Medicare Reimbursement for CPT 11920
CPT 11920 is a procedure code used for billing Medicare Part B services; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, presented nationally and adjustable by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $216.44 | $102.54 |
| ALASKA* (AK) | $248.51 | $127.21 |
| ALABAMA (AL) | $193.05 | $93.39 |
| ARKANSAS (AR) | $190.10 | $92.26 |
| ARIZONA (AZ) | $210.30 | $99.93 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $279.45 | $118.85 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $284.92 | $120.68 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $242.53 | $107.90 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $243.75 | $109.01 |
| NAPA (CA) | $264.32 | $114.20 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $279.76 | $119.17 |
| VALLEJO (CA) | $263.86 | $113.74 |
| BAKERSFIELD (CA) | $228.62 | $103.79 |
| CHICO (CA) | $227.84 | $103.00 |
| FRESNO (CA) | $227.84 | $103.00 |
| HANFORD-CORCORAN (CA) | $227.84 | $103.00 |
| MADERA (CA) | $227.84 | $103.00 |
| MERCED (CA) | $227.84 | $103.00 |
| MODESTO (CA) | $227.84 | $103.00 |
| REDDING (CA) | $227.84 | $103.00 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $230.85 | $106.02 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $239.19 | $106.73 |
| SALINAS (CA) | $238.31 | $106.31 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $286.22 | $121.98 |
| SANTA CRUZ-WATSONVILLE (CA) | $246.45 | $108.06 |
| SANTA ROSA-PETALUMA (CA) | $248.93 | $109.07 |
| STOCKTON (CA) | $227.84 | $103.00 |
| VISALIA (CA) | $227.84 | $103.00 |
| YUBA CITY (CA) | $227.84 | $103.00 |
| EL CENTRO (CA) | $227.88 | $103.05 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $244.04 | $107.82 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $234.49 | $104.76 |
| SANTA MARIA-SANTA BARBARA (CA) | $239.24 | $106.43 |
| REST OF CALIFORNIA (CA) | $227.84 | $103.00 |
| COLORADO (CO) | $224.92 | $103.73 |
| CONNECTICUT (CT) | $231.36 | $108.69 |
| DC + MD/VA SUBURBS (DC) | $247.85 | $113.68 |
| DELAWARE (DE) | $213.90 | $101.37 |
| FORT LAUDERDALE (FL) | $226.00 | $110.63 |
| MIAMI (FL) | $237.08 | $118.51 |
| REST OF FLORIDA (FL) | $214.34 | $105.45 |
| ATLANTA (GA) | $220.95 | $105.23 |
| REST OF GEORGIA (GA) | $201.53 | $99.94 |
| HAWAII, GUAM (HI) | $233.69 | $104.19 |
| IOWA (IA) | $197.65 | $93.44 |
| IDAHO (ID) | $199.14 | $94.35 |
| EAST ST. LOUIS (IL) | $213.55 | $108.76 |
| SUBURBAN CHICAGO (IL) | $228.20 | $111.23 |
| CHICAGO (IL) | $229.69 | $115.22 |
| REST OF ILLINOIS (IL) | $208.25 | $104.26 |
| INDIANA (IN) | $200.34 | $94.76 |
| KANSAS (KS) | $196.95 | $93.99 |
| KENTUCKY (KY) | $198.48 | $97.22 |
| NEW ORLEANS (LA) | $208.59 | $101.41 |
| REST OF LOUISIANA (LA) | $198.26 | $97.46 |
| METROPOLITAN BOSTON (MA) | $247.56 | $111.57 |
| REST OF MASSACHUSETTS (MA) | $223.57 | $103.64 |
| BALTIMORE/SURR. CNTYS (MD) | $230.78 | $108.57 |
| REST OF MARYLAND (MD) | $218.05 | $102.79 |
| SOUTHERN MAINE (ME) | $211.60 | $98.72 |
| REST OF MAINE (ME) | $200.53 | $95.75 |
| DETROIT (MI) | $217.44 | $107.53 |
| REST OF MICHIGAN (MI) | $204.19 | $100.20 |
| MINNESOTA (MN) | $214.34 | $97.14 |
| METROPOLITAN ST. LOUIS (MO) | $209.03 | $100.60 |
| METROPOLITAN KANSAS CITY (MO) | $206.79 | $99.84 |
| REST OF MISSOURI (MO) | $194.85 | $96.67 |
| MISSISSIPPI (MS) | $192.50 | $94.44 |
| MONTANA** (MT) | $216.42 | $102.52 |
| NORTH CAROLINA (NC) | $202.70 | $96.43 |
| NORTH DAKOTA** (ND) | $210.88 | $96.99 |
| NEBRASKA (NE) | $198.71 | $93.59 |
