Medicare Reimbursement for CPT 21935

CPT 21935 is a surgical procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for 2026, both nationally and adjusted for locality, and compares non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$955.93	$955.93
ALASKA* (AK)	$1178.83	$1178.83
ALABAMA (AL)	$863.19	$863.19
ARKANSAS (AR)	$851.87	$851.87
ARIZONA (AZ)	$928.55	$928.55
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1067.81	$1067.81
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1082.46	$1082.46
OXNARD-THOUSAND OAKS-VENTURA (CA)	$983.66	$983.66
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$995.58	$995.58
NAPA (CA)	$1031.68	$1031.68
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1071.91	$1071.91
VALLEJO (CA)	$1025.78	$1025.78
BAKERSFIELD (CA)	$949.56	$949.56
CHICO (CA)	$939.73	$939.73
FRESNO (CA)	$939.73	$939.73
HANFORD-CORCORAN (CA)	$939.73	$939.73
MADERA (CA)	$939.73	$939.73
MERCED (CA)	$939.73	$939.73
MODESTO (CA)	$939.73	$939.73
REDDING (CA)	$939.73	$939.73
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$978.46	$978.46
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$971.12	$971.12
SALINAS (CA)	$967.27	$967.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1099.22	$1099.22
SANTA CRUZ-WATSONVILLE (CA)	$980.25	$980.25
SANTA ROSA-PETALUMA (CA)	$989.06	$989.06
STOCKTON (CA)	$939.73	$939.73
VISALIA (CA)	$939.73	$939.73
YUBA CITY (CA)	$939.73	$939.73
EL CENTRO (CA)	$940.33	$940.33
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$979.44	$979.44
SAN LUIS OBISPO-PASO ROBLES (CA)	$953.63	$953.63
SANTA MARIA-SANTA BARBARA (CA)	$967.99	$967.99
REST OF CALIFORNIA (CA)	$939.73	$939.73
COLORADO (CO)	$956.36	$956.36
CONNECTICUT (CT)	$1016.39	$1016.39
DC + MD/VA SUBURBS (DC)	$1054.76	$1054.76
DELAWARE (DE)	$942.44	$942.44
FORT LAUDERDALE (FL)	$1057.56	$1057.56
MIAMI (FL)	$1153.55	$1153.55
REST OF FLORIDA (FL)	$1002.36	$1002.36
ATLANTA (GA)	$986.88	$986.88
REST OF GEORGIA (GA)	$944.17	$944.17
HAWAII, GUAM (HI)	$949.47	$949.47
IOWA (IA)	$855.74	$855.74
IDAHO (ID)	$866.52	$866.52
EAST ST. LOUIS (IL)	$1052.33	$1052.33
SUBURBAN CHICAGO (IL)	$1061.33	$1061.33
CHICAGO (IL)	$1117.28	$1117.28
REST OF ILLINOIS (IL)	$995.69	$995.69
INDIANA (IN)	$870.35	$870.35
KANSAS (KS)	$865.09	$865.09
KENTUCKY (KY)	$909.80	$909.80
NEW ORLEANS (LA)	$953.26	$953.26
REST OF LOUISIANA (LA)	$913.69	$913.69
METROPOLITAN BOSTON (MA)	$1026.39	$1026.39
REST OF MASSACHUSETTS (MA)	$956.79	$956.79
BALTIMORE/SURR. CNTYS (MD)	$1016.31	$1016.31
REST OF MARYLAND (MD)	$955.05	$955.05
SOUTHERN MAINE (ME)	$908.53	$908.53
REST OF MAINE (ME)	$884.49	$884.49
DETROIT (MI)	$1027.33	$1027.33
REST OF MICHIGAN (MI)	$943.36	$943.36
MINNESOTA (MN)	$880.42	$880.42
METROPOLITAN ST. LOUIS (MO)	$940.66	$940.66
METROPOLITAN KANSAS CITY (MO)	$933.44	$933.44
REST OF MISSOURI (MO)	$908.18	$908.18
MISSISSIPPI (MS)	$879.52	$879.52
MONTANA** (MT)	$955.69	$955.69
NORTH CAROLINA (NC)	$890.74	$890.74
NORTH DAKOTA** (ND)	$884.31	$884.31
NEBRASKA (NE)	$856.04	$856.04
NEW HAMPSHIRE (NH)	$954.12	$954.12
NORTHERN NJ (NJ)	$1048.12	$1048.12
REST OF NEW JERSEY (NJ)	$1017.86	$1017.86
NEW MEXICO (NM)	$953.33	$953.33
NEVADA** (NV)	$936.12	$936.12
MANHATTAN (NY)	$1111.74	$1111.74
