Medicare Reimbursement for CPT 20102
This page covers a specific CPT procedure code (descriptor not shown due to AMA licensing restrictions). It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount nationally and can be adjusted by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $662.01 | $245.16 |
| ALASKA* (AK) | $744.41 | $300.48 |
| ALABAMA (AL) | $585.24 | $220.50 |
| ARKANSAS (AR) | $575.56 | $217.49 |
| ARIZONA (AZ) | $641.76 | $237.84 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $860.03 | $272.29 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $877.03 | $275.94 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $744.05 | $251.34 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $747.59 | $254.46 |
| NAPA (CA) | $812.69 | $263.29 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $861.16 | $273.41 |
| VALLEJO (CA) | $811.07 | $261.67 |
| BAKERSFIELD (CA) | $699.48 | $242.62 |
| CHICO (CA) | $696.80 | $239.94 |
| FRESNO (CA) | $696.80 | $239.94 |
| HANFORD-CORCORAN (CA) | $696.80 | $239.94 |
| MADERA (CA) | $696.80 | $239.94 |
| MERCED (CA) | $696.80 | $239.94 |
| MODESTO (CA) | $696.80 | $239.94 |
| REDDING (CA) | $696.80 | $239.94 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $707.41 | $250.55 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $732.72 | $247.93 |
| SALINAS (CA) | $730.08 | $246.95 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $881.63 | $280.54 |
| SANTA CRUZ-WATSONVILLE (CA) | $756.74 | $250.28 |
| SANTA ROSA-PETALUMA (CA) | $764.40 | $252.52 |
| STOCKTON (CA) | $696.80 | $239.94 |
| VISALIA (CA) | $696.80 | $239.94 |
| YUBA CITY (CA) | $696.80 | $239.94 |
| EL CENTRO (CA) | $696.97 | $240.11 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $748.62 | $250.08 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $718.27 | $243.49 |
| SANTA MARIA-SANTA BARBARA (CA) | $733.18 | $247.14 |
| REST OF CALIFORNIA (CA) | $696.80 | $239.94 |
| COLORADO (CO) | $688.28 | $244.76 |
| CONNECTICUT (CT) | $709.99 | $261.05 |
| DC + MD/VA SUBURBS (DC) | $761.62 | $270.58 |
| DELAWARE (DE) | $653.32 | $241.48 |
| FORT LAUDERDALE (FL) | $695.22 | $272.95 |
| MIAMI (FL) | $733.04 | $299.10 |
| REST OF FLORIDA (FL) | $656.67 | $258.17 |
| ATLANTA (GA) | $677.03 | $253.52 |
| REST OF GEORGIA (GA) | $614.43 | $242.60 |
| HAWAII, GUAM (HI) | $716.49 | $242.54 |
| IOWA (IA) | $599.62 | $218.21 |
| IDAHO (ID) | $604.63 | $221.14 |
| EAST ST. LOUIS (IL) | $655.59 | $272.09 |
| SUBURBAN CHICAGO (IL) | $701.92 | $273.82 |
| CHICAGO (IL) | $708.23 | $289.30 |
| REST OF ILLINOIS (IL) | $637.18 | $256.60 |
| INDIANA (IN) | $608.56 | $222.14 |
| KANSAS (KS) | $597.67 | $220.84 |
| KENTUCKY (KY) | $603.77 | $233.19 |
| NEW ORLEANS (LA) | $637.04 | $244.79 |
| REST OF LOUISIANA (LA) | $603.19 | $234.29 |
| METROPOLITAN BOSTON (MA) | $760.55 | $262.84 |
| REST OF MASSACHUSETTS (MA) | $683.83 | $244.90 |
| BALTIMORE/SURR. CNTYS (MD) | $708.37 | $261.10 |
| REST OF MARYLAND (MD) | $666.58 | $244.74 |
| SOUTHERN MAINE (ME) | $645.31 | $232.22 |
| REST OF MAINE (ME) | $609.56 | $226.06 |
| DETROIT (MI) | $667.21 | $264.96 |
| REST OF MICHIGAN (MI) | $622.83 | $242.25 |
| MINNESOTA (MN) | $653.21 | $224.28 |
| METROPOLITAN ST. LOUIS (MO) | $638.10 | $241.27 |
| METROPOLITAN KANSAS CITY (MO) | $630.79 | $239.37 |
| REST OF MISSOURI (MO) | $592.24 | $232.92 |
| MISSISSIPPI (MS) | $583.97 | $225.06 |
| MONTANA** (MT) | $661.94 | $245.10 |
| NORTH CAROLINA (NC) | $616.61 | $227.70 |
| NORTH DAKOTA** (ND) | $642.36 | $225.52 |
