Medicare Reimbursement for CPT 20225

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code (CPT descriptors are proprietary to the AMA and not reproduced here). It shows the estimated national payment as well as how the amount can vary by locality and by site of service — non-facility versus facility.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$364.74	$113.23
ALASKA* (AK)	$418.71	$150.85
ALABAMA (AL)	$326.44	$106.37
ARKANSAS (AR)	$321.58	$105.53
ARIZONA (AZ)	$354.92	$111.21
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$480.58	$125.95
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$490.37	$127.70
OXNARD-THOUSAND OAKS-VENTURA (CA)	$413.97	$116.69
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$415.64	$118.11
NAPA (CA)	$453.33	$121.85
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$480.88	$126.25
VALLEJO (CA)	$452.91	$121.42
BAKERSFIELD (CA)	$389.38	$113.72
CHICO (CA)	$388.58	$112.93
FRESNO (CA)	$388.58	$112.93
HANFORD-CORCORAN (CA)	$388.58	$112.93
MADERA (CA)	$388.58	$112.93
MERCED (CA)	$388.58	$112.93
MODESTO (CA)	$388.58	$112.93
REDDING (CA)	$388.58	$112.93
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$391.42	$115.76
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$408.61	$116.10
SALINAS (CA)	$407.10	$115.60
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$491.58	$128.91
SANTA CRUZ-WATSONVILLE (CA)	$421.77	$116.19
SANTA ROSA-PETALUMA (CA)	$426.08	$117.23
STOCKTON (CA)	$388.58	$112.93
VISALIA (CA)	$388.58	$112.93
YUBA CITY (CA)	$388.58	$112.93
EL CENTRO (CA)	$388.63	$112.97
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$417.30	$116.49
SAN LUIS OBISPO-PASO ROBLES (CA)	$400.46	$113.99
SANTA MARIA-SANTA BARBARA (CA)	$408.80	$115.54
REST OF CALIFORNIA (CA)	$388.58	$112.93
COLORADO (CO)	$381.47	$113.87
CONNECTICUT (CT)	$389.43	$118.55
DC + MD/VA SUBURBS (DC)	$419.20	$122.92
DELAWARE (DE)	$360.95	$112.45
FORT LAUDERDALE (FL)	$375.35	$120.57
MIAMI (FL)	$389.34	$127.52
REST OF FLORIDA (FL)	$356.95	$116.51
ATLANTA (GA)	$371.14	$115.61
REST OF GEORGIA (GA)	$336.57	$112.23
HAWAII, GUAM (HI)	$398.92	$112.96
IOWA (IA)	$336.02	$105.89
IDAHO (ID)	$338.06	$106.68
EAST ST. LOUIS (IL)	$351.45	$120.06
SUBURBAN CHICAGO (IL)	$379.46	$121.16
CHICAGO (IL)	$377.92	$125.16
REST OF ILLINOIS (IL)	$345.60	$115.97
INDIANA (IN)	$340.11	$106.96
KANSAS (KS)	$333.91	$106.55
KENTUCKY (KY)	$333.34	$109.75
NEW ORLEANS (LA)	$349.62	$112.95
REST OF LOUISIANA (LA)	$332.61	$110.02
METROPOLITAN BOSTON (MA)	$420.64	$120.34
REST OF MASSACHUSETTS (MA)	$378.89	$114.05
BALTIMORE/SURR. CNTYS (MD)	$388.24	$118.37
REST OF MARYLAND (MD)	$368.14	$113.61
SOUTHERN MAINE (ME)	$359.05	$109.80
REST OF MAINE (ME)	$339.36	$107.97
DETROIT (MI)	$361.03	$118.32
REST OF MICHIGAN (MI)	$341.83	$112.20
MINNESOTA (MN)	$366.63	$107.83
METROPOLITAN ST. LOUIS (MO)	$351.50	$112.06
METROPOLITAN KANSAS CITY (MO)	$347.69	$111.52
REST OF MISSOURI (MO)	$326.39	$109.59
MISSISSIPPI (MS)	$324.08	$107.53
MONTANA** (MT)	$364.72	$113.21
NORTH CAROLINA (NC)	$343.10	$108.44
NORTH DAKOTA** (ND)	$359.58	$108.07
NEBRASKA (NE)	$338.07	$105.92
NEW HAMPSHIRE (NH)	$374.98	$113.16
NORTHERN NJ (NJ)	$414.55	$122.80
REST OF NEW JERSEY (NJ)	$394.19	$119.54
NEW MEXICO (NM)	$343.56	$112.92
NEVADA** (NV)	$363.56	$111.80
MANHATTAN (NY)	$419.68	$127.43
NYC SUBURBS/LONG ISLAND (NY)	$429.50	$130.45
POUGHKPSIE/N NYC SUBURBS (NY)	$396.40	$120.99
QUEENS (NY)	$423.96	$126.67
REST OF NEW YORK (NY)	$348.35	$109.41
OHIO (OH)	$340.78	$111.15
OKLAHOMA (OK)	$333.25	$108.65
PORTLAND (OR)	$394.45	$115.03
REST OF OREGON (OR)	$361.05	$110.55
METROPOLITAN PHILADELPHIA (PA)	$379.18	$117.36
REST OF PENNSYLVANIA (PA)	$341.61	$110.72
PUERTO RICO (PR)	$367.65	$113.37
RHODE ISLAND (RI)	$374.43	$114.62
SOUTH CAROLINA (SC)	$342.44	$110.05
SOUTH DAKOTA** (SD)	$358.97	$107.46
TENNESSEE (TN)	$335.58	$106.96
BRAZORIA (TX)	$360.98	$111.73
DALLAS (TX)	$363.12	$112.62
GALVESTON (TX)	$361.95	$112.20
HOUSTON (TX)	$366.71	$116.96
BEAUMONT (TX)	$339.26	$110.39
FORT WORTH (TX)	$360.47	$112.48
AUSTIN (TX)	$379.93	$113.83
REST OF TEXAS (TX)	$349.81	$111.13
UTAH (UT)	$347.28	$110.86
VIRGINIA (VA)	$357.49	$110.26
VIRGIN ISLANDS (VI)	$367.65	$113.37
VERMONT (VT)	$357.69	$108.69
SEATTLE (KING CNTY) (WA)	$429.84	$121.24
REST OF WASHINGTON (WA)	$378.34	$113.50
WISCONSIN (WI)	$347.13	$106.18
WEST VIRGINIA (WV)	$332.30	$113.73
WYOMING** (WY)	$362.48	$110.97