| NEW HAMPSHIRE (NH) | $221.61 | $103.04 |
| NORTHERN NJ (NJ) | $245.12 | $113.00 |
| REST OF NEW JERSEY (NJ) | $233.67 | $109.29 |
| NEW MEXICO (NM) | $205.48 | $101.04 |
| NEVADA** (NV) | $215.03 | $101.02 |
| MANHATTAN (NY) | $250.33 | $117.98 |
| NYC SUBURBS/LONG ISLAND (NY) | $257.04 | $121.61 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $235.45 | $110.74 |
| QUEENS (NY) | $252.07 | $117.45 |
| REST OF NEW YORK (NY) | $205.93 | $97.73 |
| OHIO (OH) | $203.06 | $99.07 |
| OKLAHOMA (OK) | $197.81 | $96.10 |
| PORTLAND (OR) | $232.05 | $105.51 |
| REST OF OREGON (OR) | $213.04 | $99.60 |
| METROPOLITAN PHILADELPHIA (PA) | $225.53 | $106.96 |
| REST OF PENNSYLVANIA (PA) | $203.24 | $98.68 |
| PUERTO RICO (PR) | $218.00 | $102.85 |
| RHODE ISLAND (RI) | $221.53 | $103.87 |
| SOUTH CAROLINA (SC) | $203.28 | $98.04 |
| SOUTH DAKOTA** (SD) | $210.23 | $96.33 |
| TENNESSEE (TN) | $198.03 | $94.50 |
| BRAZORIA (TX) | $213.41 | $100.54 |
| DALLAS (TX) | $214.96 | $101.52 |
| GALVESTON (TX) | $214.17 | $101.07 |
| HOUSTON (TX) | $219.29 | $106.19 |
| BEAUMONT (TX) | $201.86 | $98.21 |
| FORT WORTH (TX) | $213.54 | $101.24 |
| AUSTIN (TX) | $224.45 | $103.94 |
| REST OF TEXAS (TX) | $207.64 | $99.56 |
| UTAH (UT) | $206.21 | $99.14 |
| VIRGINIA (VA) | $211.06 | $99.10 |
| VIRGIN ISLANDS (VI) | $218.00 | $102.85 |
| VERMONT (VT) | $210.27 | $97.51 |
| SEATTLE (KING CNTY) (WA) | $252.45 | $112.70 |
| REST OF WASHINGTON (WA) | $223.08 | $103.15 |
| WISCONSIN (WI) | $203.47 | $94.36 |
| WEST VIRGINIA (WV) | $200.21 | $101.23 |
| WYOMING** (WY) | $214.01 | $100.11 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. 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 payment is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted using Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Conversion Factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, which is why the same code can have two different allowed amounts depending on where it's performed.
RVUs — work 1.57, practice expense 4.63 (non-facility) / 1.22 (facility), malpractice 0.28 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only, based on national averages and standard GPCI adjustments — actual payment varies by locality.
- Medicare typically pays 80% of the allowed amount after the patient meets the Part B deductible; the patient or secondary payer is responsible for the rest.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final payment.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the facility amount differ from the non-facility amount?
The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) is absorbing some overhead costs, while the non-facility rate reflects the full overhead of a physician office.
Will my locality's payment match the national amount shown?
Not necessarily. The national figure uses standard GPCI values; actual payment in your area depends on your specific locality's GPCI adjustments for work, practice expense, and malpractice.
Does this amount include the patient's share?
No. The allowed amount shown is the total Medicare-approved amount; Medicare generally pays 80% after the deductible, with the remainder billed to the patient or a secondary payer.
Can I use this figure to guarantee what I'll be paid?
No. This is an estimate for reference purposes only. Modifiers, claim edits, sequestration, and yearly fee schedule updates can all affect the final reimbursement.
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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