Medicare Reimbursement for CPT 21825

CPT 21825 is a physician procedure code reported to Medicare for payment purposes; the full descriptor is maintained by the AMA and is not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount nationally and can vary by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$563.81	$563.81
ALASKA* (AK)	$678.34	$678.34
ALABAMA (AL)	$505.64	$505.64
ARKANSAS (AR)	$498.48	$498.48
ARIZONA (AZ)	$547.11	$547.11
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$653.80	$653.80
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$663.80	$663.80
OXNARD-THOUSAND OAKS-VENTURA (CA)	$592.57	$592.57
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$598.66	$598.66
NAPA (CA)	$628.03	$628.03
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$655.92	$655.92
VALLEJO (CA)	$624.97	$624.97
BAKERSFIELD (CA)	$568.05	$568.05
CHICO (CA)	$562.98	$562.98
FRESNO (CA)	$562.98	$562.98
HANFORD-CORCORAN (CA)	$562.98	$562.98
MADERA (CA)	$562.98	$562.98
MERCED (CA)	$562.98	$562.98
MODESTO (CA)	$562.98	$562.98
REDDING (CA)	$562.98	$562.98
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$583.03	$583.03
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$584.43	$584.43
SALINAS (CA)	$582.18	$582.18
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$672.48	$672.48
SANTA CRUZ-WATSONVILLE (CA)	$593.56	$593.56
SANTA ROSA-PETALUMA (CA)	$599.07	$599.07
STOCKTON (CA)	$562.98	$562.98
VISALIA (CA)	$562.98	$562.98
YUBA CITY (CA)	$562.98	$562.98
EL CENTRO (CA)	$563.29	$563.29
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$591.49	$591.49
SAN LUIS OBISPO-PASO ROBLES (CA)	$573.67	$573.67
SANTA MARIA-SANTA BARBARA (CA)	$583.16	$583.16
REST OF CALIFORNIA (CA)	$562.98	$562.98
COLORADO (CO)	$569.07	$569.07
CONNECTICUT (CT)	$601.12	$601.12
DC + MD/VA SUBURBS (DC)	$628.75	$628.75
DELAWARE (DE)	$555.78	$555.78
FORT LAUDERDALE (FL)	$617.51	$617.51
MIAMI (FL)	$669.50	$669.50
REST OF FLORIDA (FL)	$584.29	$584.29
ATLANTA (GA)	$581.10	$581.10
REST OF GEORGIA (GA)	$548.96	$548.96
HAWAII, GUAM (HI)	$571.56	$571.56
IOWA (IA)	$505.02	$505.02
IDAHO (ID)	$511.01	$511.01
EAST ST. LOUIS (IL)	$607.26	$607.26
SUBURBAN CHICAGO (IL)	$620.51	$620.51
CHICAGO (IL)	$647.70	$647.70
REST OF ILLINOIS (IL)	$577.35	$577.35
INDIANA (IN)	$513.56	$513.56
KANSAS (KS)	$508.97	$508.97
KENTUCKY (KY)	$530.91	$530.91
NEW ORLEANS (LA)	$557.64	$557.64
REST OF LOUISIANA (LA)	$532.61	$532.61
METROPOLITAN BOSTON (MA)	$615.51	$615.51
REST OF MASSACHUSETTS (MA)	$568.34	$568.34
BALTIMORE/SURR. CNTYS (MD)	$600.80	$600.80
REST OF MARYLAND (MD)	$564.20	$564.20
SOUTHERN MAINE (ME)	$538.52	$538.52
REST OF MAINE (ME)	$520.32	$520.32
DETROIT (MI)	$597.96	$597.96
REST OF MICHIGAN (MI)	$550.24	$550.24
MINNESOTA (MN)	$527.04	$527.04
METROPOLITAN ST. LOUIS (MO)	$552.00	$552.00
METROPOLITAN KANSAS CITY (MO)	$547.21	$547.21
REST OF MISSOURI (MO)	$527.89	$527.89
MISSISSIPPI (MS)	$512.96	$512.96
MONTANA** (MT)	$563.68	$563.68
NORTH CAROLINA (NC)	$524.61	$524.61
NORTH DAKOTA** (ND)	$526.71	$526.71
NEBRASKA (NE)	$505.82	$505.82
NEW HAMPSHIRE (NH)	$566.19	$566.19
NORTHERN NJ (NJ)	$623.74	$623.74
REST OF NEW JERSEY (NJ)	$602.84	$602.84
NEW MEXICO (NM)	$555.74	$555.74
NEVADA** (NV)	$553.62	$553.62
MANHATTAN (NY)	$656.85	$656.85
NYC SUBURBS/LONG ISLAND (NY)	$680.48	$680.48
POUGHKPSIE/N NYC SUBURBS (NY)	$611.91	$611.91
QUEENS (NY)	$652.82	$652.82
REST OF NEW YORK (NY)	$532.83	$532.83
OHIO (OH)	$542.69	$542.69
OKLAHOMA (OK)	$523.29	$523.29
PORTLAND (OR)	$579.45	$579.45
REST OF OREGON (OR)	$544.26	$544.26
METROPOLITAN PHILADELPHIA (PA)	$590.60	$590.60
REST OF PENNSYLVANIA (PA)	$539.99	$539.99
PUERTO RICO (PR)	$565.60	$565.60
RHODE ISLAND (RI)	$570.07	$570.07
SOUTH CAROLINA (SC)	$535.55	$535.55
SOUTH DAKOTA** (SD)	$522.33	$522.33
TENNESSEE (TN)	$512.27	$512.27
BRAZORIA (TX)	$549.85	$549.85
DALLAS (TX)	$556.22	$556.22
GALVESTON (TX)	$553.35	$553.35
HOUSTON (TX)	$587.58	$587.58
BEAUMONT (TX)	$537.01	$537.01
FORT WORTH (TX)	$554.55	$554.55
AUSTIN (TX)	$571.61	$571.61
REST OF TEXAS (TX)	$545.07	$545.07
UTAH (UT)	$542.53	$542.53
VIRGINIA (VA)	$541.22	$541.22
VIRGIN ISLANDS (VI)	$565.60	$565.60
VERMONT (VT)	$530.47	$530.47
SEATTLE (KING CNTY) (WA)	$621.43	$621.43
REST OF WASHINGTON (WA)	$565.34	$565.34
WISCONSIN (WI)	$510.15	$510.15
WEST VIRGINIA (WV)	$558.17	$558.17
WYOMING** (WY)	$547.57	$547.57

