Medicare Reimbursement for CPT 20100

CPT 20100 is a procedure code reported to Medicare and other payers; this page is intended to show the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted for locality, under non-facility and facility settings. Because the CPT descriptor is proprietary to the AMA, this page refers to it generically rather than reproducing the official code description.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$545.77	$545.77
ALASKA* (AK)	$690.17	$690.17
ALABAMA (AL)	$496.89	$496.89
ARKANSAS (AR)	$490.97	$490.97
ARIZONA (AZ)	$530.95	$530.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$590.02	$590.02
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$597.29	$597.29
OXNARD-THOUSAND OAKS-VENTURA (CA)	$551.60	$551.60
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$559.16	$559.16
NAPA (CA)	$573.07	$573.07
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$592.54	$592.54
VALLEJO (CA)	$569.44	$569.44
BAKERSFIELD (CA)	$536.03	$536.03
CHICO (CA)	$529.94	$529.94
FRESNO (CA)	$529.94	$529.94
HANFORD-CORCORAN (CA)	$529.94	$529.94
MADERA (CA)	$529.94	$529.94
MERCED (CA)	$529.94	$529.94
MODESTO (CA)	$529.94	$529.94
REDDING (CA)	$529.94	$529.94
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$553.78	$553.78
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$545.31	$545.31
SALINAS (CA)	$543.09	$543.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$607.60	$607.60
SANTA CRUZ-WATSONVILLE (CA)	$547.19	$547.19
SANTA ROSA-PETALUMA (CA)	$551.97	$551.97
STOCKTON (CA)	$529.94	$529.94
VISALIA (CA)	$529.94	$529.94
YUBA CITY (CA)	$529.94	$529.94
EL CENTRO (CA)	$530.31	$530.31
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$548.14	$548.14
SAN LUIS OBISPO-PASO ROBLES (CA)	$535.68	$535.68
SANTA MARIA-SANTA BARBARA (CA)	$543.01	$543.01
REST OF CALIFORNIA (CA)	$529.94	$529.94
COLORADO (CO)	$542.14	$542.14
CONNECTICUT (CT)	$578.39	$578.39
DC + MD/VA SUBURBS (DC)	$596.18	$596.18
DELAWARE (DE)	$538.37	$538.37
FORT LAUDERDALE (FL)	$607.42	$607.42
MIAMI (FL)	$664.62	$664.62
REST OF FLORIDA (FL)	$577.19	$577.19
ATLANTA (GA)	$563.83	$563.83
REST OF GEORGIA (GA)	$545.58	$545.58
HAWAII, GUAM (HI)	$532.86	$532.86
IOWA (IA)	$489.70	$489.70
IDAHO (ID)	$496.01	$496.01
EAST ST. LOUIS (IL)	$610.27	$610.27
SUBURBAN CHICAGO (IL)	$608.99	$608.99
CHICAGO (IL)	$644.83	$644.83
REST OF ILLINOIS (IL)	$575.89	$575.89
INDIANA (IN)	$497.90	$497.90
KANSAS (KS)	$496.17	$496.17
KENTUCKY (KY)	$524.64	$524.64
NEW ORLEANS (LA)	$547.97	$547.97
REST OF LOUISIANA (LA)	$527.29	$527.29
METROPOLITAN BOSTON (MA)	$577.39	$577.39
REST OF MASSACHUSETTS (MA)	$543.21	$543.21
BALTIMORE/SURR. CNTYS (MD)	$578.51	$578.51
REST OF MARYLAND (MD)	$544.67	$544.67
SOUTHERN MAINE (ME)	$517.21	$517.21
REST OF MAINE (ME)	$507.05	$507.05
DETROIT (MI)	$591.96	$591.96
REST OF MICHIGAN (MI)	$543.71	$543.71
MINNESOTA (MN)	$497.44	$497.44
METROPOLITAN ST. LOUIS (MO)	$539.51	$539.51
METROPOLITAN KANSAS CITY (MO)	$535.92	$535.92
REST OF MISSOURI (MO)	$525.41	$525.41
MISSISSIPPI (MS)	$507.85	$507.85
MONTANA** (MT)	$545.62	$545.62
NORTH CAROLINA (NC)	$510.05	$510.05
NORTH DAKOTA** (ND)	$501.73	$501.73
NEBRASKA (NE)	$489.36	$489.36
NEW HAMPSHIRE (NH)	$541.98	$541.98
