Medicare Reimbursement for CPT 20251

CPT 20251 is a procedure code reported to Medicare and other payers; the descriptive text itself is proprietary to the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both nationally and adjustable by locality, and broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$421.19	$421.19
ALASKA* (AK)	$501.14	$501.14
ALABAMA (AL)	$374.70	$374.70
ARKANSAS (AR)	$369.00	$369.00
ARIZONA (AZ)	$407.64	$407.64
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$480.55	$480.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$487.53	$487.53
OXNARD-THOUSAND OAKS-VENTURA (CA)	$438.14	$438.14
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$443.02	$443.02
NAPA (CA)	$462.69	$462.69
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$482.43	$482.43
VALLEJO (CA)	$459.97	$459.97
BAKERSFIELD (CA)	$420.27	$420.27
CHICO (CA)	$415.85	$415.85
FRESNO (CA)	$415.85	$415.85
HANFORD-CORCORAN (CA)	$415.85	$415.85
MADERA (CA)	$415.85	$415.85
MERCED (CA)	$415.85	$415.85
MODESTO (CA)	$415.85	$415.85
REDDING (CA)	$415.85	$415.85
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$433.61	$433.61
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$431.40	$431.40
SALINAS (CA)	$429.76	$429.76
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$495.24	$495.24
SANTA CRUZ-WATSONVILLE (CA)	$437.94	$437.94
SANTA ROSA-PETALUMA (CA)	$441.94	$441.94
STOCKTON (CA)	$415.85	$415.85
VISALIA (CA)	$415.85	$415.85
YUBA CITY (CA)	$415.85	$415.85
EL CENTRO (CA)	$416.12	$416.12
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$436.54	$436.54
SAN LUIS OBISPO-PASO ROBLES (CA)	$423.56	$423.56
SANTA MARIA-SANTA BARBARA (CA)	$430.45	$430.45
REST OF CALIFORNIA (CA)	$415.85	$415.85
COLORADO (CO)	$422.76	$422.76
CONNECTICUT (CT)	$450.37	$450.37
DC + MD/VA SUBURBS (DC)	$469.44	$469.44
DELAWARE (DE)	$414.36	$414.36
FORT LAUDERDALE (FL)	$468.32	$468.32
MIAMI (FL)	$513.32	$513.32
REST OF FLORIDA (FL)	$441.18	$441.18
ATLANTA (GA)	$435.76	$435.76
REST OF GEORGIA (GA)	$412.46	$412.46
HAWAII, GUAM (HI)	$422.42	$422.42
IOWA (IA)	$372.51	$372.51
IDAHO (ID)	$377.62	$377.62
EAST ST. LOUIS (IL)	$463.06	$463.06
SUBURBAN CHICAGO (IL)	$470.14	$470.14
CHICAGO (IL)	$495.19	$495.19
REST OF ILLINOIS (IL)	$436.80	$436.80
INDIANA (IN)	$379.59	$379.59
KANSAS (KS)	$376.47	$376.47
KENTUCKY (KY)	$396.56	$396.56
NEW ORLEANS (LA)	$418.14	$418.14
REST OF LOUISIANA (LA)	$398.23	$398.23
METROPOLITAN BOSTON (MA)	$457.52	$457.52
REST OF MASSACHUSETTS (MA)	$422.42	$422.42
BALTIMORE/SURR. CNTYS (MD)	$450.40	$450.40
REST OF MARYLAND (MD)	$420.65	$420.65
SOUTHERN MAINE (ME)	$399.11	$399.11
REST OF MAINE (ME)	$385.88	$385.88
DETROIT (MI)	$452.94	$452.94
REST OF MICHIGAN (MI)	$412.73	$412.73
MINNESOTA (MN)	$387.35	$387.35
METROPOLITAN ST. LOUIS (MO)	$412.69	$412.69
METROPOLITAN KANSAS CITY (MO)	$408.97	$408.97
REST OF MISSOURI (MO)	$394.99	$394.99
MISSISSIPPI (MS)	$381.78	$381.78
MONTANA** (MT)	$421.07	$421.07
NORTH CAROLINA (NC)	$389.15	$389.15
NORTH DAKOTA** (ND)	$388.25	$388.25
NEBRASKA (NE)	$372.89	$372.89
NEW HAMPSHIRE (NH)	$421.61	$421.61
NORTHERN NJ (NJ)	$465.40	$465.40
REST OF NEW JERSEY (NJ)	$450.52	$450.52
NEW MEXICO (NM)	$417.44	$417.44
NEVADA** (NV)	$412.11	$412.11
MANHATTAN (NY)	$494.66	$494.66
NYC SUBURBS/LONG ISLAND (NY)	$514.53	$514.53
POUGHKPSIE/N NYC SUBURBS (NY)	$458.26	$458.26
QUEENS (NY)	$490.26	$490.26
REST OF NEW YORK (NY)	$395.75	$395.75
OHIO (OH)	$406.02	$406.02
OKLAHOMA (OK)	$389.63	$389.63
PORTLAND (OR)	$429.88	$429.88
REST OF OREGON (OR)	$404.00	$404.00
METROPOLITAN PHILADELPHIA (PA)	$442.59	$442.59
REST OF PENNSYLVANIA (PA)	$403.43	$403.43
PUERTO RICO (PR)	$422.33	$422.33
RHODE ISLAND (RI)	$424.66	$424.66
SOUTH CAROLINA (SC)	$399.24	$399.24
SOUTH DAKOTA** (SD)	$384.37	$384.37
TENNESSEE (TN)	$379.19	$379.19
BRAZORIA (TX)	$408.86	$408.86
DALLAS (TX)	$414.27	$414.27
GALVESTON (TX)	$411.88	$411.88
HOUSTON (TX)	$442.27	$442.27
BEAUMONT (TX)	$401.11	$401.11
FORT WORTH (TX)	$413.20	$413.20
AUSTIN (TX)	$425.64	$425.64
REST OF TEXAS (TX)	$406.66	$406.66
UTAH (UT)	$404.77	$404.77
VIRGINIA (VA)	$401.84	$401.84
VIRGIN ISLANDS (VI)	$422.33	$422.33
VERMONT (VT)	$392.00	$392.00
SEATTLE (KING CNTY) (WA)	$461.07	$461.07
REST OF WASHINGTON (WA)	$419.86	$419.86
WISCONSIN (WI)	$375.28	$375.28
WEST VIRGINIA (WV)	$421.59	$421.59
WYOMING** (WY)	$406.77	$406.77

