Medicare Reimbursement for CPT 21811

CPT 21811 is a procedure code on the Medicare Physician Fee Schedule (PFS); the official AMA descriptor is not reproduced here. This page shows CareNiva's estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$544.77	$544.77
ALASKA* (AK)	$688.39	$688.39
ALABAMA (AL)	$493.76	$493.76
ARKANSAS (AR)	$487.63	$487.63
ARIZONA (AZ)	$528.96	$528.96
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$571.90	$571.90
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$578.15	$578.15
OXNARD-THOUSAND OAKS-VENTURA (CA)	$541.26	$541.26
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$549.49	$549.49
NAPA (CA)	$558.06	$558.06
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$574.85	$574.85
VALLEJO (CA)	$553.81	$553.81
BAKERSFIELD (CA)	$527.72	$527.72
CHICO (CA)	$520.68	$520.68
FRESNO (CA)	$520.68	$520.68
HANFORD-CORCORAN (CA)	$520.68	$520.68
MADERA (CA)	$520.68	$520.68
MERCED (CA)	$520.68	$520.68
MODESTO (CA)	$520.68	$520.68
REDDING (CA)	$520.68	$520.68
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$548.56	$548.56
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$534.49	$534.49
SALINAS (CA)	$532.31	$532.31
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$590.22	$590.22
SANTA CRUZ-WATSONVILLE (CA)	$534.76	$534.76
SANTA ROSA-PETALUMA (CA)	$539.31	$539.31
STOCKTON (CA)	$520.68	$520.68
VISALIA (CA)	$520.68	$520.68
YUBA CITY (CA)	$520.68	$520.68
EL CENTRO (CA)	$521.11	$521.11
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$536.42	$536.42
SAN LUIS OBISPO-PASO ROBLES (CA)	$525.26	$525.26
SANTA MARIA-SANTA BARBARA (CA)	$532.00	$532.00
REST OF CALIFORNIA (CA)	$520.68	$520.68
COLORADO (CO)	$536.79	$536.79
CONNECTICUT (CT)	$578.24	$578.24
DC + MD/VA SUBURBS (DC)	$592.52	$592.52
DELAWARE (DE)	$536.48	$536.48
FORT LAUDERDALE (FL)	$616.32	$616.32
MIAMI (FL)	$681.92	$681.92
REST OF FLORIDA (FL)	$583.76	$583.76
ATLANTA (GA)	$564.98	$564.98
REST OF GEORGIA (GA)	$549.94	$549.94
HAWAII, GUAM (HI)	$522.81	$522.81
IOWA (IA)	$483.35	$483.35
IDAHO (ID)	$490.48	$490.48
EAST ST. LOUIS (IL)	$624.30	$624.30
SUBURBAN CHICAGO (IL)	$617.15	$617.15
CHICAGO (IL)	$660.22	$660.22
REST OF ILLINOIS (IL)	$584.39	$584.39
INDIANA (IN)	$492.35	$492.35
KANSAS (KS)	$491.47	$491.47
KENTUCKY (KY)	$525.56	$525.56
NEW ORLEANS (LA)	$550.29	$550.29
REST OF LOUISIANA (LA)	$528.87	$528.87
METROPOLITAN BOSTON (MA)	$570.29	$570.29
REST OF MASSACHUSETTS (MA)	$538.41	$538.41
BALTIMORE/SURR. CNTYS (MD)	$578.75	$578.75
REST OF MARYLAND (MD)	$542.44	$542.44
SOUTHERN MAINE (ME)	$511.76	$511.76
REST OF MAINE (ME)	$503.42	$503.42
DETROIT (MI)	$600.61	$600.61
REST OF MICHIGAN (MI)	$546.70	$546.70
MINNESOTA (MN)	$486.72	$486.72
METROPOLITAN ST. LOUIS (MO)	$539.83	$539.83
METROPOLITAN KANSAS CITY (MO)	$536.27	$536.27
REST OF MISSOURI (MO)	$527.81	$527.81
MISSISSIPPI (MS)	$507.29	$507.29
MONTANA** (MT)	$544.59	$544.59
NORTH CAROLINA (NC)	$506.28	$506.28
NORTH DAKOTA** (ND)	$493.18	$493.18
NEBRASKA (NE)	$482.55	$482.55
NEW HAMPSHIRE (NH)	$538.28	$538.28
NORTHERN NJ (NJ)	$589.86	$589.86
REST OF NEW JERSEY (NJ)	$577.05	$577.05
NEW MEXICO (NM)	$553.38	$553.38
NEVADA** (NV)	$530.37	$530.37
MANHATTAN (NY)	$635.41	$635.41
NYC SUBURBS/LONG ISLAND (NY)	$661.82	$661.82
POUGHKPSIE/N NYC SUBURBS (NY)	$588.94	$588.94
QUEENS (NY)	$625.03	$625.03
REST OF NEW YORK (NY)	$513.65	$513.65
OHIO (OH)	$536.19	$536.19
OKLAHOMA (OK)	$514.00	$514.00
PORTLAND (OR)	$539.99	$539.99
REST OF OREGON (OR)	$518.55	$518.55
METROPOLITAN PHILADELPHIA (PA)	$572.22	$572.22
REST OF PENNSYLVANIA (PA)	$531.26	$531.26
PUERTO RICO (PR)	$544.64	$544.64
RHODE ISLAND (RI)	$545.58	$545.58
SOUTH CAROLINA (SC)	$523.64	$523.64
SOUTH DAKOTA** (SD)	$487.11	$487.11
TENNESSEE (TN)	$494.86	$494.86
BRAZORIA (TX)	$527.52	$527.52
DALLAS (TX)	$535.17	$535.17
GALVESTON (TX)	$531.90	$531.90
HOUSTON (TX)	$579.49	$579.49
BEAUMONT (TX)	$529.01	$529.01
FORT WORTH (TX)	$535.24	$535.24
AUSTIN (TX)	$541.75	$541.75
REST OF TEXAS (TX)	$530.91	$530.91
UTAH (UT)	$529.52	$529.52
VIRGINIA (VA)	$517.43	$517.43
VIRGIN ISLANDS (VI)	$544.64	$544.64
VERMONT (VT)	$500.80	$500.80
SEATTLE (KING CNTY) (WA)	$570.63	$570.63
REST OF WASHINGTON (WA)	$534.23	$534.23
WISCONSIN (WI)	$480.20	$480.20
WEST VIRGINIA (WV)	$568.24	$568.24
WYOMING** (WY)	$522.19	$522.19

