Medicare Reimbursement for CPT 21820
This page explains the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 21820, a procedure code whose official descriptor is maintained by the AMA and not reproduced here. It shows the national estimate as well as locality-adjusted figures, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings, since payment can differ depending on where the service is performed.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $179.70 | $169.01 |
| ALASKA* (AK) | $205.72 | $194.34 |
| ALABAMA (AL) | $159.79 | $150.44 |
| ARKANSAS (AR) | $157.29 | $148.11 |
| ARIZONA (AZ) | $174.41 | $164.05 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $229.84 | $214.77 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $234.25 | $218.84 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $200.15 | $187.51 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $201.25 | $188.60 |
| NAPA (CA) | $217.67 | $203.58 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $230.17 | $215.10 |
| VALLEJO (CA) | $217.19 | $203.10 |
| BAKERSFIELD (CA) | $188.81 | $177.10 |
| CHICO (CA) | $188.01 | $176.30 |
| FRESNO (CA) | $188.01 | $176.30 |
| HANFORD-CORCORAN (CA) | $188.01 | $176.30 |
| MADERA (CA) | $188.01 | $176.30 |
| MERCED (CA) | $188.01 | $176.30 |
| MODESTO (CA) | $188.01 | $176.30 |
| REDDING (CA) | $188.01 | $176.30 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $191.13 | $179.41 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $197.27 | $184.84 |
| SALINAS (CA) | $196.55 | $184.16 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $235.60 | $220.19 |
| SANTA CRUZ-WATSONVILLE (CA) | $203.14 | $190.15 |
| SANTA ROSA-PETALUMA (CA) | $205.17 | $192.04 |
| STOCKTON (CA) | $188.01 | $176.30 |
| VISALIA (CA) | $188.01 | $176.30 |
| YUBA CITY (CA) | $188.01 | $176.30 |
| EL CENTRO (CA) | $188.06 | $176.35 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $201.21 | $188.43 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $193.41 | $181.24 |
| SANTA MARIA-SANTA BARBARA (CA) | $197.29 | $184.83 |
| REST OF CALIFORNIA (CA) | $188.01 | $176.30 |
| COLORADO (CO) | $186.15 | $174.77 |
| CONNECTICUT (CT) | $192.29 | $180.78 |
| DC + MD/VA SUBURBS (DC) | $205.54 | $192.95 |
| DELAWARE (DE) | $177.43 | $166.87 |
| FORT LAUDERDALE (FL) | $189.16 | $178.33 |
| MIAMI (FL) | $199.66 | $188.53 |
| REST OF FLORIDA (FL) | $179.04 | $168.83 |
| ATLANTA (GA) | $183.79 | $172.93 |
| REST OF GEORGIA (GA) | $167.99 | $158.46 |
| HAWAII, GUAM (HI) | $192.82 | $180.67 |
| IOWA (IA) | $163.18 | $153.40 |
| IDAHO (ID) | $164.55 | $154.71 |
| EAST ST. LOUIS (IL) | $179.47 | $169.64 |
| SUBURBAN CHICAGO (IL) | $190.88 | $179.90 |
| CHICAGO (IL) | $193.18 | $182.44 |
| REST OF ILLINOIS (IL) | $174.22 | $164.47 |
| INDIANA (IN) | $165.55 | $155.64 |
| KANSAS (KS) | $162.84 | $153.17 |
| KENTUCKY (KY) | $164.93 | $155.43 |
| NEW ORLEANS (LA) | $173.60 | $163.55 |
| REST OF LOUISIANA (LA) | $164.85 | $155.39 |
| METROPOLITAN BOSTON (MA) | $204.82 | $192.05 |
| REST OF MASSACHUSETTS (MA) | $185.10 | $173.84 |
| BALTIMORE/SURR. CNTYS (MD) | $191.87 | $180.40 |
| REST OF MARYLAND (MD) | $180.85 | $170.04 |
| SOUTHERN MAINE (ME) | $174.99 | $164.40 |
| REST OF MAINE (ME) | $165.99 | $156.16 |
| DETROIT (MI) | $181.95 | $171.63 |
| REST OF MICHIGAN (MI) | $170.02 | $160.26 |
| MINNESOTA (MN) | $176.52 | $165.52 |
| METROPOLITAN ST. LOUIS (MO) | $173.69 | $163.51 |
| METROPOLITAN KANSAS CITY (MO) | $171.81 | $161.78 |
| REST OF MISSOURI (MO) | $162.11 | $152.90 |
| MISSISSIPPI (MS) | $159.71 | $150.51 |
| MONTANA** (MT) | $179.68 | $168.99 |
| NORTH CAROLINA (NC) | $167.79 | $157.81 |