Look up another code or locality →

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

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 Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, to reflect local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs can differ between non-facility (e.g., office) and facility (e.g., hospital) settings, though for this code the published PE RVU is the same in both settings, so the resulting national allowed amount does not differ by site of service here.

RVUs — work 5.58, practice expense 5.37 (non-facility) / 5.37 (facility), malpractice 1.66 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates based on the national PFS formula and may not reflect your exact payment.
Medicare typically pays 80% of the approved amount after the patient meets their deductible; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary by locality GPCIs, applicable modifiers, claims-processing adjustments, sequestration, and annual budget-neutrality changes to the conversion factor.
Always confirm the current, locality-specific allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the amount shown differ from what my MAC paid?

The MAC applies your specific locality GPCIs, any modifiers on the claim, sequestration, and other adjustments that aren't reflected in this generic national estimate.

Why are the non-facility and facility amounts the same for this code?

The practice-expense RVU used in the fee schedule calculation is identical for both settings for CPT 20251, so the site-of-service differential that affects some codes does not apply here.

Does this amount include the patient's share?

No. The figure represents the total Medicare-approved amount; Medicare generally pays 80% of this after the deductible, with the patient or secondary insurance covering the rest.

Will this amount change next year?

Yes. RVUs, GPCIs, and the conversion factor are updated annually (and sometimes through mid-year corrections), so the allowed amount can change each calendar 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.