Medicare Reimbursement for CPT 20205

CPT code 20205 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$338.69	$146.96
ALASKA* (AK)	$382.81	$178.63
ALABAMA (AL)	$299.20	$131.45
ARKANSAS (AR)	$294.25	$129.56
ARIZONA (AZ)	$328.10	$142.33
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$432.07	$161.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$440.30	$163.84
OXNARD-THOUSAND OAKS-VENTURA (CA)	$376.41	$149.80
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$378.54	$151.73
NAPA (CA)	$409.30	$156.61
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$432.81	$162.48
VALLEJO (CA)	$408.23	$155.54
BAKERSFIELD (CA)	$354.74	$144.61
CHICO (CA)	$353.00	$142.87
FRESNO (CA)	$353.00	$142.87
HANFORD-CORCORAN (CA)	$353.00	$142.87
MADERA (CA)	$353.00	$142.87
MERCED (CA)	$353.00	$142.87
MODESTO (CA)	$353.00	$142.87
REDDING (CA)	$353.00	$142.87
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$359.96	$149.83
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$370.56	$147.59
SALINAS (CA)	$369.22	$147.02
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$443.32	$166.86
SANTA CRUZ-WATSONVILLE (CA)	$381.92	$148.98
SANTA ROSA-PETALUMA (CA)	$385.74	$150.30
STOCKTON (CA)	$353.00	$142.87
VISALIA (CA)	$353.00	$142.87
YUBA CITY (CA)	$353.00	$142.87
EL CENTRO (CA)	$353.11	$142.98
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$378.17	$148.87
SAN LUIS OBISPO-PASO ROBLES (CA)	$363.34	$144.97
SANTA MARIA-SANTA BARBARA (CA)	$370.67	$147.13
REST OF CALIFORNIA (CA)	$353.00	$142.87
COLORADO (CO)	$350.24	$146.25
CONNECTICUT (CT)	$363.29	$156.81
DC + MD/VA SUBURBS (DC)	$388.08	$162.23
DELAWARE (DE)	$333.99	$144.57
FORT LAUDERDALE (FL)	$359.35	$165.14
MIAMI (FL)	$381.74	$182.16
REST OF FLORIDA (FL)	$339.02	$155.74
ATLANTA (GA)	$347.13	$152.34
REST OF GEORGIA (GA)	$316.88	$145.87
HAWAII, GUAM (HI)	$362.49	$144.50
IOWA (IA)	$305.15	$129.73
IDAHO (ID)	$308.00	$131.62
EAST ST. LOUIS (IL)	$341.46	$165.08
SUBURBAN CHICAGO (IL)	$362.47	$165.58
CHICAGO (IL)	$368.54	$175.86
REST OF ILLINOIS (IL)	$329.99	$154.94
INDIANA (IN)	$309.97	$132.24
KANSAS (KS)	$304.83	$131.51
KENTUCKY (KY)	$310.15	$139.71
NEW ORLEANS (LA)	$327.45	$147.04
REST OF LOUISIANA (LA)	$310.12	$140.44
METROPOLITAN BOSTON (MA)	$386.09	$157.17
REST OF MASSACHUSETTS (MA)	$348.25	$146.37
BALTIMORE/SURR. CNTYS (MD)	$362.61	$156.89
REST OF MARYLAND (MD)	$340.56	$146.53
SOUTHERN MAINE (ME)	$328.51	$138.51
REST OF MAINE (ME)	$311.24	$134.86
DETROIT (MI)	$345.16	$160.15
REST OF MICHIGAN (MI)	$320.56	$145.52
MINNESOTA (MN)	$330.37	$133.09
METROPOLITAN ST. LOUIS (MO)	$327.19	$144.67
METROPOLITAN KANSAS CITY (MO)	$323.52	$143.49
REST OF MISSOURI (MO)	$304.93	$139.67
MISSISSIPPI (MS)	$299.59	$134.52
MONTANA** (MT)	$338.64	$146.92
NORTH CAROLINA (NC)	$314.74	$135.86
NORTH DAKOTA** (ND)	$325.79	$134.07
NEBRASKA (NE)	$306.66	$129.71
NEW HAMPSHIRE (NH)	$345.83	$146.25
NORTHERN NJ (NJ)	$383.46	$161.06
REST OF NEW JERSEY (NJ)	$365.98	$156.62
NEW MEXICO (NM)	$323.09	$147.28
NEVADA** (NV)	$335.30	$143.39
MANHATTAN (NY)	$395.26	$172.48
NYC SUBURBS/LONG ISLAND (NY)	$407.64	$179.68
POUGHKPSIE/N NYC SUBURBS (NY)	$369.53	$159.60
QUEENS (NY)	$396.94	$170.33
REST OF NEW YORK (NY)	$320.21	$138.08
OHIO (OH)	$317.94	$142.90
OKLAHOMA (OK)	$308.11	$136.90
PORTLAND (OR)	$361.05	$148.04
REST OF OREGON (OR)	$331.28	$140.32
METROPOLITAN PHILADELPHIA (PA)	$354.11	$154.53
REST OF PENNSYLVANIA (PA)	$317.77	$141.77
PUERTO RICO (PR)	$341.00	$147.17
RHODE ISLAND (RI)	$345.73	$147.68
SOUTH CAROLINA (SC)	$317.15	$140.00
SOUTH DAKOTA** (SD)	$324.27	$132.55
TENNESSEE (TN)	$306.75	$132.47
BRAZORIA (TX)	$332.36	$142.36
DALLAS (TX)	$335.33	$144.37
GALVESTON (TX)	$333.88	$143.50
HOUSTON (TX)	$345.78	$155.40
BEAUMONT (TX)	$315.50	$141.03
FORT WORTH (TX)	$333.21	$144.17
AUSTIN (TX)	$350.31	$147.47
REST OF TEXAS (TX)	$324.31	$142.37
UTAH (UT)	$322.04	$141.82
VIRGINIA (VA)	$328.21	$139.75
VIRGIN ISLANDS (VI)	$341.00	$147.17
VERMONT (VT)	$325.56	$135.75
SEATTLE (KING CNTY) (WA)	$393.13	$157.89
REST OF WASHINGTON (WA)	$347.24	$145.35
WISCONSIN (WI)	$313.56	$129.89
WEST VIRGINIA (WV)	$316.54	$149.93
WYOMING** (WY)	$333.04	$141.32

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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

The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to this procedure code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly in the practice-expense RVU, since non-facility settings (like a physician's office) include overhead costs that are not included when the service is performed in a facility (like a hospital), where the facility itself bills separately for overhead.

RVUs — work 2.29, practice expense 7.2 (non-facility) / 1.46 (facility), malpractice 0.65 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national PFS inputs — actual payment depends on your specific Medicare Administrative Contractor (MAC) and locality.
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, bilateral/multiple procedure rules, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Always verify current rates and coverage policy with your local MAC before billing or appealing a claim.

Frequently asked

Why is the facility rate lower than the non-facility rate for this code?

The facility rate uses a lower practice-expense RVU because overhead costs (equipment, supplies, staff time) are assumed to be covered separately by the facility, not the billing physician.

Does this amount reflect what Medicare will actually pay?

No — this is an estimated allowed amount. Actual Medicare payment is typically 80% of the allowed amount after the deductible, and can be further adjusted by locality, modifiers, and claims processing rules.

Why do rates vary by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs) that adjust the RVUs to reflect local differences in wages, rent, and malpractice costs.

Will this rate change next year?

Yes — RVUs, GPCIs, and the conversion factor are reviewed and can be updated annually, so the allowed amount for this code may change 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.