Medicare Reimbursement for CPT Code 20245

CPT code 20245 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 Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$303.28	$303.28
ALASKA* (AK)	$389.96	$389.96
ALABAMA (AL)	$278.96	$278.96
ARKANSAS (AR)	$276.00	$276.00
ARIZONA (AZ)	$295.97	$295.97
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$331.53	$331.53
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$335.81	$335.81
OXNARD-THOUSAND OAKS-VENTURA (CA)	$308.78	$308.78
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$312.83	$312.83
NAPA (CA)	$321.49	$321.49
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$332.72	$332.72
VALLEJO (CA)	$319.77	$319.77
BAKERSFIELD (CA)	$300.27	$300.27
CHICO (CA)	$297.32	$297.32
FRESNO (CA)	$297.32	$297.32
HANFORD-CORCORAN (CA)	$297.32	$297.32
MADERA (CA)	$297.32	$297.32
MERCED (CA)	$297.32	$297.32
MODESTO (CA)	$297.32	$297.32
REDDING (CA)	$297.32	$297.32
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$308.63	$308.63
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$305.91	$305.91
SALINAS (CA)	$304.64	$304.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$340.68	$340.68
SANTA CRUZ-WATSONVILLE (CA)	$306.77	$306.77
SANTA ROSA-PETALUMA (CA)	$309.47	$309.47
STOCKTON (CA)	$297.32	$297.32
VISALIA (CA)	$297.32	$297.32
YUBA CITY (CA)	$297.32	$297.32
EL CENTRO (CA)	$297.49	$297.49
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$307.35	$307.35
SAN LUIS OBISPO-PASO ROBLES (CA)	$300.45	$300.45
SANTA MARIA-SANTA BARBARA (CA)	$304.57	$304.57
REST OF CALIFORNIA (CA)	$297.32	$297.32
COLORADO (CO)	$302.60	$302.60
CONNECTICUT (CT)	$320.16	$320.16
DC + MD/VA SUBURBS (DC)	$330.76	$330.76
DELAWARE (DE)	$299.84	$299.84
FORT LAUDERDALE (FL)	$332.56	$332.56
MIAMI (FL)	$359.89	$359.89
REST OF FLORIDA (FL)	$317.72	$317.72
ATLANTA (GA)	$312.08	$312.08
REST OF GEORGIA (GA)	$302.15	$302.15
HAWAII, GUAM (HI)	$298.49	$298.49
IOWA (IA)	$275.94	$275.94
IDAHO (ID)	$278.97	$278.97
EAST ST. LOUIS (IL)	$333.02	$333.02
SUBURBAN CHICAGO (IL)	$333.69	$333.69
CHICAGO (IL)	$350.43	$350.43
REST OF ILLINOIS (IL)	$316.69	$316.69
INDIANA (IN)	$279.94	$279.94
KANSAS (KS)	$278.89	$278.89
KENTUCKY (KY)	$292.22	$292.22
NEW ORLEANS (LA)	$303.75	$303.75
REST OF LOUISIANA (LA)	$293.43	$293.43
METROPOLITAN BOSTON (MA)	$321.56	$321.56
REST OF MASSACHUSETTS (MA)	$303.15	$303.15
BALTIMORE/SURR. CNTYS (MD)	$320.03	$320.03
REST OF MARYLAND (MD)	$303.23	$303.23
SOUTHERN MAINE (ME)	$289.68	$289.68
REST OF MAINE (ME)	$284.20	$284.20
DETROIT (MI)	$324.79	$324.79
REST OF MICHIGAN (MI)	$301.47	$301.47
MINNESOTA (MN)	$280.70	$280.70
METROPOLITAN ST. LOUIS (MO)	$299.86	$299.86
METROPOLITAN KANSAS CITY (MO)	$298.03	$298.03
REST OF MISSOURI (MO)	$292.32	$292.32
MISSISSIPPI (MS)	$284.01	$284.01
MONTANA** (MT)	$303.21	$303.21
NORTH CAROLINA (NC)	$285.74	$285.74
NORTH DAKOTA** (ND)	$282.45	$282.45
NEBRASKA (NE)	$275.86	$275.86
NEW HAMPSHIRE (NH)	$301.88	$301.88
NORTHERN NJ (NJ)	$329.63	$329.63
REST OF NEW JERSEY (NJ)	$321.20	$321.20
NEW MEXICO (NM)	$304.29	$304.29
NEVADA** (NV)	$297.50	$297.50
MANHATTAN (NY)	$348.13	$348.13
NYC SUBURBS/LONG ISLAND (NY)	$359.60	$359.60
POUGHKPSIE/N NYC SUBURBS (NY)	$326.36	$326.36
QUEENS (NY)	$344.54	$344.54
REST OF NEW YORK (NY)	$289.22	$289.22
OHIO (OH)	$297.23	$297.23
OKLAHOMA (OK)	$287.67	$287.67
PORTLAND (OR)	$305.51	$305.51
REST OF OREGON (OR)	$292.57	$292.57
METROPOLITAN PHILADELPHIA (PA)	$316.55	$316.55
REST OF PENNSYLVANIA (PA)	$295.38	$295.38
PUERTO RICO (PR)	$303.56	$303.56
RHODE ISLAND (RI)	$305.61	$305.61
SOUTH CAROLINA (SC)	$292.49	$292.49
SOUTH DAKOTA** (SD)	$279.99	$279.99
TENNESSEE (TN)	$280.42	$280.42
BRAZORIA (TX)	$296.47	$296.47
DALLAS (TX)	$299.77	$299.77
GALVESTON (TX)	$298.30	$298.30
HOUSTON (TX)	$317.52	$317.52
BEAUMONT (TX)	$294.24	$294.24
FORT WORTH (TX)	$299.50	$299.50
AUSTIN (TX)	$303.90	$303.90
REST OF TEXAS (TX)	$296.16	$296.16
UTAH (UT)	$295.33	$295.33
VIRGINIA (VA)	$291.73	$291.73
VIRGIN ISLANDS (VI)	$303.56	$303.56
VERMONT (VT)	$285.23	$285.23
SEATTLE (KING CNTY) (WA)	$323.16	$323.16
REST OF WASHINGTON (WA)	$301.30	$301.30
WISCONSIN (WI)	$275.95	$275.95
WEST VIRGINIA (WV)	$308.86	$308.86
WYOMING** (WY)	$294.16	$294.16

