Medicare Reimbursement for CPT 21920

CPT 21920 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$263.87	$142.29
ALASKA* (AK)	$305.80	$176.32
ALABAMA (AL)	$236.39	$130.01
ARKANSAS (AR)	$232.92	$128.48
ARIZONA (AZ)	$256.69	$138.88
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$340.51	$169.08
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$347.18	$171.86
OXNARD-THOUSAND OAKS-VENTURA (CA)	$295.69	$151.99
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$297.18	$153.36
NAPA (CA)	$322.11	$161.87
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$340.85	$169.42
VALLEJO (CA)	$321.62	$161.38
BAKERSFIELD (CA)	$279.02	$145.77
CHICO (CA)	$278.15	$144.90
FRESNO (CA)	$278.15	$144.90
HANFORD-CORCORAN (CA)	$278.15	$144.90
MADERA (CA)	$278.15	$144.90
MERCED (CA)	$278.15	$144.90
MODESTO (CA)	$278.15	$144.90
REDDING (CA)	$278.15	$144.90
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$281.40	$148.15
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$291.86	$150.46
SALINAS (CA)	$290.77	$149.86
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$348.57	$173.26
SANTA CRUZ-WATSONVILLE (CA)	$300.45	$152.73
SANTA ROSA-PETALUMA (CA)	$303.47	$154.17
STOCKTON (CA)	$278.15	$144.90
VISALIA (CA)	$278.15	$144.90
YUBA CITY (CA)	$278.15	$144.90
EL CENTRO (CA)	$278.20	$144.95
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$297.61	$152.20
SAN LUIS OBISPO-PASO ROBLES (CA)	$286.11	$147.63
SANTA MARIA-SANTA BARBARA (CA)	$291.86	$150.10
REST OF CALIFORNIA (CA)	$278.15	$144.90
COLORADO (CO)	$274.34	$144.98
CONNECTICUT (CT)	$281.60	$150.65
DC + MD/VA SUBURBS (DC)	$301.65	$158.43
DELAWARE (DE)	$260.98	$140.86
FORT LAUDERDALE (FL)	$274.37	$151.21
MIAMI (FL)	$286.77	$160.21
REST OF FLORIDA (FL)	$260.77	$144.54
ATLANTA (GA)	$269.05	$145.52
REST OF GEORGIA (GA)	$245.81	$137.36
HAWAII, GUAM (HI)	$285.00	$146.76
IOWA (IA)	$242.10	$130.85
IDAHO (ID)	$243.78	$131.93
EAST ST. LOUIS (IL)	$259.22	$147.37
SUBURBAN CHICAGO (IL)	$277.08	$152.22
CHICAGO (IL)	$278.25	$156.06
REST OF ILLINOIS (IL)	$253.41	$142.41
INDIANA (IN)	$245.21	$132.50
KANSAS (KS)	$241.13	$131.23
KENTUCKY (KY)	$242.48	$134.39
NEW ORLEANS (LA)	$254.31	$139.91
REST OF LOUISIANA (LA)	$242.17	$134.57
METROPOLITAN BOSTON (MA)	$301.48	$156.32
REST OF MASSACHUSETTS (MA)	$272.74	$144.72
BALTIMORE/SURR. CNTYS (MD)	$280.85	$150.40
REST OF MARYLAND (MD)	$265.95	$142.92
SOUTHERN MAINE (ME)	$258.50	$138.02
REST OF MAINE (ME)	$245.28	$133.42
DETROIT (MI)	$264.26	$146.94
REST OF MICHIGAN (MI)	$249.06	$138.06
MINNESOTA (MN)	$262.18	$137.07
METROPOLITAN ST. LOUIS (MO)	$255.01	$139.26
METROPOLITAN KANSAS CITY (MO)	$252.35	$138.19
REST OF MISSOURI (MO)	$238.07	$133.27
MISSISSIPPI (MS)	$235.53	$130.85
MONTANA** (MT)	$263.85	$142.27
NORTH CAROLINA (NC)	$247.85	$134.42
NORTH DAKOTA** (ND)	$257.92	$136.34
NEBRASKA (NE)	$243.39	$131.17
NEW HAMPSHIRE (NH)	$270.20	$143.64
NORTHERN NJ (NJ)	$298.49	$157.46
REST OF NEW JERSEY (NJ)	$284.62	$151.85
NEW MEXICO (NM)	$250.52	$139.03
NEVADA** (NV)	$262.38	$140.68
MANHATTAN (NY)	$304.12	$162.84
NYC SUBURBS/LONG ISLAND (NY)	$311.83	$167.27
POUGHKPSIE/N NYC SUBURBS (NY)	$286.65	$153.52
QUEENS (NY)	$306.38	$162.67
REST OF NEW YORK (NY)	$251.64	$136.14
OHIO (OH)	$247.85	$136.85
OKLAHOMA (OK)	$241.83	$133.26
PORTLAND (OR)	$282.94	$147.87
REST OF OREGON (OR)	$260.15	$139.06
METROPOLITAN PHILADELPHIA (PA)	$274.63	$148.06
REST OF PENNSYLVANIA (PA)	$248.14	$136.53
PUERTO RICO (PR)	$265.75	$142.84
RHODE ISLAND (RI)	$270.20	$144.61
SOUTH CAROLINA (SC)	$248.30	$135.96
SOUTH DAKOTA** (SD)	$257.21	$135.63
TENNESSEE (TN)	$242.39	$131.87
BRAZORIA (TX)	$260.55	$140.06
DALLAS (TX)	$262.32	$141.23
GALVESTON (TX)	$261.40	$140.67
HOUSTON (TX)	$266.89	$146.16
BEAUMONT (TX)	$246.50	$135.86
FORT WORTH (TX)	$260.60	$140.73
AUSTIN (TX)	$273.59	$144.96
REST OF TEXAS (TX)	$253.46	$138.08
UTAH (UT)	$251.74	$137.46
VIRGINIA (VA)	$257.78	$138.26
VIRGIN ISLANDS (VI)	$265.75	$142.84
VERMONT (VT)	$257.07	$136.70
SEATTLE (KING CNTY) (WA)	$307.48	$158.30
REST OF WASHINGTON (WA)	$272.17	$144.15
WISCONSIN (WI)	$249.16	$132.69
WEST VIRGINIA (WV)	$243.95	$138.29
WYOMING** (WY)	$261.26	$139.68

