Medicare Reimbursement for CPT 20220

This page covers CPT code 20220, a procedure code valued under the Medicare Physician Fee Schedule (PFS). It shows the estimated Medicare-allowed amount 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)	$223.12	$76.49
ALASKA* (AK)	$258.09	$101.93
ALABAMA (AL)	$200.20	$71.89
ARKANSAS (AR)	$197.29	$71.33
ARIZONA (AZ)	$217.23	$75.14
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$292.06	$85.32
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$297.95	$86.51
OXNARD-THOUSAND OAKS-VENTURA (CA)	$252.27	$78.95
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$253.37	$79.90
NAPA (CA)	$275.76	$82.50
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$292.26	$85.51
VALLEJO (CA)	$275.48	$82.22
BAKERSFIELD (CA)	$237.63	$76.92
CHICO (CA)	$237.11	$76.40
FRESNO (CA)	$237.11	$76.40
HANFORD-CORCORAN (CA)	$237.11	$76.40
MADERA (CA)	$237.11	$76.40
MERCED (CA)	$237.11	$76.40
MODESTO (CA)	$237.11	$76.40
REDDING (CA)	$237.11	$76.40
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$238.96	$78.26
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$249.10	$78.57
SALINAS (CA)	$248.17	$78.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$298.74	$87.30
SANTA CRUZ-WATSONVILLE (CA)	$256.80	$78.65
SANTA ROSA-PETALUMA (CA)	$259.41	$79.35
STOCKTON (CA)	$237.11	$76.40
VISALIA (CA)	$237.11	$76.40
YUBA CITY (CA)	$237.11	$76.40
EL CENTRO (CA)	$237.14	$76.43
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$254.21	$78.84
SAN LUIS OBISPO-PASO ROBLES (CA)	$244.15	$77.14
SANTA MARIA-SANTA BARBARA (CA)	$249.16	$78.19
REST OF CALIFORNIA (CA)	$237.11	$76.40
COLORADO (CO)	$232.99	$76.98
CONNECTICUT (CT)	$237.99	$80.07
DC + MD/VA SUBURBS (DC)	$255.80	$83.07
DELAWARE (DE)	$220.85	$75.98
FORT LAUDERDALE (FL)	$229.83	$81.30
MIAMI (FL)	$238.51	$85.87
REST OF FLORIDA (FL)	$218.77	$78.59
ATLANTA (GA)	$227.04	$78.06
REST OF GEORGIA (GA)	$206.53	$75.74
HAWAII, GUAM (HI)	$243.15	$76.43
IOWA (IA)	$205.78	$71.62
IDAHO (ID)	$207.03	$72.13
EAST ST. LOUIS (IL)	$215.78	$80.88
SUBURBAN CHICAGO (IL)	$232.30	$81.71
CHICAGO (IL)	$231.67	$84.30
REST OF ILLINOIS (IL)	$212.08	$78.20
INDIANA (IN)	$208.25	$72.33
KANSAS (KS)	$204.59	$72.04
KENTUCKY (KY)	$204.47	$74.11
NEW ORLEANS (LA)	$214.23	$76.26
REST OF LOUISIANA (LA)	$204.06	$74.29
METROPOLITAN BOSTON (MA)	$256.45	$81.37
REST OF MASSACHUSETTS (MA)	$231.50	$77.10
BALTIMORE/SURR. CNTYS (MD)	$237.27	$79.94
REST OF MARYLAND (MD)	$225.15	$76.76
SOUTHERN MAINE (ME)	$219.55	$74.24
REST OF MAINE (ME)	$207.88	$72.98
DETROIT (MI)	$221.28	$79.79
REST OF MICHIGAN (MI)	$209.61	$75.74
MINNESOTA (MN)	$223.87	$72.98
METROPOLITAN ST. LOUIS (MO)	$215.27	$75.68
METROPOLITAN KANSAS CITY (MO)	$213.00	$75.32
REST OF MISSOURI (MO)	$200.38	$73.99
MISSISSIPPI (MS)	$198.89	$72.64
MONTANA** (MT)	$223.11	$76.48
NORTH CAROLINA (NC)	$210.10	$73.30
NORTH DAKOTA** (ND)	$219.75	$73.12
NEBRASKA (NE)	$206.98	$71.64
NEW HAMPSHIRE (NH)	$229.12	$76.48
NORTHERN NJ (NJ)	$253.08	$82.99
REST OF NEW JERSEY (NJ)	$240.88	$80.76
NEW MEXICO (NM)	$210.68	$76.22
NEVADA** (NV)	$222.33	$75.56
MANHATTAN (NY)	$256.40	$86.02
NYC SUBURBS/LONG ISLAND (NY)	$262.36	$88.02
POUGHKPSIE/N NYC SUBURBS (NY)	$242.28	$81.72
QUEENS (NY)	$258.86	$85.54
REST OF NEW YORK (NY)	$213.25	$73.95
OHIO (OH)	$208.92	$75.05
OKLAHOMA (OK)	$204.34	$73.40
PORTLAND (OR)	$240.69	$77.79
REST OF OREGON (OR)	$220.78	$74.73
METROPOLITAN PHILADELPHIA (PA)	$231.89	$79.25
REST OF PENNSYLVANIA (PA)	$209.39	$74.78
PUERTO RICO (PR)	$224.83	$76.59
RHODE ISLAND (RI)	$228.93	$77.46
SOUTH CAROLINA (SC)	$209.83	$74.34
SOUTH DAKOTA** (SD)	$219.35	$72.72
TENNESSEE (TN)	$205.60	$72.31
BRAZORIA (TX)	$220.83	$75.52
DALLAS (TX)	$222.14	$76.10
GALVESTON (TX)	$221.43	$75.82
HOUSTON (TX)	$224.54	$78.93
BEAUMONT (TX)	$207.99	$74.55
FORT WORTH (TX)	$220.58	$76.00
AUSTIN (TX)	$232.07	$76.94
REST OF TEXAS (TX)	$214.22	$75.07
UTAH (UT)	$212.72	$74.89
VIRGINIA (VA)	$218.67	$74.53
VIRGIN ISLANDS (VI)	$224.83	$76.59
VERMONT (VT)	$218.68	$73.51
SEATTLE (KING CNTY) (WA)	$261.92	$82.00
REST OF WASHINGTON (WA)	$231.13	$76.73
WISCONSIN (WI)	$212.31	$71.84
WEST VIRGINIA (WV)	$204.13	$76.70
WYOMING** (WY)	$221.64	$75.01

