Medicare Reimbursement for CPT 20101
CPT 20101 is a physician procedure code; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjustable by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $626.27 | $201.74 |
| ALASKA* (AK) | $698.32 | $246.20 |
| ALABAMA (AL) | $552.47 | $181.01 |
| ARKANSAS (AR) | $543.15 | $178.48 |
| ARIZONA (AZ) | $606.94 | $195.58 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $822.26 | $223.68 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $838.83 | $226.66 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $708.36 | $206.57 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $711.37 | $209.16 |
| NAPA (CA) | $775.86 | $216.34 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $823.21 | $224.63 |
| VALLEJO (CA) | $774.49 | $214.97 |
| BAKERSFIELD (CA) | $664.62 | $199.34 |
| CHICO (CA) | $662.36 | $197.09 |
| FRESNO (CA) | $662.36 | $197.09 |
| HANFORD-CORCORAN (CA) | $662.36 | $197.09 |
| MADERA (CA) | $662.36 | $197.09 |
| MERCED (CA) | $662.36 | $197.09 |
| MODESTO (CA) | $662.36 | $197.09 |
| REDDING (CA) | $662.36 | $197.09 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $671.36 | $206.08 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $697.39 | $203.67 |
| SALINAS (CA) | $694.90 | $202.87 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $842.73 | $230.56 |
| SANTA CRUZ-WATSONVILLE (CA) | $721.45 | $205.65 |
| SANTA ROSA-PETALUMA (CA) | $728.81 | $207.49 |
| STOCKTON (CA) | $662.36 | $197.09 |
| VISALIA (CA) | $662.36 | $197.09 |
| YUBA CITY (CA) | $662.36 | $197.09 |
| EL CENTRO (CA) | $662.51 | $197.23 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $713.20 | $205.47 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $683.56 | $200.03 |
| SANTA MARIA-SANTA BARBARA (CA) | $698.03 | $203.04 |
| REST OF CALIFORNIA (CA) | $662.36 | $197.09 |
| COLORADO (CO) | $652.94 | $201.24 |
| CONNECTICUT (CT) | $672.22 | $215.01 |
| DC + MD/VA SUBURBS (DC) | $722.87 | $222.78 |
| DELAWARE (DE) | $618.04 | $198.61 |
| FORT LAUDERDALE (FL) | $655.35 | $225.30 |
| MIAMI (FL) | $689.38 | $247.45 |
| REST OF FLORIDA (FL) | $618.69 | $212.84 |
| ATLANTA (GA) | $640.11 | $208.79 |
| REST OF GEORGIA (GA) | $578.41 | $199.73 |
| HAWAII, GUAM (HI) | $682.00 | $199.31 |
| IOWA (IA) | $567.44 | $179.00 |
| IDAHO (ID) | $572.04 | $181.48 |
| EAST ST. LOUIS (IL) | $615.28 | $224.71 |
| SUBURBAN CHICAGO (IL) | $661.97 | $225.99 |
| CHICAGO (IL) | $665.80 | $239.15 |
| REST OF ILLINOIS (IL) | $599.17 | $211.58 |
| INDIANA (IN) | $575.86 | $182.32 |
| KANSAS (KS) | $565.02 | $181.25 |
| KENTUCKY (KY) | $569.16 | $191.76 |
| NEW ORLEANS (LA) | $601.00 | $201.52 |
| REST OF LOUISIANA (LA) | $568.39 | $192.69 |
| METROPOLITAN BOSTON (MA) | $723.14 | $216.25 |
| REST OF MASSACHUSETTS (MA) | $648.38 | $201.36 |
| BALTIMORE/SURR. CNTYS (MD) | $670.59 | $215.07 |
| REST OF MARYLAND (MD) | $630.93 | $201.31 |
| SOUTHERN MAINE (ME) | $611.48 | $190.77 |
| REST OF MAINE (ME) | $576.22 | $185.66 |
| DETROIT (MI) | $628.26 | $218.59 |
| REST OF MICHIGAN (MI) | $587.00 | $199.40 |
| MINNESOTA (MN) | $620.81 | $183.98 |
| METROPOLITAN ST. LOUIS (MO) | $602.66 | $198.51 |
| METROPOLITAN KANSAS CITY (MO) | $595.55 | $196.92 |
| REST OF MISSOURI (MO) | $557.50 | $191.56 |
| MISSISSIPPI (MS) | $550.42 | $184.90 |
| MONTANA** (MT) | $626.21 | $201.69 |
| NORTH CAROLINA (NC) | $583.11 | $187.03 |
| NORTH DAKOTA** (ND) | $609.60 | $185.08 |
| NEBRASKA (NE) | $570.85 | $179.02 |
| NEW HAMPSHIRE (NH) | $642.97 | $201.04 |
| NORTHERN NJ (NJ) | $713.68 | $221.23 |
| REST OF NEW JERSEY (NJ) | $678.55 | $214.97 |
| NEW MEXICO (NM) | $590.99 | $201.70 |
| NEVADA** (NV) | $622.07 | $197.12 |
