Medicare Reimbursement for CPT 20206

CPT 20206 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and 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)	$209.76	$51.10
ALASKA* (AK)	$235.60	$66.63
ALABAMA (AL)	$186.45	$47.63
ARKANSAS (AR)	$183.49	$47.20
ARIZONA (AZ)	$203.84	$50.11
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$281.93	$58.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$287.87	$59.10
OXNARD-THOUSAND OAKS-VENTURA (CA)	$240.89	$53.36
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$241.64	$53.95
NAPA (CA)	$265.22	$56.12
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$282.06	$58.36
VALLEJO (CA)	$265.04	$55.94
BAKERSFIELD (CA)	$225.61	$51.73
CHICO (CA)	$225.28	$51.39
FRESNO (CA)	$225.28	$51.39
HANFORD-CORCORAN (CA)	$225.28	$51.39
MADERA (CA)	$225.28	$51.39
MERCED (CA)	$225.28	$51.39
MODESTO (CA)	$225.28	$51.39
REDDING (CA)	$225.28	$51.39
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$226.47	$52.59
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$237.53	$53.01
SALINAS (CA)	$236.67	$52.79
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$288.39	$59.61
SANTA CRUZ-WATSONVILLE (CA)	$246.08	$53.31
SANTA ROSA-PETALUMA (CA)	$248.62	$53.80
STOCKTON (CA)	$225.28	$51.39
VISALIA (CA)	$225.28	$51.39
YUBA CITY (CA)	$225.28	$51.39
EL CENTRO (CA)	$225.30	$51.41
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$243.09	$53.34
SAN LUIS OBISPO-PASO ROBLES (CA)	$232.75	$52.04
SANTA MARIA-SANTA BARBARA (CA)	$237.79	$52.80
REST OF CALIFORNIA (CA)	$225.28	$51.39
COLORADO (CO)	$220.46	$51.65
CONNECTICUT (CT)	$224.55	$53.68
DC + MD/VA SUBURBS (DC)	$242.84	$55.94
DELAWARE (DE)	$207.46	$50.71
FORT LAUDERDALE (FL)	$214.98	$54.27
MIAMI (FL)	$222.50	$57.34
REST OF FLORIDA (FL)	$203.96	$52.29
ATLANTA (GA)	$213.37	$52.18
REST OF GEORGIA (GA)	$191.71	$50.19
HAWAII, GUAM (HI)	$232.01	$51.62
IOWA (IA)	$192.78	$47.61
IDAHO (ID)	$193.93	$47.96
EAST ST. LOUIS (IL)	$199.59	$53.63
SUBURBAN CHICAGO (IL)	$217.51	$54.57
CHICAGO (IL)	$215.61	$56.16
REST OF ILLINOIS (IL)	$196.72	$51.86
INDIANA (IN)	$195.19	$48.12
KANSAS (KS)	$191.26	$47.84
KENTUCKY (KY)	$190.17	$49.12
NEW ORLEANS (LA)	$200.01	$50.72
REST OF LOUISIANA (LA)	$189.63	$49.22
METROPOLITAN BOSTON (MA)	$244.38	$54.94
REST OF MASSACHUSETTS (MA)	$218.74	$51.67
BALTIMORE/SURR. CNTYS (MD)	$223.83	$53.59
REST OF MARYLAND (MD)	$211.86	$51.31
SOUTHERN MAINE (ME)	$206.84	$49.61
REST OF MAINE (ME)	$194.47	$48.51
DETROIT (MI)	$206.20	$53.10
REST OF MICHIGAN (MI)	$195.12	$50.27
MINNESOTA (MN)	$212.21	$48.95
METROPOLITAN ST. LOUIS (MO)	$201.43	$50.39
METROPOLITAN KANSAS CITY (MO)	$199.08	$50.10
REST OF MISSOURI (MO)	$185.69	$48.93
MISSISSIPPI (MS)	$184.66	$48.06
MONTANA** (MT)	$209.75	$51.10
NORTH CAROLINA (NC)	$196.79	$48.77
NORTH DAKOTA** (ND)	$207.58	$48.92
NEBRASKA (NE)	$194.10	$47.66
NEW HAMPSHIRE (NH)	$216.42	$51.26
NORTHERN NJ (NJ)	$239.84	$55.80
REST OF NEW JERSEY (NJ)	$227.39	$54.14
NEW MEXICO (NM)	$196.08	$50.59
NEVADA** (NV)	$209.32	$50.50
MANHATTAN (NY)	$242.12	$57.76
NYC SUBURBS/LONG ISLAND (NY)	$247.81	$59.17
POUGHKPSIE/N NYC SUBURBS (NY)	$228.49	$54.76
QUEENS (NY)	$245.07	$57.54
REST OF NEW YORK (NY)	$199.98	$49.26
OHIO (OH)	$194.68	$49.83
OKLAHOMA (OK)	$190.35	$48.68
PORTLAND (OR)	$228.61	$52.35
REST OF OREGON (OR)	$207.97	$49.95
METROPOLITAN PHILADELPHIA (PA)	$218.17	$53.01
REST OF PENNSYLVANIA (PA)	$195.31	$49.67
PUERTO RICO (PR)	$211.61	$51.21
RHODE ISLAND (RI)	$215.71	$51.82
SOUTH CAROLINA (SC)	$196.01	$49.41
SOUTH DAKOTA** (SD)	$207.32	$48.66
TENNESSEE (TN)	$192.25	$48.03
BRAZORIA (TX)	$207.65	$50.42
DALLAS (TX)	$208.83	$50.81
GALVESTON (TX)	$208.17	$50.63
HOUSTON (TX)	$210.18	$52.64
BEAUMONT (TX)	$193.87	$49.49
FORT WORTH (TX)	$207.14	$50.71
AUSTIN (TX)	$219.48	$51.62
REST OF TEXAS (TX)	$200.54	$49.98
UTAH (UT)	$198.96	$49.83
VIRGINIA (VA)	$205.72	$49.77
VIRGIN ISLANDS (VI)	$211.61	$51.21
VERMONT (VT)	$206.21	$49.14
SEATTLE (KING CNTY) (WA)	$250.13	$55.46
REST OF WASHINGTON (WA)	$218.51	$51.44
WISCONSIN (WI)	$199.92	$47.93
WEST VIRGINIA (WV)	$188.59	$50.72
WYOMING** (WY)	$208.80	$50.15

