Medicare Reimbursement for CPT 20250
This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 20250, a procedure code defined by the American Medical Association. Because CPT descriptors are proprietary, this page does not reproduce the code's official description. The figures shown reflect the national PFS rate as well as locality-adjusted estimates, broken out by non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $387.45 | $387.45 |
| ALASKA* (AK) | $461.09 | $461.09 |
| ALABAMA (AL) | $345.08 | $345.08 |
| ARKANSAS (AR) | $339.87 | $339.87 |
| ARIZONA (AZ) | $375.17 | $375.17 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $445.03 | $445.03 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $451.63 | $451.63 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $404.68 | $404.68 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $409.05 | $409.05 |
| NAPA (CA) | $428.06 | $428.06 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $446.69 | $446.69 |
| VALLEJO (CA) | $425.67 | $425.67 |
| BAKERSFIELD (CA) | $387.88 | $387.88 |
| CHICO (CA) | $383.99 | $383.99 |
| FRESNO (CA) | $383.99 | $383.99 |
| HANFORD-CORCORAN (CA) | $383.99 | $383.99 |
| MADERA (CA) | $383.99 | $383.99 |
| MERCED (CA) | $383.99 | $383.99 |
| MODESTO (CA) | $383.99 | $383.99 |
| REDDING (CA) | $383.99 | $383.99 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $399.61 | $399.61 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $398.56 | $398.56 |
| SALINAS (CA) | $397.04 | $397.04 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $458.41 | $458.41 |
| SANTA CRUZ-WATSONVILLE (CA) | $404.85 | $404.85 |
| SANTA ROSA-PETALUMA (CA) | $408.58 | $408.58 |
| STOCKTON (CA) | $383.99 | $383.99 |
| VISALIA (CA) | $383.99 | $383.99 |
| YUBA CITY (CA) | $383.99 | $383.99 |
| EL CENTRO (CA) | $384.23 | $384.23 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $403.44 | $403.44 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $391.28 | $391.28 |
| SANTA MARIA-SANTA BARBARA (CA) | $397.72 | $397.72 |
| REST OF CALIFORNIA (CA) | $383.99 | $383.99 |
| COLORADO (CO) | $389.66 | $389.66 |
| CONNECTICUT (CT) | $414.14 | $414.14 |
| DC + MD/VA SUBURBS (DC) | $432.29 | $432.29 |
| DELAWARE (DE) | $381.33 | $381.33 |
| FORT LAUDERDALE (FL) | $429.06 | $429.06 |
| MIAMI (FL) | $468.97 | $468.97 |
| REST OF FLORIDA (FL) | $404.51 | $404.51 |
| ATLANTA (GA) | $400.47 | $400.47 |
| REST OF GEORGIA (GA) | $378.49 | $378.49 |
| HAWAII, GUAM (HI) | $390.17 | $390.17 |
| IOWA (IA) | $343.62 | $343.62 |
| IDAHO (ID) | $348.18 | $348.18 |
| EAST ST. LOUIS (IL) | $423.32 | $423.32 |
| SUBURBAN CHICAGO (IL) | $430.86 | $430.86 |
| CHICAGO (IL) | $452.63 | $452.63 |
| REST OF ILLINOIS (IL) | $400.14 | $400.14 |
| INDIANA (IN) | $350.00 | $350.00 |
| KANSAS (KS) | $346.97 | $346.97 |
| KENTUCKY (KY) | $364.47 | $364.47 |
| NEW ORLEANS (LA) | $384.07 | $384.07 |
| REST OF LOUISIANA (LA) | $365.89 | $365.89 |
| METROPOLITAN BOSTON (MA) | $421.93 | $421.93 |
| REST OF MASSACHUSETTS (MA) | $389.25 | $389.25 |
| BALTIMORE/SURR. CNTYS (MD) | $414.10 | $414.10 |
| REST OF MARYLAND (MD) | $387.18 | $387.18 |
| SOUTHERN MAINE (ME) | $367.93 | $367.93 |
| REST OF MAINE (ME) | $355.44 | $355.44 |
| DETROIT (MI) | $414.96 | $414.96 |
| REST OF MICHIGAN (MI) | $378.98 | $378.98 |
| MINNESOTA (MN) | $358.04 | $358.04 |
| METROPOLITAN ST. LOUIS (MO) | $379.40 | $379.40 |
| METROPOLITAN KANSAS CITY (MO) | $375.98 | $375.98 |
| REST OF MISSOURI (MO) | $362.77 | $362.77 |
| MISSISSIPPI (MS) | $351.14 | $351.14 |
| MONTANA** (MT) | $387.35 | $387.35 |
| NORTH CAROLINA (NC) | $358.48 | $358.48 |
| NORTH DAKOTA** (ND) | $358.48 | $358.48 |
| NEBRASKA (NE) | $344.05 | $344.05 |
| NEW HAMPSHIRE (NH) | $388.31 | $388.31 |
| NORTHERN NJ (NJ) | $428.56 | $428.56 |
