Medicare Reimbursement for CPT 12020

CPT 12020 is a physician procedure code reimbursed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount at the national level and, where available, by locality, with separate figures for non-facility and facility settings. Because CPT descriptors are proprietary to the AMA, this page does not reproduce the official code description.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$316.64	$178.69
ALASKA* (AK)	$367.62	$220.70
ALABAMA (AL)	$283.48	$162.78
ARKANSAS (AR)	$279.30	$160.80
ARIZONA (AZ)	$307.89	$174.22
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$404.96	$210.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$412.76	$213.84
OXNARD-THOUSAND OAKS-VENTURA (CA)	$352.87	$189.81
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$354.80	$191.61
NAPA (CA)	$383.55	$201.74
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$405.45	$210.95
VALLEJO (CA)	$382.85	$201.04
BAKERSFIELD (CA)	$333.36	$182.17
CHICO (CA)	$332.13	$180.95
FRESNO (CA)	$332.13	$180.95
HANFORD-CORCORAN (CA)	$332.13	$180.95
MADERA (CA)	$332.13	$180.95
MERCED (CA)	$332.13	$180.95
MODESTO (CA)	$332.13	$180.95
REDDING (CA)	$332.13	$180.95
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$336.77	$185.59
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$348.22	$187.79
SALINAS (CA)	$346.92	$187.04
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$414.75	$215.83
SANTA CRUZ-WATSONVILLE (CA)	$358.12	$190.51
SANTA ROSA-PETALUMA (CA)	$361.70	$192.30
STOCKTON (CA)	$332.13	$180.95
VISALIA (CA)	$332.13	$180.95
YUBA CITY (CA)	$332.13	$180.95
EL CENTRO (CA)	$332.21	$181.02
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$354.89	$189.91
SAN LUIS OBISPO-PASO ROBLES (CA)	$341.40	$184.28
SANTA MARIA-SANTA BARBARA (CA)	$348.17	$187.33
REST OF CALIFORNIA (CA)	$332.13	$180.95
COLORADO (CO)	$328.33	$181.55
CONNECTICUT (CT)	$337.98	$189.41
DC + MD/VA SUBURBS (DC)	$361.30	$198.80
DELAWARE (DE)	$313.04	$176.75
FORT LAUDERDALE (FL)	$331.05	$191.31
MIAMI (FL)	$347.43	$203.83
REST OF FLORIDA (FL)	$314.39	$182.51
ATLANTA (GA)	$323.23	$183.08
REST OF GEORGIA (GA)	$296.13	$173.08
HAWAII, GUAM (HI)	$340.11	$183.26
IOWA (IA)	$289.67	$163.45
IDAHO (ID)	$291.84	$164.93
EAST ST. LOUIS (IL)	$313.97	$187.06
SUBURBAN CHICAGO (IL)	$334.15	$192.48
CHICAGO (IL)	$336.92	$198.29
REST OF ILLINOIS (IL)	$305.98	$180.04
INDIANA (IN)	$293.53	$165.66
KANSAS (KS)	$288.83	$164.13
KENTUCKY (KY)	$291.51	$168.87
NEW ORLEANS (LA)	$305.88	$176.08
REST OF LOUISIANA (LA)	$291.26	$169.18
METROPOLITAN BOSTON (MA)	$360.42	$195.71
REST OF MASSACHUSETTS (MA)	$326.53	$181.28
BALTIMORE/SURR. CNTYS (MD)	$337.16	$189.14
REST OF MARYLAND (MD)	$318.92	$179.32
SOUTHERN MAINE (ME)	$309.40	$172.70
REST OF MAINE (ME)	$293.98	$167.07
DETROIT (MI)	$318.95	$185.84
REST OF MICHIGAN (MI)	$299.75	$173.81
MINNESOTA (MN)	$312.78	$170.83
METROPOLITAN ST. LOUIS (MO)	$306.33	$175.00
METROPOLITAN KANSAS CITY (MO)	$303.17	$173.64
REST OF MISSOURI (MO)	$286.54	$167.63
MISSISSIPPI (MS)	$282.95	$164.18
MONTANA** (MT)	$316.61	$178.67
NORTH CAROLINA (NC)	$297.02	$168.32
NORTH DAKOTA** (ND)	$308.11	$170.16
NEBRASKA (NE)	$291.12	$163.79
