Medicare Reimbursement for CPT 21936
CPT code 21936 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $1307.98 | $1307.98 |
| ALASKA* (AK) | $1622.71 | $1622.71 |
| ALABAMA (AL) | $1182.31 | $1182.31 |
| ARKANSAS (AR) | $1167.02 | $1167.02 |
| ARIZONA (AZ) | $1270.46 | $1270.46 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1440.82 | $1440.82 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1459.71 | $1459.71 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1335.27 | $1335.27 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1352.38 | $1352.38 |
| NAPA (CA) | $1395.13 | $1395.13 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1446.76 | $1446.76 |
| VALLEJO (CA) | $1386.57 | $1386.57 |
| BAKERSFIELD (CA) | $1291.92 | $1291.92 |
| CHICO (CA) | $1277.70 | $1277.70 |
| FRESNO (CA) | $1277.70 | $1277.70 |
| HANFORD-CORCORAN (CA) | $1277.70 | $1277.70 |
| MADERA (CA) | $1277.70 | $1277.70 |
| MERCED (CA) | $1277.70 | $1277.70 |
| MODESTO (CA) | $1277.70 | $1277.70 |
| REDDING (CA) | $1277.70 | $1277.70 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $1333.81 | $1333.81 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1318.37 | $1318.37 |
| SALINAS (CA) | $1313.10 | $1313.10 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1483.99 | $1483.99 |
| SANTA CRUZ-WATSONVILLE (CA) | $1328.09 | $1328.09 |
| SANTA ROSA-PETALUMA (CA) | $1339.89 | $1339.89 |
| STOCKTON (CA) | $1277.70 | $1277.70 |
| VISALIA (CA) | $1277.70 | $1277.70 |
| YUBA CITY (CA) | $1277.70 | $1277.70 |
| EL CENTRO (CA) | $1278.57 | $1278.57 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1328.17 | $1328.17 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $1294.85 | $1294.85 |
| SANTA MARIA-SANTA BARBARA (CA) | $1313.69 | $1313.69 |
| REST OF CALIFORNIA (CA) | $1277.70 | $1277.70 |
| COLORADO (CO) | $1304.06 | $1304.06 |
| CONNECTICUT (CT) | $1390.06 | $1390.06 |
| DC + MD/VA SUBURBS (DC) | $1438.37 | $1438.37 |
| DELAWARE (DE) | $1289.22 | $1289.22 |
| FORT LAUDERDALE (FL) | $1454.31 | $1454.31 |
| MIAMI (FL) | $1591.43 | $1591.43 |
| REST OF FLORIDA (FL) | $1378.30 | $1378.30 |
| ATLANTA (GA) | $1351.68 | $1351.68 |
| REST OF GEORGIA (GA) | $1298.45 | $1298.45 |
| HAWAII, GUAM (HI) | $1289.07 | $1289.07 |
| IOWA (IA) | $1168.74 | $1168.74 |
| IDAHO (ID) | $1184.01 | $1184.01 |
| EAST ST. LOUIS (IL) | $1453.21 | $1453.21 |
| SUBURBAN CHICAGO (IL) | $1458.75 | $1458.75 |
| CHICAGO (IL) | $1541.33 | $1541.33 |
| REST OF ILLINOIS (IL) | $1371.63 | $1371.63 |
| INDIANA (IN) | $1189.08 | $1189.08 |
| KANSAS (KS) | $1183.05 | $1183.05 |
| KENTUCKY (KY) | $1248.86 | $1248.86 |
| NEW ORLEANS (LA) | $1308.21 | $1308.21 |
| REST OF LOUISIANA (LA) | $1254.78 | $1254.78 |
| METROPOLITAN BOSTON (MA) | $1396.25 | $1396.25 |
| REST OF MASSACHUSETTS (MA) | $1305.41 | $1305.41 |
| BALTIMORE/SURR. CNTYS (MD) | $1390.24 | $1390.24 |
| REST OF MARYLAND (MD) | $1305.79 | $1305.79 |
| SOUTHERN MAINE (ME) | $1239.93 | $1239.93 |
| REST OF MAINE (ME) | $1210.04 | $1210.04 |
| DETROIT (MI) | $1413.86 | $1413.86 |
| REST OF MICHIGAN (MI) | $1295.82 | $1295.82 |
| MINNESOTA (MN) | $1196.57 | $1196.57 |
| METROPOLITAN ST. LOUIS (MO) | $1289.19 | $1289.19 |
| METROPOLITAN KANSAS CITY (MO) | $1279.63 | $1279.63 |
| REST OF MISSOURI (MO) | $1248.40 | $1248.40 |
| MISSISSIPPI (MS) | $1206.95 | $1206.95 |
| MONTANA** (MT) | $1307.63 | $1307.63 |
| NORTH CAROLINA (NC) | $1218.20 | $1218.20 |
| NORTH DAKOTA** (ND) | $1204.22 | $1204.22 |
| NEBRASKA (NE) | $1168.62 | $1168.62 |
| NEW HAMPSHIRE (NH) | $1302.49 | $1302.49 |