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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 allowed amount for a PFS code is built from three Relative Value Units (RVUs) — physician work, practice expense (PE), and malpractice (MP) — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. The geographically adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ; for this code, those PE RVUs happen to be the same, so the non-facility and facility estimates shown are identical. Because GPCIs vary by locality, the same code can price differently depending on where it's billed.

RVUs — work 10.52, practice expense 3.19 (non-facility) / 3.19 (facility), malpractice 2.6 — × 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 patient or secondary payer is generally responsible for the rest.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Final payment also depends on your Medicare Administrative Contractor (MAC), claim-specific edits, and local coverage policies — verify with your MAC before relying on this figure.

Frequently asked

Why are the non-facility and facility amounts the same for this code?

The non-facility and facility amounts differ only when the practice-expense RVU differs between settings. For this code, the practice-expense RVU is the same in both settings, so the calculated allowed amount is identical.

Why does the Medicare amount vary by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs) for work, practice expense, and malpractice, which adjust the national RVUs to reflect local cost differences before the conversion factor is applied.

Does this figure reflect what Medicare will actually pay?

No — it's an estimate based on standard PFS inputs. Actual payment can be affected by modifiers, secondary payer adjustments, sequestration, and annual rule changes, so the final remittance may differ.

Where can I find the official descriptor for CPT 21811?

CPT code descriptors are copyrighted by the American Medical Association. Check your CPT codebook, encoder software, or AMA resources for the official language.

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.