Medicare Reimbursement for CPT Code 21750

This page explains how Medicare's Physician Fee Schedule (PFS) allowed amount is calculated for this procedure code. Because the CPT descriptor is proprietary to the AMA, it is not reproduced here, but the pricing logic applies regardless of the specific service described. Amounts are shown nationally and, where available, adjusted for locality and site of service (non-facility vs. facility).

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$660.67	$660.67
ALASKA* (AK)	$818.31	$818.31
ALABAMA (AL)	$596.34	$596.34
ARKANSAS (AR)	$588.52	$588.52
ARIZONA (AZ)	$641.40	$641.40
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$724.73	$724.73
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$734.09	$734.09
OXNARD-THOUSAND OAKS-VENTURA (CA)	$672.74	$672.74
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$681.51	$681.51
NAPA (CA)	$702.19	$702.19
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$727.83	$727.83
VALLEJO (CA)	$697.72	$697.72
BAKERSFIELD (CA)	$651.09	$651.09
CHICO (CA)	$643.69	$643.69
FRESNO (CA)	$643.69	$643.69
HANFORD-CORCORAN (CA)	$643.69	$643.69
MADERA (CA)	$643.69	$643.69
MERCED (CA)	$643.69	$643.69
MODESTO (CA)	$643.69	$643.69
REDDING (CA)	$643.69	$643.69
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$672.97	$672.97
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$664.02	$664.02
SALINAS (CA)	$661.37	$661.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$746.76	$746.76
SANTA CRUZ-WATSONVILLE (CA)	$668.74	$668.74
SANTA ROSA-PETALUMA (CA)	$674.66	$674.66
STOCKTON (CA)	$643.69	$643.69
VISALIA (CA)	$643.69	$643.69
YUBA CITY (CA)	$643.69	$643.69
EL CENTRO (CA)	$644.14	$644.14
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$668.87	$668.87
SAN LUIS OBISPO-PASO ROBLES (CA)	$652.21	$652.21
SANTA MARIA-SANTA BARBARA (CA)	$661.64	$661.64
REST OF CALIFORNIA (CA)	$643.69	$643.69
COLORADO (CO)	$657.83	$657.83
CONNECTICUT (CT)	$702.50	$702.50
DC + MD/VA SUBURBS (DC)	$726.29	$726.29
DELAWARE (DE)	$650.94	$650.94
FORT LAUDERDALE (FL)	$736.92	$736.92
MIAMI (FL)	$808.21	$808.21
REST OF FLORIDA (FL)	$697.82	$697.82
ATLANTA (GA)	$683.28	$683.28
REST OF GEORGIA (GA)	$656.79	$656.79
HAWAII, GUAM (HI)	$649.42	$649.42
IOWA (IA)	$588.85	$588.85
IDAHO (ID)	$596.77	$596.77
EAST ST. LOUIS (IL)	$737.29	$737.29
SUBURBAN CHICAGO (IL)	$739.01	$739.01
CHICAGO (IL)	$782.34	$782.34
REST OF ILLINOIS (IL)	$694.77	$694.77
INDIANA (IN)	$599.34	$599.34
KANSAS (KS)	$596.43	$596.43
KENTUCKY (KY)	$630.93	$630.93
NEW ORLEANS (LA)	$661.38	$661.38
REST OF LOUISIANA (LA)	$634.06	$634.06
METROPOLITAN BOSTON (MA)	$704.29	$704.29
REST OF MASSACHUSETTS (MA)	$658.60	$658.60
BALTIMORE/SURR. CNTYS (MD)	$702.68	$702.68
REST OF MARYLAND (MD)	$659.28	$659.28
SOUTHERN MAINE (ME)	$625.24	$625.24
REST OF MAINE (ME)	$610.36	$610.36
DETROIT (MI)	$716.29	$716.29
REST OF MICHIGAN (MI)	$655.20	$655.20
MINNESOTA (MN)	$602.22	$602.22
METROPOLITAN ST. LOUIS (MO)	$651.34	$651.34
METROPOLITAN KANSAS CITY (MO)	$646.49	$646.49
REST OF MISSOURI (MO)	$630.97	$630.97
MISSISSIPPI (MS)	$609.34	$609.34
MONTANA** (MT)	$660.49	$660.49
