Medicare Reimbursement for CPT 20525

CPT code 20525 refers to a specific procedure defined by the American Medical Association; its exact 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, broken out separately for non-facility (e.g., office) and facility (e.g., hospital) settings. All figures shown are estimates derived from Medicare's standard payment formula.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$497.01	$233.14
ALASKA* (AK)	$568.11	$287.09
ALABAMA (AL)	$442.47	$211.59
ARKANSAS (AR)	$435.59	$208.93
ARIZONA (AZ)	$482.68	$226.99
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$642.77	$270.71
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$655.39	$274.89
OXNARD-THOUSAND OAKS-VENTURA (CA)	$557.39	$245.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$560.15	$248.00
NAPA (CA)	$607.81	$260.04
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$643.51	$271.46
VALLEJO (CA)	$606.73	$258.96
BAKERSFIELD (CA)	$525.11	$235.91
CHICO (CA)	$523.27	$234.07
FRESNO (CA)	$523.27	$234.07
HANFORD-CORCORAN (CA)	$523.27	$234.07
MADERA (CA)	$523.27	$234.07
MERCED (CA)	$523.27	$234.07
MODESTO (CA)	$523.27	$234.07
REDDING (CA)	$523.27	$234.07
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$530.37	$241.17
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$549.56	$242.68
SALINAS (CA)	$547.55	$241.72
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$658.45	$277.96
SANTA CRUZ-WATSONVILLE (CA)	$566.54	$245.94
SANTA ROSA-PETALUMA (CA)	$572.25	$248.22
STOCKTON (CA)	$523.27	$234.07
VISALIA (CA)	$523.27	$234.07
YUBA CITY (CA)	$523.27	$234.07
EL CENTRO (CA)	$523.38	$234.18
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$560.87	$245.29
SAN LUIS OBISPO-PASO ROBLES (CA)	$538.74	$238.19
SANTA MARIA-SANTA BARBARA (CA)	$549.72	$242.05
REST OF CALIFORNIA (CA)	$523.27	$234.07
COLORADO (CO)	$516.58	$235.83
CONNECTICUT (CT)	$531.64	$247.45
DC + MD/VA SUBURBS (DC)	$569.75	$258.92
DELAWARE (DE)	$491.04	$230.34
FORT LAUDERDALE (FL)	$519.49	$252.20
MIAMI (FL)	$545.46	$270.77
REST OF FLORIDA (FL)	$492.27	$240.01
ATLANTA (GA)	$507.54	$239.45
REST OF GEORGIA (GA)	$462.39	$227.02
HAWAII, GUAM (HI)	$537.01	$236.99
IOWA (IA)	$453.14	$211.70
IDAHO (ID)	$456.61	$213.85
EAST ST. LOUIS (IL)	$490.58	$247.82
SUBURBAN CHICAGO (IL)	$524.54	$253.55
CHICAGO (IL)	$528.16	$262.97
REST OF ILLINOIS (IL)	$478.12	$237.21
INDIANA (IN)	$459.41	$214.81
KANSAS (KS)	$451.54	$213.00
KENTUCKY (KY)	$455.20	$220.62
NEW ORLEANS (LA)	$478.78	$230.48
REST OF LOUISIANA (LA)	$454.71	$221.19
METROPOLITAN BOSTON (MA)	$569.09	$254.03
REST OF MASSACHUSETTS (MA)	$513.44	$235.59
BALTIMORE/SURR. CNTYS (MD)	$530.33	$247.20
REST OF MARYLAND (MD)	$500.67	$233.63
SOUTHERN MAINE (ME)	$485.63	$224.14
REST OF MAINE (ME)	$459.89	$217.14
DETROIT (MI)	$499.54	$244.91
REST OF MICHIGAN (MI)	$468.55	$227.64
MINNESOTA (MN)	$491.92	$220.40
METROPOLITAN ST. LOUIS (MO)	$479.78	$228.58
METROPOLITAN KANSAS CITY (MO)	$474.55	$226.78
REST OF MISSOURI (MO)	$446.79	$219.34
MISSISSIPPI (MS)	$441.25	$214.06
MONTANA** (MT)	$496.96	$233.09
NORTH CAROLINA (NC)	$464.95	$218.76
NORTH DAKOTA** (ND)	$483.91	$220.04
NEBRASKA (NE)	$455.59	$212.05
NEW HAMPSHIRE (NH)	$509.00	$234.31
NORTHERN NJ (NJ)	$563.32	$257.23
REST OF NEW JERSEY (NJ)	$536.85	$248.71
NEW MEXICO (NM)	$471.58	$229.61
NEVADA** (NV)	$493.68	$229.55
MANHATTAN (NY)	$575.57	$268.96
NYC SUBURBS/LONG ISLAND (NY)	$591.26	$277.52
POUGHKPSIE/N NYC SUBURBS (NY)	$540.99	$252.06
QUEENS (NY)	$579.59	$267.70
REST OF NEW YORK (NY)	$472.47	$221.80
OHIO (OH)	$465.89	$224.97
OKLAHOMA (OK)	$453.60	$217.97
PORTLAND (OR)	$533.14	$239.98
REST OF OREGON (OR)	$489.02	$226.21
METROPOLITAN PHILADELPHIA (PA)	$518.08	$243.40
REST OF PENNSYLVANIA (PA)	$466.30	$224.07
PUERTO RICO (PR)	$500.63	$233.86
RHODE ISLAND (RI)	$508.69	$236.11
SOUTH CAROLINA (SC)	$466.36	$222.55
SOUTH DAKOTA** (SD)	$482.37	$218.50
TENNESSEE (TN)	$454.06	$214.21
BRAZORIA (TX)	$489.84	$228.35
DALLAS (TX)	$493.47	$230.66
GALVESTON (TX)	$491.62	$229.60
HOUSTON (TX)	$503.70	$241.68
BEAUMONT (TX)	$463.06	$222.95
FORT WORTH (TX)	$490.16	$229.99
AUSTIN (TX)	$515.59	$236.42
REST OF TEXAS (TX)	$476.52	$226.11
UTAH (UT)	$473.17	$225.14
VIRGINIA (VA)	$484.41	$225.03
VIRGIN ISLANDS (VI)	$500.63	$233.86
VERMONT (VT)	$482.52	$221.29
SEATTLE (KING CNTY) (WA)	$580.39	$256.63
REST OF WASHINGTON (WA)	$512.30	$234.45
WISCONSIN (WI)	$466.64	$213.86
WEST VIRGINIA (WV)	$459.38	$230.08
WYOMING** (WY)	$491.27	$227.41