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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 (PE), and malpractice (MP) — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is furnished, reflecting local cost-of-living and practice-cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates differ because the PE RVU is typically higher in non-facility settings (where the practice bears more overhead) and lower in facility settings (where the facility, not the physician, bears most overhead costs).

RVUs — work 1.61, practice expense 4.9 (non-facility) / 0.51 (facility), malpractice 0.17 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary insurer is generally responsible for the remainder.
Actual payment can vary based on modifiers, place of service, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the non-facility amount different from the facility amount?

The non-facility rate includes higher practice expense RVUs because the billing practice absorbs overhead costs like supplies, staff, and equipment. In a facility setting, the facility bears most of those costs, so the physician's practice expense RVU — and the resulting payment — is lower.

Does this amount reflect what Medicare will actually pay my practice?

No — it's a national or locality-adjusted estimate based on standard RVUs and the conversion factor. Your actual payment depends on your specific locality GPCIs, any applicable modifiers, and other adjustments such as sequestration.

Why can't you show the CPT code's official description?

CPT code descriptors are copyrighted by the American Medical Association (AMA) and cannot be reproduced without a license. We refer to the code generically instead.

How often do these amounts change?

The conversion factor, RVUs, and GPCIs are updated annually (and sometimes mid-year) by CMS, so amounts shown are tied to a specific year and may change in future rule updates.

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.