| MANHATTAN (NY) | $729.31 | $236.01 |
| NYC SUBURBS/LONG ISLAND (NY) | $750.22 | $245.46 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $683.73 | $218.87 |
| QUEENS (NY) | $735.13 | $233.34 |
| REST OF NEW YORK (NY) | $593.28 | $189.98 |
| OHIO (OH) | $583.60 | $196.01 |
| OKLAHOMA (OK) | $567.26 | $188.16 |
| PORTLAND (OR) | $675.49 | $203.84 |
| REST OF OREGON (OR) | $615.96 | $193.13 |
| METROPOLITAN PHILADELPHIA (PA) | $653.79 | $211.86 |
| REST OF PENNSYLVANIA (PA) | $584.30 | $194.58 |
| PUERTO RICO (PR) | $631.27 | $202.07 |
| RHODE ISLAND (RI) | $641.50 | $202.97 |
| SOUTH CAROLINA (SC) | $584.59 | $192.33 |
| SOUTH DAKOTA** (SD) | $607.64 | $183.11 |
| TENNESSEE (TN) | $568.41 | $182.52 |
| BRAZORIA (TX) | $616.50 | $195.79 |
| DALLAS (TX) | $621.26 | $198.43 |
| GALVESTON (TX) | $618.83 | $197.28 |
| HOUSTON (TX) | $634.21 | $212.65 |
| BEAUMONT (TX) | $579.91 | $193.59 |
| FORT WORTH (TX) | $616.69 | $198.11 |
| AUSTIN (TX) | $651.87 | $202.72 |
| REST OF TEXAS (TX) | $598.40 | $195.53 |
| UTAH (UT) | $593.83 | $194.77 |
| VIRGINIA (VA) | $609.64 | $192.33 |
| VIRGIN ISLANDS (VI) | $631.27 | $202.07 |
| VERMONT (VT) | $607.48 | $187.20 |
| SEATTLE (KING CNTY) (WA) | $738.30 | $217.41 |
| REST OF WASHINGTON (WA) | $647.06 | $200.03 |
| WISCONSIN (WI) | $586.15 | $179.45 |
| WEST VIRGINIA (WV) | $573.78 | $204.86 |
| WYOMING** (WY) | $618.97 | $194.45 |
Look up another code or locality →
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) — physician work, practice expense, and malpractice — that are assigned to each code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher in non-facility settings (where the provider bears more overhead) and lower in facility settings (where the facility bills separately for overhead). The national amounts shown use national averages before locality adjustment; the locality-specific amount applies the GPCI adjustments for a chosen area.
RVUs — work 3.15, practice expense 14.76 (non-facility) / 2.05 (facility), malpractice 0.84 — × 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 patient meets the annual Part B deductible; the patient or secondary payer is responsible for the remainder.
- Actual payment can vary by locality, applicable modifiers, claims-based adjustments (e.g., sequestration), and annual budget-neutrality changes to RVUs or the conversion factor.
- Always confirm the final allowed amount and any site-of-service or modifier rules with your Medicare Administrative Contractor (MAC).
Frequently asked
Why is the facility amount lower than the non-facility amount for this code?
In the facility setting, the facility (e.g., hospital) bills separately for overhead costs, so the practice-expense RVU assigned to the physician's fee is lower, reducing the total PFS amount compared to the non-facility setting.
Does this amount reflect what Medicare will actually pay?
No. It reflects the Medicare-allowed amount before the 80/20 coinsurance split, deductible status, modifiers, and any claim-level adjustments like sequestration are applied.
Why does the amount change by locality?
Each locality has its own Geographic Practice Cost Indices (GPCIs) for work, practice expense, and malpractice, which adjust the RVUs to reflect regional cost-of-living and practice cost differences before the conversion factor is applied.
Will this amount change next year?
Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and these changes — along with budget-neutrality adjustments — can raise or lower the allowed amount from year to year.
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.
Bill accurately, get paid faster
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free