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 4 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, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility and facility amounts differ primarily because practice-expense RVUs are lower when the service is performed in a facility setting, since the facility (not the billing physician) absorbs certain overhead costs.

RVUs — work 3.45, practice expense 10.77 (non-facility) / 2.87 (facility), malpractice 0.66 — × 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 patient meets their deductible; the remaining 20% is patient responsibility or secondary-payer coverage.
Modifiers, place-of-service codes, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts vary by locality due to GPCI differences; always confirm with your local Medicare Administrative Contractor (MAC) for the applicable rate.
Figures shown reflect a specific calendar year's fee schedule and may change with future updates.

Frequently asked

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

The facility amount excludes most practice-expense costs because the facility, rather than the billing provider, incurs overhead such as space, equipment, and supplies when the service is performed there.

Does this amount represent what Medicare actually pays?

It represents the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this figure after the deductible, with the patient or secondary insurance covering the remainder.

Why might my MAC's payment differ from the national amount shown?

Local GPCI adjustments, sequestration, modifiers applied to the claim, and annual budget-neutrality factors can all cause the locality-specific payment to differ from the national average.

Can I use this figure to predict exact patient billing?

No — this page provides an estimate for reference purposes. Actual patient responsibility depends on deductible status, secondary coverage, and the specific claim details submitted to your MAC.

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.