| NORTH DAKOTA** (ND) | $173.94 | $163.25 |
| NEBRASKA (NE) | $164.00 | $154.14 |
| NEW HAMPSHIRE (NH) | $183.64 | $172.51 |
| NORTHERN NJ (NJ) | $203.25 | $190.85 |
| REST OF NEW JERSEY (NJ) | $193.97 | $182.30 |
| NEW MEXICO (NM) | $171.22 | $161.42 |
| NEVADA** (NV) | $178.20 | $167.51 |
| MANHATTAN (NY) | $208.56 | $196.14 |
| NYC SUBURBS/LONG ISLAND (NY) | $214.58 | $201.87 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $195.66 | $183.96 |
| QUEENS (NY) | $209.68 | $197.04 |
| REST OF NEW YORK (NY) | $170.54 | $160.39 |
| OHIO (OH) | $168.85 | $159.09 |
| OKLAHOMA (OK) | $164.10 | $154.55 |
| PORTLAND (OR) | $191.87 | $179.99 |
| REST OF OREGON (OR) | $176.32 | $165.67 |
| METROPOLITAN PHILADELPHIA (PA) | $187.51 | $176.39 |
| REST OF PENNSYLVANIA (PA) | $168.87 | $159.05 |
| PUERTO RICO (PR) | $180.93 | $170.13 |
| RHODE ISLAND (RI) | $183.64 | $172.60 |
| SOUTH CAROLINA (SC) | $168.70 | $158.82 |
| SOUTH DAKOTA** (SD) | $173.27 | $162.58 |
| TENNESSEE (TN) | $163.78 | $154.07 |
| BRAZORIA (TX) | $176.79 | $166.20 |
| DALLAS (TX) | $178.22 | $167.57 |
| GALVESTON (TX) | $177.51 | $166.89 |
| HOUSTON (TX) | $182.82 | $172.20 |
| BEAUMONT (TX) | $167.71 | $157.98 |
| FORT WORTH (TX) | $177.09 | $166.55 |
| AUSTIN (TX) | $185.97 | $174.66 |
| REST OF TEXAS (TX) | $172.35 | $162.21 |
| UTAH (UT) | $171.17 | $161.13 |
| VIRGINIA (VA) | $174.71 | $164.21 |
| VIRGIN ISLANDS (VI) | $180.93 | $170.13 |
| VERMONT (VT) | $173.66 | $163.07 |
| SEATTLE (KING CNTY) (WA) | $208.65 | $195.54 |
| REST OF WASHINGTON (WA) | $184.62 | $173.36 |
| WISCONSIN (WI) | $167.72 | $157.48 |
| WEST VIRGINIA (WV) | $167.42 | $158.13 |
| WYOMING** (WY) | $177.18 | $166.49 |
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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (equipment, staff, supplies) vary by site of service, which is why the two allowed amounts differ.
RVUs — work 1.33, practice expense 3.76 (non-facility) / 3.44 (facility), malpractice 0.29 — × 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 the annual deductible; the patient or secondary payer is responsible for the remainder.
- Modifiers, multiple-procedure rules, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
- Locality-specific GPCIs and conversion factor updates are applied each year and may differ from the figures shown.
- Always confirm current rates and coverage rules 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 for the same code?
Facility and non-facility rates use different practice-expense RVUs because overhead costs (staff, equipment, supplies) are typically lower when the procedure is performed in a hospital or facility setting versus a physician's office.
Why might the amount I receive differ from the national figure shown here?
Medicare adjusts payment by locality using GPCIs, so the actual allowed amount depends on where the service was rendered. Modifiers, secondary payers, and sequestration can also change the final payment.
Does this page tell me whether CPT 21820 is covered by Medicare?
No. This page only estimates the PFS allowed amount if the service is covered and billed correctly. Coverage, medical necessity, and documentation requirements should be verified separately with your MAC or Medicare policy guidance.
Can I use this amount to predict a denial or appeal outcome?
No. Fee schedule amounts relate to payment calculation, not coverage decisions. Denials are typically based on medical necessity, documentation, or coding issues, which this page does not address.
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.
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