65	$493.65
PUERTO RICO (PR)	$517.18	$517.18
RHODE ISLAND (RI)	$522.14	$522.14
SOUTH CAROLINA (SC)	$490.34	$490.34
SOUTH DAKOTA** (SD)	$482.55	$482.55
TENNESSEE (TN)	$471.39	$471.39
BRAZORIA (TX)	$504.29	$504.29
DALLAS (TX)	$509.54	$509.54
GALVESTON (TX)	$507.12	$507.12
HOUSTON (TX)	$534.21	$534.21
BEAUMONT (TX)	$491.00	$491.00
FORT WORTH (TX)	$507.86	$507.86
AUSTIN (TX)	$523.65	$523.65
REST OF TEXAS (TX)	$498.76	$498.76
UTAH (UT)	$496.43	$496.43
VIRGINIA (VA)	$496.90	$496.90
VIRGIN ISLANDS (VI)	$517.18	$517.18
VERMONT (VT)	$488.64	$488.64
SEATTLE (KING CNTY) (WA)	$570.66	$570.66
REST OF WASHINGTON (WA)	$518.89	$518.89
WISCONSIN (WI)	$471.43	$471.43
WEST VIRGINIA (WV)	$506.32	$506.32
WYOMING** (WY)	$502.52	$502.52

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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 pricing for this code starts with three Relative Value Units (RVUs) — work, practice expense (PE), and malpractice (MP) — that reflect the physician effort, overhead costs, and liability risk associated with the service. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific Medicare locality to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Because practice-expense RVUs differ when a service is performed in a non-facility (e.g., office) setting versus a facility (e.g., hospital) setting, the resulting allowed amount can vary between the two.

RVUs — work 7.01, practice expense 6.94 (non-facility) / 6.94 (facility), malpractice 1.48 — × 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 meets their deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can be affected by modifiers, place-of-service coding, sequestration, and annual budget-neutrality adjustments.
Locality-specific GPCIs can cause the final allowed amount to differ from the national figure.
Always confirm current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The practice expense RVU component is calculated differently depending on whether the service is performed in a non-facility setting (like a physician's office, where the practice bears more overhead) or a facility setting (like a hospital, where the facility bears more overhead). This difference affects the total RVUs and, consequently, the allowed amount.

Will my locality's reimbursement match the national amount shown?

Not necessarily. The national amount uses a standard GPCI baseline, but actual payments are adjusted using locality-specific GPCIs for work, practice expense, and malpractice costs, which can increase or decrease the final allowed amount.

Does this figure include patient cost-sharing?

No. The amount shown represents the full Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible is met, with the patient or supplemental insurance responsible for the remaining 20%.

Can modifiers change the reimbursement for this code?

Yes. Modifiers (such as those indicating bilateral procedures, reduced services, or multiple procedures) can increase, decrease, or otherwise adjust the base allowed amount. Check current Medicare billing guidance for applicable modifiers.

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.