NEW HAMPSHIRE (NH)	$323.68	$180.08
NORTHERN NJ (NJ)	$357.56	$197.54
REST OF NEW JERSEY (NJ)	$341.33	$190.69
NEW MEXICO (NM)	$301.65	$175.15
NEVADA** (NV)	$314.46	$176.37
MANHATTAN (NY)	$365.52	$205.22
NYC SUBURBS/LONG ISLAND (NY)	$375.22	$211.21
POUGHKPSIE/N NYC SUBURBS (NY)	$344.03	$192.98
QUEENS (NY)	$367.76	$204.70
REST OF NEW YORK (NY)	$301.60	$170.55
OHIO (OH)	$298.01	$172.07
OKLAHOMA (OK)	$290.39	$167.20
PORTLAND (OR)	$338.27	$185.01
REST OF OREGON (OR)	$311.51	$174.12
METROPOLITAN PHILADELPHIA (PA)	$329.81	$186.21
REST OF PENNSYLVANIA (PA)	$298.18	$171.55
PUERTO RICO (PR)	$318.79	$179.33
RHODE ISLAND (RI)	$323.85	$181.35
SOUTH CAROLINA (SC)	$298.11	$170.65
SOUTH DAKOTA** (SD)	$307.10	$169.16
TENNESSEE (TN)	$290.39	$164.99
BRAZORIA (TX)	$312.24	$175.53
DALLAS (TX)	$314.52	$177.13
GALVESTON (TX)	$313.36	$176.38
HOUSTON (TX)	$321.23	$184.25
BEAUMONT (TX)	$296.23	$170.70
FORT WORTH (TX)	$312.55	$176.54
AUSTIN (TX)	$327.67	$181.73
REST OF TEXAS (TX)	$304.26	$173.35
UTAH (UT)	$302.25	$172.58
VIRGINIA (VA)	$308.76	$173.15
VIRGIN ISLANDS (VI)	$318.79	$179.33
VERMONT (VT)	$307.39	$170.82
SEATTLE (KING CNTY) (WA)	$367.26	$198.00
REST OF WASHINGTON (WA)	$325.75	$180.50
WISCONSIN (WI)	$297.65	$165.50
WEST VIRGINIA (WV)	$294.61	$174.73
WYOMING** (WY)	$312.91	$174.96

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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

Each CPT code is assigned three Relative Value Units (RVUs) — work, practice expense (PE), and malpractice (MP) — that reflect physician effort, overhead costs, and liability risk. These RVUs are each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different PE RVUs because overhead costs differ, which is why two separate allowed amounts are shown. The conversion factor and RVU values are updated annually and can shift due to budget-neutrality adjustments mandated by CMS.

RVUs — work 2.6, practice expense 6.45 (non-facility) / 2.32 (facility), malpractice 0.43 — × 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 deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, claim-specific adjustments, and annual sequestration or budget-neutrality changes.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility amount lower than the non-facility amount?

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) — not the billing physician — is absorbing certain overhead and equipment costs.

Does this amount reflect what my specific locality will be paid?

No — the national amount is a baseline. Actual payment depends on the GPCI values for the specific locality where the service was rendered, which can raise or lower the final amount.

Why did this amount change from a previous year?

Annual updates to RVUs, GPCIs, and the conversion factor, along with CMS budget-neutrality adjustments, can change the allowed amount year over year even if the code itself hasn't changed.

Can modifiers affect this amount?

Yes — modifiers (e.g., bilateral, multiple procedure, or professional/technical component splits) can increase or decrease the final allowed amount relative to the base PFS rate shown here.

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.