Medicare Reimbursement for CPT 21931

CPT 21931 is a physician procedure code identified by the American Medical Association; because CPT descriptors are proprietary, a description isn't shown here. This page presents the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code at the national level and by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$453.58	$453.58
ALASKA* (AK)	$552.06	$552.06
ALABAMA (AL)	$407.77	$407.77
ARKANSAS (AR)	$402.16	$402.16
ARIZONA (AZ)	$440.21	$440.21
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$514.34	$514.34
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$521.72	$521.72
OXNARD-THOUSAND OAKS-VENTURA (CA)	$470.63	$470.63
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$475.99	$475.99
NAPA (CA)	$495.76	$495.76
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$516.23	$516.23
VALLEJO (CA)	$493.05	$493.05
BAKERSFIELD (CA)	$452.87	$452.87
CHICO (CA)	$448.37	$448.37
FRESNO (CA)	$448.37	$448.37
HANFORD-CORCORAN (CA)	$448.37	$448.37
MADERA (CA)	$448.37	$448.37
MERCED (CA)	$448.37	$448.37
MODESTO (CA)	$448.37	$448.37
REDDING (CA)	$448.37	$448.37
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$466.17	$466.17
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$464.29	$464.29
SALINAS (CA)	$462.47	$462.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$529.43	$529.43
SANTA CRUZ-WATSONVILLE (CA)	$469.98	$469.98
SANTA ROSA-PETALUMA (CA)	$474.26	$474.26
STOCKTON (CA)	$448.37	$448.37
VISALIA (CA)	$448.37	$448.37
YUBA CITY (CA)	$448.37	$448.37
EL CENTRO (CA)	$448.65	$448.65
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$469.02	$469.02
SAN LUIS OBISPO-PASO ROBLES (CA)	$455.86	$455.86
SANTA MARIA-SANTA BARBARA (CA)	$463.02	$463.02
REST OF CALIFORNIA (CA)	$448.37	$448.37
COLORADO (CO)	$455.27	$455.27
CONNECTICUT (CT)	$483.11	$483.11
DC + MD/VA SUBURBS (DC)	$502.93	$502.93
DELAWARE (DE)	$447.02	$447.02
FORT LAUDERDALE (FL)	$500.65	$500.65
MIAMI (FL)	$545.50	$545.50
REST OF FLORIDA (FL)	$473.82	$473.82
ATLANTA (GA)	$468.19	$468.19
REST OF GEORGIA (GA)	$445.44	$445.44
HAWAII, GUAM (HI)	$454.08	$454.08
IOWA (IA)	$405.36	$405.36
IDAHO (ID)	$410.44	$410.44
EAST ST. LOUIS (IL)	$495.88	$495.88
SUBURBAN CHICAGO (IL)	$502.66	$502.66
CHICAGO (IL)	$527.83	$527.83
REST OF ILLINOIS (IL)	$469.66	$469.66
INDIANA (IN)	$412.38	$412.38
KANSAS (KS)	$409.38	$409.38
KENTUCKY (KY)	$429.56	$429.56
NEW ORLEANS (LA)	$450.86	$450.86
REST OF LOUISIANA (LA)	$431.24	$431.24
METROPOLITAN BOSTON (MA)	$490.43	$490.43
REST OF MASSACHUSETTS (MA)	$455.14	$455.14
BALTIMORE/SURR. CNTYS (MD)	$483.01	$483.01
REST OF MARYLAND (MD)	$453.37	$453.37
SOUTHERN MAINE (ME)	$431.56	$431.56
REST OF MAINE (ME)	$418.70	$418.70
DETROIT (MI)	$485.53	$485.53
REST OF MICHIGAN (MI)	$445.60	$445.60
MINNESOTA (MN)	$419.60	$419.60
METROPOLITAN ST. LOUIS (MO)	$445.34	$445.34
METROPOLITAN KANSAS CITY (MO)	$441.69	$441.69
REST OF MISSOURI (MO)	$428.13	$428.13
MISSISSIPPI (MS)	$414.92	$414.92
MONTANA** (MT)	$453.47	$453.47
NORTH CAROLINA (NC)	$421.91	$421.91
NORTH DAKOTA** (ND)	$420.65	$420.65
NEBRASKA (NE)	$405.70	$405.70
NEW HAMPSHIRE (NH)	$453.79	$453.79
NORTHERN NJ (NJ)	$499.32	$499.32
REST OF NEW JERSEY (NJ)	$483.94	$483.94
NEW MEXICO (NM)	$450.29	$450.29
NEVADA** (NV)	$444.50	$444.50
MANHATTAN (NY)	$528.61	$528.61
NYC SUBURBS/LONG ISLAND (NY)	$548.33	$548.33
POUGHKPSIE/N NYC SUBURBS (NY)	$491.84	$491.84
QUEENS (NY)	$524.11	$524.11
REST OF NEW YORK (NY)	$428.42	$428.42
OHIO (OH)	$438.89	$438.89
OKLAHOMA (OK)	$422.60	$422.60
PORTLAND (OR)	$462.29	$462.29
REST OF OREGON (OR)	$436.42	$436.42
METROPOLITAN PHILADELPHIA (PA)	$475.45	$475.45
REST OF PENNSYLVANIA (PA)	$436.27	$436.27
PUERTO RICO (PR)	$454.67	$454.67
RHODE ISLAND (RI)	$457.60	$457.60
SOUTH CAROLINA (SC)	$432.04	$432.04
SOUTH DAKOTA** (SD)	$416.77	$416.77
TENNESSEE (TN)	$412.08	$412.08
BRAZORIA (TX)	$441.61	$441.61
DALLAS (TX)	$447.03	$447.03
GALVESTON (TX)	$444.62	$444.62
HOUSTON (TX)	$475.01	$475.01
BEAUMONT (TX)	$433.99	$433.99
FORT WORTH (TX)	$446.01	$446.01
AUSTIN (TX)	$457.80	$457.80
REST OF TEXAS (TX)	$439.33	$439.33
UTAH (UT)	$437.49	$437.49
VIRGINIA (VA)	$434.32	$434.32
VIRGIN ISLANDS (VI)	$454.67	$454.67
VERMONT (VT)	$424.45	$424.45
SEATTLE (KING CNTY) (WA)	$494.15	$494.15
REST OF WASHINGTON (WA)	$452.47	$452.47
WISCONSIN (WI)	$407.91	$407.91
WEST VIRGINIA (WV)	$454.68	$454.68
WYOMING** (WY)	$439.17	$439.17

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 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 procedure code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs, since facility settings (like hospitals) typically have lower physician overhead costs than office settings; when these RVUs match, the resulting allowed amounts are the same.

RVUs — work 6.71, practice expense 5.21 (non-facility) / 5.21 (facility), malpractice 1.66 — × 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 remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final payment.
Amounts vary by locality due to GPCI differences; always confirm current rates with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the allowed amount differ by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs) for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost-of-living and practice cost differences before the conversion factor is applied.

Why are the non-facility and facility amounts the same for this code?

When the practice-expense RVU is identical in both non-facility and facility settings, the calculated allowed amount is the same regardless of place of service.

Is this the amount my practice will actually be paid?

No. This is an estimated PFS allowed amount. Actual payment depends on the patient's deductible status, applicable modifiers, secondary payer rules, and any sequestration or budget-neutrality adjustments in effect.

Where can I verify the official rate for my area?

Contact your Medicare Administrative Contractor (MAC) or consult the current CMS Physician Fee Schedule lookup tool for your specific locality.

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.