Medicare Reimbursement for CPT 20500

CPT 20500 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code at the national level, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings. Actual payment can vary by geographic locality and other claim-specific factors.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$128.59	$83.50
ALASKA* (AK)	$152.54	$104.52
ALABAMA (AL)	$116.19	$76.74
ARKANSAS (AR)	$114.63	$75.89
ARIZONA (AZ)	$125.34	$81.64
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$163.23	$99.65
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$166.33	$101.31
OXNARD-THOUSAND OAKS-VENTURA (CA)	$142.77	$89.47
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$143.60	$90.25
NAPA (CA)	$154.78	$95.35
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$163.40	$99.82
VALLEJO (CA)	$154.54	$95.11
BAKERSFIELD (CA)	$135.28	$85.86
CHICO (CA)	$134.83	$85.41
FRESNO (CA)	$134.83	$85.41
HANFORD-CORCORAN (CA)	$134.83	$85.41
MADERA (CA)	$134.83	$85.41
MERCED (CA)	$134.83	$85.41
MODESTO (CA)	$134.83	$85.41
REDDING (CA)	$134.83	$85.41
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$136.46	$87.04
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$141.11	$88.67
SALINAS (CA)	$140.57	$88.31
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$167.03	$102.01
SANTA CRUZ-WATSONVILLE (CA)	$144.74	$89.95
SANTA ROSA-PETALUMA (CA)	$146.18	$90.81
STOCKTON (CA)	$134.83	$85.41
VISALIA (CA)	$134.83	$85.41
YUBA CITY (CA)	$134.83	$85.41
EL CENTRO (CA)	$134.86	$85.44
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$143.59	$89.66
SAN LUIS OBISPO-PASO ROBLES (CA)	$138.35	$86.99
SANTA MARIA-SANTA BARBARA (CA)	$141.02	$88.45
REST OF CALIFORNIA (CA)	$134.83	$85.41
COLORADO (CO)	$133.23	$85.26
CONNECTICUT (CT)	$136.78	$88.22
DC + MD/VA SUBURBS (DC)	$145.98	$92.86
DELAWARE (DE)	$127.31	$82.76
FORT LAUDERDALE (FL)	$133.71	$88.03
MIAMI (FL)	$139.61	$92.67
REST OF FLORIDA (FL)	$127.51	$84.41
ATLANTA (GA)	$131.04	$85.22
REST OF GEORGIA (GA)	$120.72	$80.50
HAWAII, GUAM (HI)	$137.70	$86.43
IOWA (IA)	$118.62	$77.36
IDAHO (ID)	$119.41	$77.92
EAST ST. LOUIS (IL)	$127.13	$85.64
SUBURBAN CHICAGO (IL)	$134.96	$88.65
CHICAGO (IL)	$135.78	$90.47
REST OF ILLINOIS (IL)	$124.29	$83.13
INDIANA (IN)	$120.04	$78.24
KANSAS (KS)	$118.25	$77.49
KENTUCKY (KY)	$119.08	$79.00
NEW ORLEANS (LA)	$124.45	$82.02
REST OF LOUISIANA (LA)	$118.97	$79.07
METROPOLITAN BOSTON (MA)	$145.63	$91.79
REST OF MASSACHUSETTS (MA)	$132.58	$85.10
BALTIMORE/SURR. CNTYS (MD)	$136.42	$88.04
REST OF MARYLAND (MD)	$129.58	$83.95
SOUTHERN MAINE (ME)	$126.01	$81.32
REST OF MAINE (ME)	$120.15	$78.67
DETROIT (MI)	$129.17	$85.65
REST OF MICHIGAN (MI)	$122.12	$80.95
MINNESOTA (MN)	$127.44	$81.04
METROPOLITAN ST. LOUIS (MO)	$124.68	$81.75
METROPOLITAN KANSAS CITY (MO)	$123.49	$81.15
REST OF MISSOURI (MO)	$117.17	$78.30
MISSISSIPPI (MS)	$115.91	$77.09
MONTANA** (MT)	$128.58	$83.49
NORTH CAROLINA (NC)	$121.30	$79.23
NORTH DAKOTA** (ND)	$125.62	$80.53
NEBRASKA (NE)	$119.18	$77.56
NEW HAMPSHIRE (NH)	$131.32	$84.38
NORTHERN NJ (NJ)	$144.66	$92.35
REST OF NEW JERSEY (NJ)	$138.28	$89.04
NEW MEXICO (NM)	$122.81	$81.46
NEVADA** (NV)	$127.84	$82.70
MANHATTAN (NY)	$147.46	$95.06
NYC SUBURBS/LONG ISLAND (NY)	$151.03	$97.41
POUGHKPSIE/N NYC SUBURBS (NY)	$139.30	$89.92
QUEENS (NY)	$148.37	$95.08
REST OF NEW YORK (NY)	$123.01	$80.18
OHIO (OH)	$121.51	$80.35
OKLAHOMA (OK)	$118.72	$78.45
PORTLAND (OR)	$137.06	$86.97
REST OF OREGON (OR)	$126.78	$81.87
METROPOLITAN PHILADELPHIA (PA)	$133.67	$86.73
REST OF PENNSYLVANIA (PA)	$121.61	$80.21
PUERTO RICO (PR)	$129.42	$83.83
RHODE ISLAND (RI)	$131.55	$84.97
SOUTH CAROLINA (SC)	$121.62	$79.96
SOUTH DAKOTA** (SD)	$125.27	$80.18
TENNESSEE (TN)	$118.83	$77.84
BRAZORIA (TX)	$127.09	$82.40
DALLAS (TX)	$127.93	$83.02
GALVESTON (TX)	$127.49	$82.72
HOUSTON (TX)	$130.24	$85.46
BEAUMONT (TX)	$120.87	$79.84
FORT WORTH (TX)	$127.18	$82.72
AUSTIN (TX)	$132.85	$85.15
REST OF TEXAS (TX)	$123.93	$81.14
UTAH (UT)	$123.17	$80.79
VIRGINIA (VA)	$125.73	$81.40
VIRGIN ISLANDS (VI)	$129.42	$83.83
VERMONT (VT)	$125.30	$80.66
SEATTLE (KING CNTY) (WA)	$148.34	$93.01
REST OF WASHINGTON (WA)	$132.28	$84.79
WISCONSIN (WI)	$121.69	$78.49
WEST VIRGINIA (WV)	$120.03	$80.85
WYOMING** (WY)	$127.29	$82.20