| NEBRASKA (NE) | $602.99 | $218.24 |
| NEW HAMPSHIRE (NH) | $678.35 | $244.41 |
| NORTHERN NJ (NJ) | $752.31 | $268.78 |
| REST OF NEW JERSEY (NJ) | $716.34 | $261.14 |
| NEW MEXICO (NM) | $627.21 | $244.96 |
| NEVADA** (NV) | $656.98 | $239.72 |
| MANHATTAN (NY) | $770.57 | $286.20 |
| NYC SUBURBS/LONG ISLAND (NY) | $793.01 | $297.39 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $722.22 | $265.78 |
| QUEENS (NY) | $775.80 | $283.09 |
| REST OF NEW YORK (NY) | $627.22 | $231.22 |
| OHIO (OH) | $618.83 | $238.25 |
| OKLAHOMA (OK) | $601.20 | $228.96 |
| PORTLAND (OR) | $711.04 | $247.93 |
| REST OF OREGON (OR) | $650.19 | $235.01 |
| METROPOLITAN PHILADELPHIA (PA) | $691.19 | $257.26 |
| REST OF PENNSYLVANIA (PA) | $619.24 | $236.58 |
| PUERTO RICO (PR) | $667.00 | $245.57 |
| RHODE ISLAND (RI) | $677.38 | $246.78 |
| SOUTH CAROLINA (SC) | $619.10 | $233.93 |
| SOUTH DAKOTA** (SD) | $640.05 | $223.21 |
| TENNESSEE (TN) | $601.26 | $222.35 |
| BRAZORIA (TX) | $651.27 | $238.18 |
| DALLAS (TX) | $656.48 | $241.30 |
| GALVESTON (TX) | $653.86 | $239.93 |
| HOUSTON (TX) | $671.98 | $258.06 |
| BEAUMONT (TX) | $614.72 | $235.39 |
| FORT WORTH (TX) | $651.92 | $240.91 |
| AUSTIN (TX) | $687.46 | $246.44 |
| REST OF TEXAS (TX) | $633.33 | $237.75 |
| UTAH (UT) | $628.67 | $236.84 |
| VIRGINIA (VA) | $643.80 | $234.04 |
| VIRGIN ISLANDS (VI) | $667.00 | $245.57 |
| VERMONT (VT) | $640.68 | $228.00 |
| SEATTLE (KING CNTY) (WA) | $775.79 | $264.32 |
| REST OF WASHINGTON (WA) | $682.25 | $243.32 |
| WISCONSIN (WI) | $618.15 | $218.82 |
| WEST VIRGINIA (WV) | $610.84 | $248.61 |
| WYOMING** (WY) | $653.41 | $236.57 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 3 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 — each adjusted by the Geographic Practice Cost Indices (GPCIs) for a given locality. These locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the same code can have two different allowed amounts depending on where the service is performed. National figures use a 1.0 GPCI and serve as a baseline before locality adjustment.
RVUs — work 3.88, practice expense 14.95 (non-facility) / 2.47 (facility), malpractice 0.99 — × 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 Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
- Locality-specific GPCIs can meaningfully raise or lower the amount from the national figure shown.
- Always confirm current rates and edits with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why are there two different amounts for this code?
The non-facility amount applies when the service is performed in a setting like a physician's office, while the facility amount applies in settings like a hospital, where Medicare separately pays the facility for overhead costs. This is reflected in different practice-expense RVUs.
Is this the amount Medicare will actually pay?
No. It's an estimate based on national RVUs and the conversion factor. Actual payment depends on the patient's locality, applicable modifiers, deductible status, and other claim-specific factors.
Why isn't the CPT code description shown?
CPT code descriptors are copyrighted by the American Medical Association (AMA) and cannot be republished without a license, so this page refers to the code generically.
Do RVUs change every year?
Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, so allowed amounts can shift from year to year even for the same code.
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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