NYC SUBURBS/LONG ISLAND (NY)	$1153.15	$1153.15
POUGHKPSIE/N NYC SUBURBS (NY)	$1035.01	$1035.01
QUEENS (NY)	$1100.84	$1100.84
REST OF NEW YORK (NY)	$903.96	$903.96
OHIO (OH)	$928.77	$928.77
OKLAHOMA (OK)	$894.45	$894.45
PORTLAND (OR)	$969.15	$969.15
REST OF OREGON (OR)	$918.83	$918.83
METROPOLITAN PHILADELPHIA (PA)	$1001.68	$1001.68
REST OF PENNSYLVANIA (PA)	$922.79	$922.79
PUERTO RICO (PR)	$957.68	$957.68
RHODE ISLAND (RI)	$963.31	$963.31
SOUTH CAROLINA (SC)	$913.27	$913.27
SOUTH DAKOTA** (SD)	$875.87	$875.87
TENNESSEE (TN)	$870.68	$870.68
BRAZORIA (TX)	$930.59	$930.59
DALLAS (TX)	$942.13	$942.13
GALVESTON (TX)	$937.03	$937.03
HOUSTON (TX)	$1003.10	$1003.10
BEAUMONT (TX)	$918.27	$918.27
FORT WORTH (TX)	$940.46	$940.46
AUSTIN (TX)	$961.96	$961.96
REST OF TEXAS (TX)	$927.75	$927.75
UTAH (UT)	$924.24	$924.24
VIRGINIA (VA)	$914.99	$914.99
VIRGIN ISLANDS (VI)	$957.68	$957.68
VERMONT (VT)	$893.14	$893.14
SEATTLE (KING CNTY) (WA)	$1032.86	$1032.86
REST OF WASHINGTON (WA)	$950.91	$950.91
WISCONSIN (WI)	$858.91	$858.91
WEST VIRGINIA (WV)	$965.55	$965.55
WYOMING** (WY)	$924.58	$924.58

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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: 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's PFS amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. The practice-expense RVU often differs between non-facility (e.g., physician office) and facility (e.g., hospital or ASC) settings because overhead costs differ; for some codes, including this one, the practice-expense RVU is the same in both settings, so the non-facility and facility allowed amounts are equal.

RVUs — work 15.33, practice expense 9.68 (non-facility) / 9.68 (facility), malpractice 3.61 — × 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 reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Local Medicare Administrative Contractor (MAC) policies and locality-specific GPCIs can cause the actual payment to differ from the national figure.
Always verify current-year rates and coverage rules with your MAC before billing or appealing a denial.

Frequently asked

Why does the allowed amount change by locality?

Each locality has its own GPCI values for work, practice expense, and malpractice, reflecting regional cost differences. These multipliers are applied to the RVUs before the conversion factor, so the same code can price differently across the country.

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

The allowed amount differs between settings only when the practice-expense RVU differs. For CPT 21935, the practice-expense RVU is identical in both non-facility and facility settings, so the calculated amounts match.

Is this the amount the patient or payer will actually pay?

No. This figure is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% after the deductible, and modifiers, denials, or secondary insurance can further change the final payment.

Will this amount change next year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can shift payments even when RVUs stay the same.

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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.