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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

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 Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, since costs vary by region. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility settings use different practice-expense RVUs because overhead costs (equipment, staff, supplies) differ depending on whether the service is performed in a physician office versus a hospital or facility setting.

RVUs — work 0.97, practice expense 5.2 (non-facility) / 0.45 (facility), malpractice 0.11 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement depends on claim-specific factors.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and other claim adjustments can lower the actual payment below the base PFS amount.
Annual budget-neutrality adjustments and conversion factor updates change these amounts each calendar year.
Always verify the current amount and any local policies with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the allowed amount differ between non-facility and facility settings?

The practice-expense RVU component is different for each setting because overhead costs (staff, supplies, equipment) are typically higher when a service is performed in a non-facility setting like a physician's office, compared to a facility where the facility itself bears some of those costs.

Why does the amount change by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to adjust for regional differences in labor, rent, and malpractice insurance costs, so the same code can have a different allowed amount depending on where the service is billed.

Does this amount reflect what Medicare will actually pay?

No. The figure shown is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible, and actual payment can be further affected by modifiers, secondary payer rules, or claim-specific adjustments.

Why might the amount change next year?

The conversion factor, RVUs, and GPCIs are updated annually (and sometimes mid-year) based on CMS rulemaking, budget-neutrality requirements, and legislative changes, so the allowed amount for this code can shift 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.