Medicare Reimbursement for CPT 16020

CPT 16020 is a procedure code reported to Medicare for physician and outpatient services; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$92.85	$54.44
ALASKA* (AK)	$106.86	$65.95
ALABAMA (AL)	$82.89	$49.28
ARKANSAS (AR)	$81.63	$48.64
ARIZONA (AZ)	$90.24	$53.02
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$119.72	$65.56
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$122.06	$66.67
OXNARD-THOUSAND OAKS-VENTURA (CA)	$103.96	$58.56
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$104.49	$59.05
NAPA (CA)	$113.26	$62.63
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$119.85	$65.69
VALLEJO (CA)	$113.06	$62.44
BAKERSFIELD (CA)	$98.04	$55.94
CHICO (CA)	$97.70	$55.60
FRESNO (CA)	$97.70	$55.60
HANFORD-CORCORAN (CA)	$97.70	$55.60
MADERA (CA)	$97.70	$55.60
MERCED (CA)	$97.70	$55.60
MODESTO (CA)	$97.70	$55.60
REDDING (CA)	$97.70	$55.60
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$99.00	$56.90
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$102.55	$57.88
SALINAS (CA)	$102.17	$57.65
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$122.61	$67.22
SANTA CRUZ-WATSONVILLE (CA)	$105.63	$58.96
SANTA ROSA-PETALUMA (CA)	$106.69	$59.52
STOCKTON (CA)	$97.70	$55.60
VISALIA (CA)	$97.70	$55.60
YUBA CITY (CA)	$97.70	$55.60
EL CENTRO (CA)	$97.72	$55.62
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$104.61	$58.67
SAN LUIS OBISPO-PASO ROBLES (CA)	$100.53	$56.78
SANTA MARIA-SANTA BARBARA (CA)	$102.56	$57.78
REST OF CALIFORNIA (CA)	$97.70	$55.60
COLORADO (CO)	$96.46	$55.60
CONNECTICUT (CT)	$99.22	$57.86
DC + MD/VA SUBURBS (DC)	$106.26	$61.02
DELAWARE (DE)	$91.78	$53.83
FORT LAUDERDALE (FL)	$96.95	$58.04
MIAMI (FL)	$101.68	$61.69
REST OF FLORIDA (FL)	$91.98	$55.25
ATLANTA (GA)	$94.78	$55.76
REST OF GEORGIA (GA)	$86.52	$52.26
HAWAII, GUAM (HI)	$100.18	$56.51
IOWA (IA)	$84.84	$49.70
IDAHO (ID)	$85.48	$50.14
EAST ST. LOUIS (IL)	$91.65	$56.32
SUBURBAN CHICAGO (IL)	$97.89	$58.44
CHICAGO (IL)	$98.54	$59.93
REST OF ILLINOIS (IL)	$89.39	$54.32
INDIANA (IN)	$85.99	$50.38
KANSAS (KS)	$84.55	$49.83
KENTUCKY (KY)	$85.21	$51.06
NEW ORLEANS (LA)	$89.52	$53.37
REST OF LOUISIANA (LA)	$85.12	$51.13
METROPOLITAN BOSTON (MA)	$106.12	$60.26
REST OF MASSACHUSETTS (MA)	$95.90	$55.45
BALTIMORE/SURR. CNTYS (MD)	$98.98	$57.76
REST OF MARYLAND (MD)	$93.55	$54.67
SOUTHERN MAINE (ME)	$90.78	$52.72
REST OF MAINE (ME)	$86.08	$50.74
DETROIT (MI)	$93.30	$56.23
REST OF MICHIGAN (MI)	$87.65	$52.58
MINNESOTA (MN)	$91.94	$52.42
METROPOLITAN ST. LOUIS (MO)	$89.70	$53.14
METROPOLITAN KANSAS CITY (MO)	$88.75	$52.68
REST OF MISSOURI (MO)	$83.67	$50.56
MISSISSIPPI (MS)	$82.66	$49.59
MONTANA** (MT)	$92.85	$54.44
NORTH CAROLINA (NC)	$87.00	$51.16
NORTH DAKOTA** (ND)	$90.47	$52.06
NEBRASKA (NE)	$85.29	$49.84
NEW HAMPSHIRE (NH)	$95.05	$55.07
NORTHERN NJ (NJ)	$105.11	$60.55
REST OF NEW JERSEY (NJ)	$100.22	$58.27
NEW MEXICO (NM)	$88.20	$52.98
NEVADA** (NV)	$92.25	$53.80
MANHATTAN (NY)	$107.34	$62.70
NYC SUBURBS/LONG ISLAND (NY)	$110.20	$64.53
POUGHKPSIE/N NYC SUBURBS (NY)	$100.98	$58.92
QUEENS (NY)	$108.08	$62.67
REST OF NEW YORK (NY)	$88.37	$51.88
OHIO (OH)	$87.16	$52.09
OKLAHOMA (OK)	$84.92	$50.62
PORTLAND (OR)	$99.50	$56.83
REST OF OREGON (OR)	$91.40	$53.14
METROPOLITAN PHILADELPHIA (PA)	$96.74	$56.75
REST OF PENNSYLVANIA (PA)	$87.24	$51.98
PUERTO RICO (PR)	$93.52	$54.68
RHODE ISLAND (RI)	$95.03	$55.35
SOUTH CAROLINA (SC)	$87.25	$51.76
SOUTH DAKOTA** (SD)	$90.19	$51.78
TENNESSEE (TN)	$85.01	$50.10
BRAZORIA (TX)	$91.56	$53.50
DALLAS (TX)	$92.23	$53.97
GALVESTON (TX)	$91.89	$53.75
HOUSTON (TX)	$94.09	$55.94
BEAUMONT (TX)	$86.65	$51.69
FORT WORTH (TX)	$91.62	$53.75
AUSTIN (TX)	$96.26	$55.62
REST OF TEXAS (TX)	$89.11	$52.66
UTAH (UT)	$88.50	$52.39
VIRGINIA (VA)	$90.56	$52.80
VIRGIN ISLANDS (VI)	$93.52	$54.68
VERMONT (VT)	$90.22	$52.19
SEATTLE (KING CNTY) (WA)	$108.21	$61.08
REST OF WASHINGTON (WA)	$95.68	$55.24
WISCONSIN (WI)	$87.32	$50.52
WEST VIRGINIA (WV)	$85.96	$52.58
WYOMING** (WY)	$91.81	$53.40

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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 the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, reflecting local cost differences. The locality-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why the two amounts shown differ.

RVUs — work 0.69, practice expense 1.97 (non-facility) / 0.82 (facility), malpractice 0.12 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure 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 patient or secondary insurer is responsible for the rest.
Modifiers, place-of-service codes, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Local Medicare Administrative Contractor (MAC) policies and coverage determinations may affect whether and how this code is paid.
Always verify current-year rates and locality-specific amounts with your MAC or the CMS Physician Fee Schedule Look-Up Tool before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The practice-expense RVU is lower in the facility setting because the facility (e.g., hospital) absorbs certain overhead costs, such as equipment and staff, that a physician office would otherwise bear.

Why might my locality's allowed amount differ from the national figure?

The Geographic Practice Cost Index (GPCI) adjusts each RVU component for local wage, rent, and malpractice cost differences, so the same code can price differently from one locality to another.

Does this amount reflect what the patient will owe?

No. This is the Medicare-allowed amount before the standard 80/20 cost-sharing split and before the Part B deductible is applied.

Can this amount change during the year?

The conversion factor and RVUs are typically set annually, but mid-year corrections, sequestration, or policy updates from CMS can still affect the final paid amount.

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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.