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units per patient per day — Date of Service Edit: Clinical. 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 for this code is based on three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ depending on whether the service is furnished in a non-facility setting (like a physician's office, where the practice absorbs more overhead) or a facility setting (like a hospital, where the facility bears more of the cost), which is why non-facility and facility amounts differ. The conversion factor and RVU values are updated annually and can change due to legislative or regulatory adjustments.

RVUs — work 2.06, practice expense 5.54 (non-facility) / 1.9 (facility), malpractice 0.3 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount 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 generally responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the final amount can vary significantly by geographic area.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The facility amount uses a lower practice-expense RVU because the facility (e.g., hospital) is assumed to bear more of the overhead cost, such as equipment and staff, compared to a non-facility setting like a physician's office.

Does this figure reflect what my practice will actually be paid?

No. This is a national or locality-adjusted estimate based on standard RVUs and the conversion factor. Actual payment depends on your specific locality GPCIs, any applicable modifiers, and other claim-specific adjustments.

Why might the conversion factor change year to year?

The conversion factor is updated annually by CMS based on statutory formulas, budget-neutrality requirements, and legislative action, so the allowed amount for the same code can shift from one year to the next.

Where can I find the official descriptor for CPT 21920?

CPT code descriptors are copyrighted by the American Medical Association. Refer to your licensed CPT codebook 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.