Medicare Reimbursement for CPT 20200

CPT 20200 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$241.82	$90.18
ALASKA* (AK)	$271.82	$110.32
ALABAMA (AL)	$213.70	$81.02
ARKANSAS (AR)	$210.16	$79.90
ARIZONA (AZ)	$234.40	$87.46
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$313.86	$100.04
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$320.05	$101.38
OXNARD-THOUSAND OAKS-VENTURA (CA)	$271.62	$92.38
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$272.93	$93.54
NAPA (CA)	$296.62	$96.76
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$314.28	$100.46
VALLEJO (CA)	$296.01	$96.15
BAKERSFIELD (CA)	$255.37	$89.17
CHICO (CA)	$254.37	$88.17
FRESNO (CA)	$254.37	$88.17
HANFORD-CORCORAN (CA)	$254.37	$88.17
MADERA (CA)	$254.37	$88.17
MERCED (CA)	$254.37	$88.17
MODESTO (CA)	$254.37	$88.17
REDDING (CA)	$254.37	$88.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$258.33	$92.14
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$267.47	$91.11
SALINAS (CA)	$266.50	$90.75
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$321.76	$103.10
SANTA CRUZ-WATSONVILLE (CA)	$276.22	$91.98
SANTA ROSA-PETALUMA (CA)	$279.02	$92.80
STOCKTON (CA)	$254.37	$88.17
VISALIA (CA)	$254.37	$88.17
YUBA CITY (CA)	$254.37	$88.17
EL CENTRO (CA)	$254.43	$88.23
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$273.26	$91.90
SAN LUIS OBISPO-PASO ROBLES (CA)	$262.20	$89.48
SANTA MARIA-SANTA BARBARA (CA)	$267.63	$90.82
REST OF CALIFORNIA (CA)	$254.37	$88.17
COLORADO (CO)	$251.34	$89.99
CONNECTICUT (CT)	$259.38	$96.07
DC + MD/VA SUBURBS (DC)	$278.18	$99.55
DELAWARE (DE)	$238.63	$88.81
FORT LAUDERDALE (FL)	$254.17	$100.56
MIAMI (FL)	$268.18	$110.32
REST OF FLORIDA (FL)	$240.03	$95.06
ATLANTA (GA)	$247.36	$93.30
REST OF GEORGIA (GA)	$224.54	$89.27
HAWAII, GUAM (HI)	$261.56	$89.14
IOWA (IA)	$218.90	$80.15
IDAHO (ID)	$220.75	$81.24
EAST ST. LOUIS (IL)	$239.79	$100.28
SUBURBAN CHICAGO (IL)	$256.61	$100.88
CHICAGO (IL)	$259.07	$106.67
REST OF ILLINOIS (IL)	$232.94	$94.50
INDIANA (IN)	$222.18	$81.61
KANSAS (KS)	$218.22	$81.13
KENTUCKY (KY)	$220.57	$85.76
NEW ORLEANS (LA)	$232.76	$90.07
REST OF LOUISIANA (LA)	$220.37	$86.17
METROPOLITAN BOSTON (MA)	$277.72	$96.66
REST OF MASSACHUSETTS (MA)	$249.72	$90.04
BALTIMORE/SURR. CNTYS (MD)	$258.80	$96.09
REST OF MARYLAND (MD)	$243.47	$90.01
SOUTHERN MAINE (ME)	$235.62	$85.35
REST OF MAINE (ME)	$222.59	$83.08
DETROIT (MI)	$243.93	$97.60
REST OF MICHIGAN (MI)	$227.58	$89.13
MINNESOTA (MN)	$238.40	$82.36
METROPOLITAN ST. LOUIS (MO)	$233.11	$88.75
METROPOLITAN KANSAS CITY (MO)	$230.43	$88.04
REST OF MISSOURI (MO)	$216.38	$85.67
MISSISSIPPI (MS)	$213.29	$82.73
MONTANA** (MT)	$241.80	$90.16
NORTH CAROLINA (NC)	$225.16	$83.68
NORTH DAKOTA** (ND)	$234.48	$82.84
NEBRASKA (NE)	$220.12	$80.16
NEW HAMPSHIRE (NH)	$247.74	$89.88
NORTHERN NJ (NJ)	$274.78	$98.87
REST OF NEW JERSEY (NJ)	$261.67	$96.07
NEW MEXICO (NM)	$229.20	$90.14
NEVADA** (NV)	$239.94	$88.15
MANHATTAN (NY)	$281.59	$105.38
NYC SUBURBS/LONG ISLAND (NY)	$289.85	$109.55
POUGHKPSIE/N NYC SUBURBS (NY)	$263.85	$97.80
QUEENS (NY)	$283.45	$104.21
REST OF NEW YORK (NY)	$229.05	$84.99
OHIO (OH)	$226.08	$87.64
OKLAHOMA (OK)	$219.59	$84.17
PORTLAND (OR)	$259.62	$91.15
REST OF OREGON (OR)	$237.42	$86.39
METROPOLITAN PHILADELPHIA (PA)	$252.52	$94.67
REST OF PENNSYLVANIA (PA)	$226.22	$87.01
PUERTO RICO (PR)	$243.64	$90.33
RHODE ISLAND (RI)	$247.40	$90.75
SOUTH CAROLINA (SC)	$226.13	$86.02
SOUTH DAKOTA** (SD)	$233.62	$81.98
TENNESSEE (TN)	$219.54	$81.69
BRAZORIA (TX)	$237.84	$87.57
DALLAS (TX)	$239.77	$88.73
GALVESTON (TX)	$238.80	$88.22
HOUSTON (TX)	$245.57	$95.00
BEAUMONT (TX)	$224.56	$86.57
FORT WORTH (TX)	$238.11	$88.59
AUSTIN (TX)	$251.07	$90.63
REST OF TEXAS (TX)	$231.34	$87.43
UTAH (UT)	$229.64	$87.10
VIRGINIA (VA)	$235.09	$86.03
VIRGIN ISLANDS (VI)	$243.64	$90.33
VERMONT (VT)	$233.90	$83.77
SEATTLE (KING CNTY) (WA)	$283.25	$97.19
REST OF WASHINGTON (WA)	$249.13	$89.46
WISCONSIN (WI)	$225.63	$80.35
WEST VIRGINIA (WV)	$223.30	$91.53
WYOMING** (WY)	$238.61	$86.97

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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) — 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 to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (staff, supplies, equipment) are assumed to be lower when a service is furnished in a facility that already bills its own costs separately. This is why the same code typically has two different PFS amounts depending on place of service.

RVUs — work 1.42, practice expense 5.45 (non-facility) / 0.91 (facility), malpractice 0.37 — × 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 their deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary due to modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your specific Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does CPT 20200 show two different amounts?

The non-facility amount reflects the higher practice-expense RVUs assumed when the service is performed in a setting like a physician's office, where the billing provider bears the overhead costs. The facility amount reflects lower practice-expense RVUs because overhead is billed separately by the facility.

Does this page show what Medicare will actually pay me?

No. It shows the PFS allowed amount estimate. Actual reimbursement depends on the patient's deductible status, applicable modifiers, secondary insurance, and locality-specific adjustments.

Why can't you show the CPT code description?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page refers to the code generically rather than reproducing the official descriptor.

Why do amounts change year to year?

The conversion factor, RVU values, and GPCIs are updated annually by CMS, and legislative or budget-neutrality adjustments can shift the final allowed amount even if the code itself is unchanged.

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.