Medicare Reimbursement for CPT 21812

CPT 21812 is a physician procedure code reported to Medicare for payment purposes; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings. Amounts shown are estimates based on the current year's published rates.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$655.33	$655.33
ALASKA* (AK)	$829.45	$829.45
ALABAMA (AL)	$594.67	$594.67
ARKANSAS (AR)	$587.37	$587.37
ARIZONA (AZ)	$636.55	$636.55
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$689.60	$689.60
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$697.21	$697.21
OXNARD-THOUSAND OAKS-VENTURA (CA)	$652.05	$652.05
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$661.89	$661.89
NAPA (CA)	$672.66	$672.66
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$693.08	$693.08
VALLEJO (CA)	$667.64	$667.64
BAKERSFIELD (CA)	$635.69	$635.69
CHICO (CA)	$627.36	$627.36
FRESNO (CA)	$627.36	$627.36
HANFORD-CORCORAN (CA)	$627.36	$627.36
MADERA (CA)	$627.36	$627.36
MERCED (CA)	$627.36	$627.36
MODESTO (CA)	$627.36	$627.36
REDDING (CA)	$627.36	$627.36
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$660.28	$660.28
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$644.06	$644.06
SALINAS (CA)	$641.43	$641.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$711.47	$711.47
SANTA CRUZ-WATSONVILLE (CA)	$644.43	$644.43
SANTA ROSA-PETALUMA (CA)	$649.92	$649.92
STOCKTON (CA)	$627.36	$627.36
VISALIA (CA)	$627.36	$627.36
YUBA CITY (CA)	$627.36	$627.36
EL CENTRO (CA)	$627.87	$627.87
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$646.40	$646.40
SAN LUIS OBISPO-PASO ROBLES (CA)	$632.91	$632.91
SANTA MARIA-SANTA BARBARA (CA)	$641.06	$641.06
REST OF CALIFORNIA (CA)	$627.36	$627.36
COLORADO (CO)	$646.22	$646.22
CONNECTICUT (CT)	$695.28	$695.28
DC + MD/VA SUBURBS (DC)	$712.79	$712.79
DELAWARE (DE)	$645.54	$645.54
FORT LAUDERDALE (FL)	$739.86	$739.86
MIAMI (FL)	$817.41	$817.41
REST OF FLORIDA (FL)	$701.22	$701.22
ATLANTA (GA)	$679.28	$679.28
REST OF GEORGIA (GA)	$661.05	$661.05
HAWAII, GUAM (HI)	$629.86	$629.86
IOWA (IA)	$582.51	$582.51
IDAHO (ID)	$590.95	$590.95
EAST ST. LOUIS (IL)	$748.96	$748.96
SUBURBAN CHICAGO (IL)	$740.94	$740.94
CHICAGO (IL)	$791.73	$791.73
REST OF ILLINOIS (IL)	$701.81	$701.81
INDIANA (IN)	$593.18	$593.18
KANSAS (KS)	$592.06	$592.06
KENTUCKY (KY)	$632.26	$632.26
NEW ORLEANS (LA)	$661.64	$661.64
REST OF LOUISIANA (LA)	$636.15	$636.15
METROPOLITAN BOSTON (MA)	$686.49	$686.49
REST OF MASSACHUSETTS (MA)	$648.14	$648.14
BALTIMORE/SURR. CNTYS (MD)	$695.84	$695.84
REST OF MARYLAND (MD)	$652.70	$652.70
SOUTHERN MAINE (ME)	$616.32	$616.32
REST OF MAINE (ME)	$606.22	$606.22
DETROIT (MI)	$721.14	$721.14
REST OF MICHIGAN (MI)	$657.31	$657.31
MINNESOTA (MN)	$586.89	$586.89
METROPOLITAN ST. LOUIS (MO)	$649.33	$649.33
METROPOLITAN KANSAS CITY (MO)	$645.08	$645.08
REST OF MISSOURI (MO)	$634.82	$634.82
MISSISSIPPI (MS)	$610.60	$610.60
MONTANA** (MT)	$655.12	$655.12
NORTH CAROLINA (NC)	$609.65	$609.65
NORTH DAKOTA** (ND)	$594.42	$594.42
NEBRASKA (NE)	$581.59	$581.59
NEW HAMPSHIRE (NH)	$647.81	$647.81
NORTHERN NJ (NJ)	$709.66	$709.66
REST OF NEW JERSEY (NJ)	$694.11	$694.11
NEW MEXICO (NM)	$665.21	$665.21
NEVADA** (NV)	$638.33	$638.33
MANHATTAN (NY)	$763.46	$763.46
NYC SUBURBS/LONG ISLAND (NY)	$794.74	$794.74
POUGHKPSIE/N NYC SUBURBS (NY)	$708.20	$708.20
QUEENS (NY)	$751.28	$751.28
REST OF NEW YORK (NY)	$618.41	$618.41
OHIO (OH)	$644.90	$644.90
OKLAHOMA (OK)	$618.63	$618.63
PORTLAND (OR)	$650.20	$650.20
REST OF OREGON (OR)	$624.35	$624.35
METROPOLITAN PHILADELPHIA (PA)	$688.04	$688.04
REST OF PENNSYLVANIA (PA)	$639.09	$639.09
PUERTO RICO (PR)	$655.21	$655.21
RHODE ISLAND (RI)	$656.56	$656.56
SOUTH CAROLINA (SC)	$630.12	$630.12
SOUTH DAKOTA** (SD)	$587.24	$587.24
TENNESSEE (TN)	$596.09	$596.09
BRAZORIA (TX)	$634.99	$634.99
DALLAS (TX)	$644.06	$644.06
GALVESTON (TX)	$640.17	$640.17
HOUSTON (TX)	$696.36	$696.36
BEAUMONT (TX)	$636.41	$636.41
FORT WORTH (TX)	$644.10	$644.10
AUSTIN (TX)	$651.98	$651.98
REST OF TEXAS (TX)	$638.79	$638.79
UTAH (UT)	$637.11	$637.11
VIRGINIA (VA)	$622.98	$622.98
VIRGIN ISLANDS (VI)	$655.21	$655.21
VERMONT (VT)	$603.38	$603.38
SEATTLE (KING CNTY) (WA)	$687.08	$687.08
REST OF WASHINGTON (WA)	$643.18	$643.18
WISCONSIN (WI)	$578.94	$578.94
WEST VIRGINIA (WV)	$682.59	$682.59
WYOMING** (WY)	$628.67	$628.67