| NORTHERN NJ (NJ) | $1429.94 | $1429.94 |
| REST OF NEW JERSEY (NJ) | $1390.99 | $1390.99 |
| NEW MEXICO (NM) | $1309.99 | $1309.99 |
| NEVADA** (NV) | $1279.21 | $1279.21 |
| MANHATTAN (NY) | $1521.96 | $1521.96 |
| NYC SUBURBS/LONG ISLAND (NY) | $1580.07 | $1580.07 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1415.60 | $1415.60 |
| QUEENS (NY) | $1504.78 | $1504.78 |
| REST OF NEW YORK (NY) | $1236.16 | $1236.16 |
| OHIO (OH) | $1274.68 | $1274.68 |
| OKLAHOMA (OK) | $1226.35 | $1226.35 |
| PORTLAND (OR) | $1319.28 | $1319.28 |
| REST OF OREGON (OR) | $1254.50 | $1254.50 |
| METROPOLITAN PHILADELPHIA (PA) | $1371.27 | $1371.27 |
| REST OF PENNSYLVANIA (PA) | $1265.67 | $1265.67 |
| PUERTO RICO (PR) | $1309.75 | $1309.75 |
| RHODE ISLAND (RI) | $1316.23 | $1316.23 |
| SOUTH CAROLINA (SC) | $1251.47 | $1251.47 |
| SOUTH DAKOTA** (SD) | $1191.99 | $1191.99 |
| TENNESSEE (TN) | $1190.81 | $1190.81 |
| BRAZORIA (TX) | $1271.83 | $1271.83 |
| DALLAS (TX) | $1288.19 | $1288.19 |
| GALVESTON (TX) | $1281.02 | $1281.02 |
| HOUSTON (TX) | $1376.75 | $1376.75 |
| BEAUMONT (TX) | $1259.68 | $1259.68 |
| FORT WORTH (TX) | $1286.47 | $1286.47 |
| AUSTIN (TX) | $1312.66 | $1312.66 |
| REST OF TEXAS (TX) | $1270.70 | $1270.70 |
| UTAH (UT) | $1266.23 | $1266.23 |
| VIRGINIA (VA) | $1249.84 | $1249.84 |
| VIRGIN ISLANDS (VI) | $1309.75 | $1309.75 |
| VERMONT (VT) | $1217.70 | $1217.70 |
| SEATTLE (KING CNTY) (WA) | $1403.26 | $1403.26 |
| REST OF WASHINGTON (WA) | $1296.91 | $1296.91 |
| WISCONSIN (WI) | $1170.35 | $1170.35 |
| WEST VIRGINIA (WV) | $1331.03 | $1331.03 |
| WYOMING** (WY) | $1262.56 | $1262.56 |
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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) — 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, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why two allowed amounts are typically shown. This same formula is applied nationally and locally, so the base RVUs stay constant while the GPCI adjustment changes the final figure by location.
RVUs — work 21.99, practice expense 11.94 (non-facility) / 11.94 (facility), malpractice 5.23 — × 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 beneficiary or secondary payer is responsible for the remainder.
- Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
- Locality-specific GPCIs mean the real-world payment may differ from the national figure.
- Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC).
Frequently asked
Why are the non-facility and facility amounts the same for this code?
When the practice expense RVUs are identical for both settings, the resulting allowed amounts will match. This can happen for procedures where Medicare does not differentiate overhead costs by site of service.
Why does the Medicare payment differ by location?
Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs to reflect regional cost differences, so the same code can have different allowed amounts in different localities.
Does this amount reflect what I'll actually be paid?
Not necessarily. The figure here is an estimate based on standard RVUs and GPCIs; actual payment can be affected by modifiers, secondary payers, sequestration, and annual fee schedule updates.
Where can I find the official CPT descriptor for this code?
CPT code descriptors are copyrighted by the American Medical Association. Refer to your AMA CPT codebook or licensed coding software for the exact 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.
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