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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

Each code is assigned three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — which reflect the relative resources involved in furnishing the service. These RVUs are each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. The practice-expense RVU differs depending on whether the service is reported as non-facility (e.g., physician office) or facility (e.g., hospital, ASC), which is why the two settings typically show different allowed amounts. The conversion factor is updated annually and can change due to legislation or budget-neutrality adjustments.

RVUs — work 2.39, practice expense 8.27 (non-facility) / 0.74 (facility), malpractice 0.26 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national or locality-adjusted PFS data; actual payment may differ.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Always verify current rates and applicability with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

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

In the facility setting, Medicare assumes the hospital or facility — not the physician's practice — incurs most of the overhead costs, so the practice-expense RVU used in the calculation is lower, resulting in a lower physician payment for that setting.

Does this amount reflect what my specific Medicare Administrative Contractor will pay?

Not necessarily. The figures shown are calculated using national GPCI/locality data for a given year; your MAC's actual payment can vary slightly based on locality-specific adjustments, contractor pricing, or claim-specific modifiers.

Will this code always pay the same amount every year?

No. The conversion factor, RVUs, and GPCIs are updated annually (and sometimes mid-year), so the allowed amount for this code can change from one year to the next.

Can modifiers change the reimbursement for this code?

Yes. Modifiers such as bilateral, multiple-procedure, or assistant-at-surgery indicators can increase or decrease the base allowed amount; this page does not reflect modifier-adjusted pricing.

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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.