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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 Physician Fee Schedule 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 performed, reflecting local cost-of-living and practice cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings often have different practice-expense RVUs because the resource costs borne by the physician differ, which is why the two settings can show different totals.

RVUs — work 7.57, practice expense 7.44 (non-facility) / 7.44 (facility), malpractice 1.87 — × 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 approved amount after the annual Part B deductible is met; the beneficiary or secondary insurer is responsible for the remainder.
Actual payment can differ based on your specific locality, applicable modifiers, claims-processing adjustments, sequestration, and annual budget-neutrality changes to RVUs or the conversion factor.
Always confirm the current allowed amount and coverage policy 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?

The practice-expense RVU component is usually lower in the facility setting because the facility, not the physician, bears many of the overhead costs (equipment, supplies, staff) of performing the service there.

Does this amount reflect what Medicare will actually pay?

No. It reflects the PFS allowed amount estimate. Medicare generally reimburses 80% of this amount after the deductible, and the final payment can be affected by modifiers, locality, and policy adjustments.

Why might the amount change year to year?

The conversion factor, RVUs, and GPCIs are updated annually by CMS, and budget-neutrality adjustments across all codes can shift the final allowed amount even if the code's RVUs stay the same.

Where can I find the exact amount for my location?

Use the locality-specific GPCI-adjusted figures on this page, or confirm directly with your MAC, since actual local allowed amounts can differ from the national average shown here.

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.