NORTHERN NJ (NJ)	$593.48	$593.48
REST OF NEW JERSEY (NJ)	$578.78	$578.78
NEW MEXICO (NM)	$549.59	$549.59
NEVADA** (NV)	$533.52	$533.52
MANHATTAN (NY)	$632.50	$632.50
NYC SUBURBS/LONG ISLAND (NY)	$656.20	$656.20
POUGHKPSIE/N NYC SUBURBS (NY)	$589.25	$589.25
QUEENS (NY)	$624.49	$624.49
REST OF NEW YORK (NY)	$517.07	$517.07
OHIO (OH)	$534.74	$534.74
OKLAHOMA (OK)	$514.94	$514.94
PORTLAND (OR)	$547.03	$547.03
REST OF OREGON (OR)	$523.21	$523.21
METROPOLITAN PHILADELPHIA (PA)	$571.64	$571.64
REST OF PENNSYLVANIA (PA)	$530.74	$530.74
PUERTO RICO (PR)	$546.13	$546.13
RHODE ISLAND (RI)	$548.59	$548.59
SOUTH CAROLINA (SC)	$524.49	$524.49
SOUTH DAKOTA** (SD)	$496.54	$496.54
TENNESSEE (TN)	$499.28	$499.28
BRAZORIA (TX)	$530.96	$530.96
DALLAS (TX)	$537.75	$537.75
GALVESTON (TX)	$534.79	$534.79
HOUSTON (TX)	$575.42	$575.42
BEAUMONT (TX)	$528.48	$528.48
FORT WORTH (TX)	$537.38	$537.38
AUSTIN (TX)	$545.74	$545.74
REST OF TEXAS (TX)	$531.76	$531.76
UTAH (UT)	$530.19	$530.19
VIRGINIA (VA)	$521.70	$521.70
VIRGIN ISLANDS (VI)	$546.13	$546.13
VERMONT (VT)	$507.80	$507.80
SEATTLE (KING CNTY) (WA)	$579.43	$579.43
REST OF WASHINGTON (WA)	$539.52	$539.52
WISCONSIN (WI)	$488.85	$488.85
WEST VIRGINIA (WV)	$560.23	$560.23
WYOMING** (WY)	$526.49	$526.49

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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

Medicare's PFS amount is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar-per-RVU rate set by CMS) to produce the estimated allowed amount. Non-facility and facility settings can have different practice-expense RVUs, since the practice-expense cost differs depending on whether the service is furnished in a physician office versus a facility (e.g., hospital) setting, which is why the two allowed amounts may differ.

RVUs — work 10.12, practice expense 4 (non-facility) / 4 (facility), malpractice 2.22 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimated allowed amount only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claims-based adjustments, sequestration, and annual budget-neutrality changes to RVUs or the conversion factor.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The two settings can carry different practice-expense RVUs because the cost of supplies, equipment, and staff time attributed to the physician's service differs depending on whether it's furnished in an office versus a facility, where the facility itself bills separately for overhead.

Does this amount reflect what my practice will actually collect?

No. It's an estimate based on national RVUs and a conversion factor. Your locality's GPCIs, the patient's deductible status, applicable modifiers, and sequestration all affect the final payment.

Why do these amounts change each year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, so the same code's allowed amount can shift from one year to the next.

Can I use this figure for patient cost-share estimates?

It can serve as a rough starting point, but actual patient responsibility depends on deductible status, secondary coverage, and any modifiers applied to the specific claim.

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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.