NORTH CAROLINA (NC)	$614.48	$614.48
NORTH DAKOTA** (ND)	$606.51	$606.51
NEBRASKA (NE)	$588.70	$588.70
NEW HAMPSHIRE (NH)	$657.39	$657.39
NORTHERN NJ (NJ)	$721.96	$721.96
REST OF NEW JERSEY (NJ)	$702.59	$702.59
NEW MEXICO (NM)	$662.56	$662.56
NEVADA** (NV)	$645.64	$645.64
MANHATTAN (NY)	$769.96	$769.96
NYC SUBURBS/LONG ISLAND (NY)	$800.02	$800.02
POUGHKPSIE/N NYC SUBURBS (NY)	$715.35	$715.35
QUEENS (NY)	$760.79	$760.79
REST OF NEW YORK (NY)	$623.68	$623.68
OHIO (OH)	$644.17	$644.17
OKLAHOMA (OK)	$619.14	$619.14
PORTLAND (OR)	$665.25	$665.25
REST OF OREGON (OR)	$632.80	$632.80
METROPOLITAN PHILADELPHIA (PA)	$693.07	$693.07
REST OF PENNSYLVANIA (PA)	$639.41	$639.41
PUERTO RICO (PR)	$661.48	$661.48
RHODE ISLAND (RI)	$664.42	$664.42
SOUTH CAROLINA (SC)	$631.94	$631.94
SOUTH DAKOTA** (SD)	$600.12	$600.12
TENNESSEE (TN)	$600.43	$600.43
BRAZORIA (TX)	$641.80	$641.80
DALLAS (TX)	$650.27	$650.27
GALVESTON (TX)	$646.57	$646.57
HOUSTON (TX)	$696.54	$696.54
BEAUMONT (TX)	$636.37	$636.37
FORT WORTH (TX)	$649.48	$649.48
AUSTIN (TX)	$662.51	$662.51
REST OF TEXAS (TX)	$641.72	$641.72
UTAH (UT)	$639.48	$639.48
VIRGINIA (VA)	$630.49	$630.49
VIRGIN ISLANDS (VI)	$661.48	$661.48
VERMONT (VT)	$613.64	$613.64
SEATTLE (KING CNTY) (WA)	$707.52	$707.52
REST OF WASHINGTON (WA)	$654.20	$654.20
WISCONSIN (WI)	$589.25	$589.25
WEST VIRGINIA (WV)	$674.02	$674.02
WYOMING** (WY)	$636.96	$636.96

Look up another code or locality →

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 pricing starts with three Relative Value Units (RVUs) assigned to the 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 local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can have different practice-expense RVUs, which is why the allowed amount sometimes differs by place of service, though for some codes the two amounts are the same.

RVUs — work 11.12, practice expense 5.93 (non-facility) / 5.93 (facility), malpractice 2.73 — × 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 annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Rates vary by Medicare Administrative Contractor (MAC) locality and can change each year; always confirm with your MAC's published fee schedule before billing.

Frequently asked

Why don't you show the CPT code description?

CPT descriptors are copyrighted by the American Medical Association (AMA) and cannot be republished without a license. This page focuses on the Medicare pricing mechanics, not the clinical description.

Why are the non-facility and facility amounts sometimes the same?

When the practice-expense RVU for a code doesn't differ meaningfully between the two settings, the resulting allowed amounts can end up equal, even though the formula is applied separately for each.

Does the amount shown include my coinsurance?

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

Will my local payment match the national rate shown?

Not necessarily. Local payment is derived by adjusting the RVUs with your specific locality's GPCIs, so it can be higher or lower than the national figure.

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.