| REST OF NEW JERSEY (NJ) | $414.55 | $414.55 |
| NEW MEXICO (NM) | $383.17 | $383.17 |
| NEVADA** (NV) | $379.48 | $379.48 |
| MANHATTAN (NY) | $454.33 | $454.33 |
| NYC SUBURBS/LONG ISLAND (NY) | $472.13 | $472.13 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $421.42 | $421.42 |
| QUEENS (NY) | $450.70 | $450.70 |
| REST OF NEW YORK (NY) | $364.48 | $364.48 |
| OHIO (OH) | $373.08 | $373.08 |
| OKLAHOMA (OK) | $358.42 | $358.42 |
| PORTLAND (OR) | $396.50 | $396.50 |
| REST OF OREGON (OR) | $372.29 | $372.29 |
| METROPOLITAN PHILADELPHIA (PA) | $406.86 | $406.86 |
| REST OF PENNSYLVANIA (PA) | $370.85 | $370.85 |
| PUERTO RICO (PR) | $388.59 | $388.59 |
| RHODE ISLAND (RI) | $390.99 | $390.99 |
| SOUTH CAROLINA (SC) | $367.24 | $367.24 |
| SOUTH DAKOTA** (SD) | $355.07 | $355.07 |
| TENNESSEE (TN) | $349.43 | $349.43 |
| BRAZORIA (TX) | $376.55 | $376.55 |
| DALLAS (TX) | $381.37 | $381.37 |
| GALVESTON (TX) | $379.23 | $379.23 |
| HOUSTON (TX) | $405.95 | $405.95 |
| BEAUMONT (TX) | $368.72 | $368.72 |
| FORT WORTH (TX) | $380.31 | $380.31 |
| AUSTIN (TX) | $392.07 | $392.07 |
| REST OF TEXAS (TX) | $374.07 | $374.07 |
| UTAH (UT) | $372.30 | $372.30 |
| VIRGINIA (VA) | $370.23 | $370.23 |
| VIRGIN ISLANDS (VI) | $388.59 | $388.59 |
| VERMONT (VT) | $361.66 | $361.66 |
| SEATTLE (KING CNTY) (WA) | $425.49 | $425.49 |
| REST OF WASHINGTON (WA) | $386.99 | $386.99 |
| WISCONSIN (WI) | $346.58 | $346.58 |
| WEST VIRGINIA (WV) | $386.24 | $386.24 |
| WYOMING** (WY) | $374.77 | $374.77 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 1 unit 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 fee schedule amount for a given code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates can differ because the practice-expense RVU often varies depending on whether the service is performed in a physician's office (non-facility) versus a hospital or other facility setting, reflecting different overhead costs. For this code, the non-facility and facility amounts shown happen to align, but that is not true for every code.
RVUs — work 5.06, practice expense 5.08 (non-facility) / 5.08 (facility), malpractice 1.46 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This amount is an estimate only, not a guarantee of payment.
- 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.
- Actual payment can vary by locality, applicable modifiers, claim-specific circumstances, sequestration, and annual budget-neutrality adjustments.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the fee differ between non-facility and facility settings?
The practice-expense RVU component can differ by setting because overhead costs (equipment, supplies, staff time) are typically higher when a service is performed in a physician's office compared to a hospital or facility, where some costs are already covered by a facility payment.
Does this amount reflect what my practice will actually be paid?
No. It is a national or locality-estimated allowed amount based on standard RVUs and the conversion factor. Final payment depends on your specific Medicare Administrative Contractor, locality GPCIs, modifiers, and any applicable adjustments.
Why isn't the CPT code description shown on this page?
CPT codes and their descriptors are copyrighted and licensed by the American Medical Association. This page can reference the code number but cannot reproduce the official descriptor text.
What causes the fee schedule amount to change year to year?
The conversion factor, RVU values, and GPCIs are updated annually by CMS, and budget-neutrality adjustments required by law can shift amounts even when RVUs for a specific code stay the same.
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.
Bill accurately, get paid faster
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free