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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 allowed amount is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to account for regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two allowed amounts can differ.

RVUs — work 5.85, practice expense 2.18 (non-facility) / 2.18 (facility), malpractice 1.05 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual payment can vary by claim, modifiers, and payer-specific adjustments.
Medicare typically pays 80% of the allowed amount after the patient meets their annual Part B deductible; the patient or secondary insurer is generally responsible for the remainder.
Amounts shown reflect national or locality-adjusted PFS rates and do not include sequestration reductions, which are applied separately by Medicare.
The conversion factor and RVUs are updated annually and may be revised mid-year due to budget-neutrality adjustments or legislative action.
Always confirm final payment amounts and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The two settings use different practice-expense RVU values, reflecting that overhead costs (supplies, staff, equipment) are typically borne by the facility rather than the billing physician when the service is performed in a facility setting.

Does this amount represent what Medicare actually pays?

No — it represents the PFS allowed amount. Medicare generally reimburses 80% of this amount after the deductible is met, with the patient or secondary payer covering the rest, subject to any applicable modifiers or adjustments.

Why might my local Medicare payment differ from the national figure?

Local payments are adjusted using Geographic Practice Cost Indices (GPCIs) that reflect regional differences in wages, rent, and malpractice costs, so the same code can have different allowed amounts in different localities.

Can this amount change during the year?

Yes. CMS may issue mid-year corrections, and budget-neutrality adjustments or legislative changes can alter the conversion factor or RVUs used in the calculation.

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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.