Is $1,413.17 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($1,130.54) and the patient owes 20% coinsurance ($282.63). Sequestration trims Medicare's share by about 2%, and your locality's GPCIs scale the total up or down. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay.

What's the non-participating amount for 34151?

$1,342.51 in the office setting—95% of the $1,413.17 participating fee schedule amount. A participating provider accepts the full amount as payment in full on every claim; a non-participating provider is paid this reduced amount but may choose, claim by claim, whether to accept assignment.

What's the limiting charge for 34151?

$1,543.89 in the office setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $1,413.17 Medicare amount. The non-participating amount is 95% of the fee schedule rate ($1,342.51), and the statutory cap is 115% of that.

Why would a Medicare claim for 34151 be denied or paid less?

These come from CMS indicators on this page, not general billing advice. 34151 carries a 90-day global period—routine post-operative care within that window is included in the surgical payment rather than paid on its own claim. Co-surgeons: payable with documentation. Team surgery: not permitted. Multiple procedures: standard reduction applies. Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

CPT 34151 Medicare rate in Q1 2021: $1,413.17

Office (non-facility) & facility

Historical · Q1 2021

$1,413.17

National (GPCI 1.000)

Facility-only: CMS developed no Office (non-facility) practice-expense RVUs for 34151 (NA indicator), so the file’s non-facility amount repeats the facility one.

$1,224.81–$1,881.72 across payment localities · Office (non-facility)

Participating physician · Before sequestration

Service-location ZIP

CMS evidence · Q1 2021 release

( Work26.52 × 1.000 + Practice exp.7.87 × 1.000 + Malpractice6.11 × 1.000 ) × Conv. factor$34.8931 = $1,413.17

row 8,614

F Work RVU

26.52

G Non‑facility PE RVU

7.87

K MP RVU

6.11

Y Conversion factor

34.8931

Nationally priced under PFS, using the RVU formula.

CMS RVU21AJanuary 1 – March 31, 2021

What changed in Q1 2021 Get alerts for this code Report a problem

The national PFS baseline was $1,413.17 for CPT 34151 in the Office (non-facility) setting and $1,413.17 in a facility under the Q1 2021 Physician Fee Schedule, effective January 2021. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Contract rate as % of Medicare Copy link

Applies to your locality's allowed amount, not the $1,413.17 national baseline. How to find your contract's percentage.

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Allowed amount, Medicare's share, and patient share Copy link

A physician's $1,413.17 Office (non-facility) allowed amount: Medicare pays $1,107.93 after sequestration and the patient owes $282.63, once the Part B deductible is met.

Office (non-facility) Facility

Adjust for your locality →

34151: allowed amount and each party's share by who bills it, Office (non-facility), national baseline
Billed by	Allowed amount	Participating claim		If not participating
Billed by	Allowed amount	What Medicare pays	Patient coinsurance	Non-participating amount	Limiting charge
Physician (MD/DO) 100% Calculator	$1,413.17	$1,107.93 $1,130.54 − $22.61	$282.63	$1,342.51	$1,543.89