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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 is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility rates differ primarily because the practice-expense RVU is lower in facility settings (e.g., hospitals), where the facility itself absorbs certain overhead costs; for this code those practice-expense RVUs are the same across both settings in the data shown, but that is not true for all codes.

RVUs — work 12.68, practice expense 3.87 (non-facility) / 3.87 (facility), malpractice 3.07 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates derived from the published PFS formula, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary due to modifiers, multiple-procedure reductions, sequestration, MAC-specific policies, and annual budget-neutrality adjustments.
Locality-specific GPCIs change the final amount from the national figure shown; confirm with your Medicare Administrative Contractor (MAC) for your specific locality.
This is not billing or coding advice; verify coverage, medical necessity, and documentation requirements separately.

Frequently asked

Why is the facility amount the same as the non-facility amount for this code?

The practice-expense RVU used in the calculation is identical for both settings for this particular code, so the formula produces the same national allowed amount in this instance. This is not the case for all CPT/HCPCS codes.

Why does the allowed amount differ by locality even though the RVUs are the same?

The RVUs are multiplied by locality-specific GPCI adjustments before applying the conversion factor, so areas with higher relative costs (for work, practice expense, or malpractice) will show a higher adjusted dollar amount, and lower-cost areas will show less.

Does this amount reflect what the patient will owe?

No. The figure shown is the Medicare-allowed amount before cost-sharing. Patients typically owe 20% coinsurance after the deductible, and additional amounts may apply depending on secondary insurance or site of service.

Will this amount change during the year?

The conversion factor and RVUs are set annually, but budget-neutrality adjustments, legislative changes, or correction notices from CMS can alter the amount even within a calendar year.

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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.