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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

Medicare's PFS payment is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted using Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs differ depending on whether the service is furnished in a non-facility setting (like a private office, where the practice bears more overhead) versus a facility setting (like a hospital, where the facility bills separately for overhead), which is why non-facility and facility amounts differ. These national amounts are then further adjusted locally based on each area's cost-of-living and practice-cost differences.

RVUs — work 1.25, practice expense 2.45 (non-facility) / 1.1 (facility), malpractice 0.15 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This 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 insurer is responsible for the rest.
Actual payment varies by locality GPCIs, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why is the facility amount lower than the non-facility amount?

In a facility setting, the facility (e.g., hospital) bills separately for overhead and supplies, so the practice-expense RVU assigned to the physician's service is lower than when the same service is performed in a non-facility setting like an office.

Does this amount reflect what my local Medicare contractor will actually pay?

Not exactly. The national amount is adjusted by locality-specific GPICs, so the actual allowed amount in your area may be higher or lower than the national figure shown here.

Can modifiers change the reimbursement for this code?

Yes. Modifiers such as bilateral, multiple procedure, or assistant-at-surgery indicators can increase or reduce the base allowed amount, and those adjustments aren't reflected in this baseline figure.

Why might the conversion factor or RVUs change next year?

CMS updates the conversion factor and RVUs annually through rulemaking, often incorporating budget-neutrality adjustments, so the allowed amount for this code can shift from year to 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.