Medicare Reimbursement for CPT 21930

CPT 21930 is a surgical procedure code; this page does not include the official AMA descriptor. It shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level 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)	$540.76	$351.38
ALASKA* (AK)	$627.57	$425.88
ALABAMA (AL)	$482.25	$316.54
ARKANSAS (AR)	$474.92	$312.24
ARIZONA (AZ)	$524.95	$341.44
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$676.56	$409.53
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$688.98	$415.89
OXNARD-THOUSAND OAKS-VENTURA (CA)	$594.41	$370.56
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$598.31	$374.27
NAPA (CA)	$642.72	$393.11
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$677.77	$410.74
VALLEJO (CA)	$640.97	$391.36
BAKERSFIELD (CA)	$562.87	$355.31
CHICO (CA)	$559.94	$352.38
FRESNO (CA)	$559.94	$352.38
HANFORD-CORCORAN (CA)	$559.94	$352.38
MADERA (CA)	$559.94	$352.38
MERCED (CA)	$559.94	$352.38
MODESTO (CA)	$559.94	$352.38
REDDING (CA)	$559.94	$352.38
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$571.43	$363.87
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$586.05	$365.80
SALINAS (CA)	$583.87	$364.37
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$693.95	$420.86
SANTA CRUZ-WATSONVILLE (CA)	$601.52	$371.42
SANTA ROSA-PETALUMA (CA)	$607.45	$374.88
STOCKTON (CA)	$559.94	$352.38
VISALIA (CA)	$559.94	$352.38
YUBA CITY (CA)	$559.94	$352.38
EL CENTRO (CA)	$560.12	$352.56
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$596.65	$370.15
SAN LUIS OBISPO-PASO ROBLES (CA)	$574.73	$359.03
SANTA MARIA-SANTA BARBARA (CA)	$585.79	$364.97
REST OF CALIFORNIA (CA)	$559.94	$352.38
COLORADO (CO)	$556.88	$355.38
CONNECTICUT (CT)	$577.98	$374.01
DC + MD/VA SUBURBS (DC)	$614.73	$391.64
DELAWARE (DE)	$533.83	$346.72
FORT LAUDERDALE (FL)	$574.11	$382.26
MIAMI (FL)	$609.51	$412.36
REST OF FLORIDA (FL)	$543.60	$362.55
ATLANTA (GA)	$553.93	$361.52
REST OF GEORGIA (GA)	$510.47	$341.54
HAWAII, GUAM (HI)	$572.85	$357.52
IOWA (IA)	$489.97	$316.68
IDAHO (ID)	$494.40	$320.17
EAST ST. LOUIS (IL)	$549.48	$375.25
SUBURBAN CHICAGO (IL)	$578.77	$384.27
CHICAGO (IL)	$589.89	$399.56
REST OF ILLINOIS (IL)	$530.95	$358.04
INDIANA (IN)	$497.28	$321.72
KANSAS (KS)	$490.01	$318.80
KENTUCKY (KY)	$499.54	$331.17
NEW ORLEANS (LA)	$525.32	$347.11
REST OF LOUISIANA (LA)	$499.70	$332.09
METROPOLITAN BOSTON (MA)	$610.17	$384.05
REST OF MASSACHUSETTS (MA)	$554.31	$354.89
BALTIMORE/SURR. CNTYS (MD)	$576.92	$373.71
REST OF MARYLAND (MD)	$543.57	$351.91
SOUTHERN MAINE (ME)	$524.48	$336.80
REST OF MAINE (ME)	$499.73	$325.50
DETROIT (MI)	$553.24	$370.48
REST OF MICHIGAN (MI)	$515.44	$342.53
MINNESOTA (MN)	$525.58	$330.70
METROPOLITAN ST. LOUIS (MO)	$524.32	$344.03
METROPOLITAN KANSAS CITY (MO)	$518.95	$341.12
REST OF MISSOURI (MO)	$492.36	$329.11
MISSISSIPPI (MS)	$483.61	$320.55
MONTANA** (MT)	$540.69	$351.31
NORTH CAROLINA (NC)	$504.81	$328.11
NORTH DAKOTA** (ND)	$519.53	$330.15
NEBRASKA (NE)	$492.04	$317.24
NEW HAMPSHIRE (NH)	$550.40	$353.25
NORTHERN NJ (NJ)	$608.38	$388.69
REST OF NEW JERSEY (NJ)	$582.32	$375.51
NEW MEXICO (NM)	$519.39	$345.73
NEVADA** (NV)	$535.14	$345.56
MANHATTAN (NY)	$627.74	$407.68
NYC SUBURBS/LONG ISLAND (NY)	$646.71	$421.54
POUGHKPSIE/N NYC SUBURBS (NY)	$588.19	$380.82
QUEENS (NY)	$629.47	$405.62
REST OF NEW YORK (NY)	$512.94	$333.03
OHIO (OH)	$511.12	$338.21
OKLAHOMA (OK)	$495.98	$326.86
PORTLAND (OR)	$572.37	$361.97
REST OF OREGON (OR)	$528.77	$340.14
METROPOLITAN PHILADELPHIA (PA)	$564.66	$367.51
REST OF PENNSYLVANIA (PA)	$510.58	$336.73
PUERTO RICO (PR)	$544.01	$352.54
RHODE ISLAND (RI)	$551.31	$355.68
SOUTH CAROLINA (SC)	$509.25	$334.26
SOUTH DAKOTA** (SD)	$517.03	$327.65
TENNESSEE (TN)	$492.91	$320.76
BRAZORIA (TX)	$531.09	$343.41
DALLAS (TX)	$535.76	$347.13
GALVESTON (TX)	$533.49	$345.44
HOUSTON (TX)	$553.08	$365.02
BEAUMONT (TX)	$507.26	$334.92
FORT WORTH (TX)	$532.78	$346.05
AUSTIN (TX)	$556.96	$356.59
REST OF TEXAS (TX)	$519.75	$340.02
UTAH (UT)	$516.47	$338.45
VIRGINIA (VA)	$524.40	$338.24
VIRGIN ISLANDS (VI)	$544.01	$352.54
VERMONT (VT)	$519.67	$332.18
SEATTLE (KING CNTY) (WA)	$620.36	$387.99
REST OF WASHINGTON (WA)	$552.55	$353.13
WISCONSIN (WI)	$501.58	$320.15
WEST VIRGINIA (WV)	$511.10	$346.52
WYOMING** (WY)	$531.47	$342.09

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 5 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 PFS amounts are built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because practice-expense RVUs are lower in facility settings, where the facility itself bills separately for overhead.

RVUs — work 4.82, practice expense 10.3 (non-facility) / 4.63 (facility), malpractice 1.07 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the rest.
Actual payment can vary by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why isn't the CPT code description shown?

CPT descriptors are copyrighted by the American Medical Association and licensed separately, so this page refers to the code generically rather than reproducing the official text.

Why is the facility amount lower than the non-facility amount?

In facility settings, the facility bills Medicare separately for overhead and resources, so the practice-expense RVU used for the physician's payment is reduced compared to non-facility settings.

Does this amount reflect what the patient will pay?

No. The figure shown is the Medicare-allowed amount. Patients typically owe any unmet deductible plus 20% coinsurance, unless supplemental coverage applies.

Will this amount change next year?

Yes. RVUs, GPCIs, and the conversion factor are updated annually, and budget-neutrality adjustments or legislative changes can alter the final payment.

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.