Medicare Reimbursement for CPT 20526

CPT 20526 is a procedure code reported to Medicare and other payers; the specific service it describes is defined by the AMA's CPT code set. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$88.18	$49.43
ALASKA* (AK)	$104.36	$63.09
ALABAMA (AL)	$79.24	$45.34
ARKANSAS (AR)	$78.12	$44.84
ARIZONA (AZ)	$85.76	$48.21
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$109.06	$54.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$111.02	$55.15
OXNARD-THOUSAND OAKS-VENTURA (CA)	$96.32	$50.52
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$97.00	$51.17
NAPA (CA)	$103.78	$52.72
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$109.25	$54.62
VALLEJO (CA)	$103.51	$52.44
BAKERSFIELD (CA)	$91.51	$49.05
CHICO (CA)	$91.04	$48.57
FRESNO (CA)	$91.04	$48.57
HANFORD-CORCORAN (CA)	$91.04	$48.57
MADERA (CA)	$91.04	$48.57
MERCED (CA)	$91.04	$48.57
MODESTO (CA)	$91.04	$48.57
REDDING (CA)	$91.04	$48.57
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$92.87	$50.40
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$95.09	$50.03
SALINAS (CA)	$94.73	$49.82
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$111.81	$55.94
SANTA CRUZ-WATSONVILLE (CA)	$97.32	$50.24
SANTA ROSA-PETALUMA (CA)	$98.27	$50.69
STOCKTON (CA)	$91.04	$48.57
VISALIA (CA)	$91.04	$48.57
YUBA CITY (CA)	$91.04	$48.57
EL CENTRO (CA)	$91.06	$48.60
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$96.65	$50.31
SAN LUIS OBISPO-PASO ROBLES (CA)	$93.26	$49.13
SANTA MARIA-SANTA BARBARA (CA)	$95.00	$49.82
REST OF CALIFORNIA (CA)	$91.04	$48.57
COLORADO (CO)	$90.62	$49.39
CONNECTICUT (CT)	$93.97	$52.24
DC + MD/VA SUBURBS (DC)	$99.69	$54.05
DELAWARE (DE)	$87.14	$48.86
FORT LAUDERDALE (FL)	$93.44	$54.19
MIAMI (FL)	$98.98	$58.65
REST OF FLORIDA (FL)	$88.76	$51.72
ATLANTA (GA)	$90.24	$50.88
REST OF GEORGIA (GA)	$83.68	$49.12
HAWAII, GUAM (HI)	$92.88	$48.83
IOWA (IA)	$80.35	$44.90
IDAHO (ID)	$81.04	$45.40
EAST ST. LOUIS (IL)	$89.79	$54.15
SUBURBAN CHICAGO (IL)	$94.17	$54.38
CHICAGO (IL)	$96.01	$57.07
REST OF ILLINOIS (IL)	$86.87	$51.50
INDIANA (IN)	$81.48	$45.56
KANSAS (KS)	$80.39	$45.37
KENTUCKY (KY)	$81.95	$47.50
NEW ORLEANS (LA)	$85.90	$49.44
REST OF LOUISIANA (LA)	$81.99	$47.70
METROPOLITAN BOSTON (MA)	$98.86	$52.60
REST OF MASSACHUSETTS (MA)	$90.26	$49.46
BALTIMORE/SURR. CNTYS (MD)	$93.80	$52.22
REST OF MARYLAND (MD)	$88.64	$49.43
SOUTHERN MAINE (ME)	$85.62	$47.22
REST OF MAINE (ME)	$81.89	$46.24
DETROIT (MI)	$90.26	$52.87
REST OF MICHIGAN (MI)	$84.41	$49.03
MINNESOTA (MN)	$85.68	$45.81
METROPOLITAN ST. LOUIS (MO)	$85.70	$48.82
METROPOLITAN KANSAS CITY (MO)	$84.89	$48.51
REST OF MISSOURI (MO)	$80.89	$47.49
MISSISSIPPI (MS)	$79.50	$46.14
MONTANA** (MT)	$88.17	$49.42
NORTH CAROLINA (NC)	$82.66	$46.51
NORTH DAKOTA** (ND)	$84.81	$46.06
NEBRASKA (NE)	$80.66	$44.90
NEW HAMPSHIRE (NH)	$89.59	$49.26
NORTHERN NJ (NJ)	$98.78	$53.84
REST OF NEW JERSEY (NJ)	$94.72	$52.41
NEW MEXICO (NM)	$85.02	$49.49
NEVADA** (NV)	$87.28	$48.50
MANHATTAN (NY)	$101.86	$56.84
NYC SUBURBS/LONG ISLAND (NY)	$104.80	$58.73
POUGHKPSIE/N NYC SUBURBS (NY)	$95.67	$53.25
QUEENS (NY)	$102.08	$56.28
REST OF NEW YORK (NY)	$83.90	$47.10
OHIO (OH)	$83.72	$48.35
OKLAHOMA (OK)	$81.37	$46.77
PORTLAND (OR)	$92.96	$49.92
REST OF OREGON (OR)	$86.28	$47.69
METROPOLITAN PHILADELPHIA (PA)	$91.95	$51.62
REST OF PENNSYLVANIA (PA)	$83.62	$48.05
PUERTO RICO (PR)	$88.66	$49.49
RHODE ISLAND (RI)	$89.86	$49.83
SOUTH CAROLINA (SC)	$83.39	$47.59
SOUTH DAKOTA** (SD)	$84.41	$45.66
TENNESSEE (TN)	$80.84	$45.62
BRAZORIA (TX)	$86.71	$48.31
DALLAS (TX)	$87.44	$48.85
GALVESTON (TX)	$87.09	$48.61
HOUSTON (TX)	$90.20	$51.72
BEAUMONT (TX)	$83.12	$47.86
FORT WORTH (TX)	$87.00	$48.80
AUSTIN (TX)	$90.60	$49.60
REST OF TEXAS (TX)	$84.99	$48.22
UTAH (UT)	$84.49	$48.07
VIRGINIA (VA)	$85.63	$47.54
VIRGIN ISLANDS (VI)	$88.66	$49.49
VERMONT (VT)	$84.86	$46.50
SEATTLE (KING CNTY) (WA)	$100.43	$52.89
REST OF WASHINGTON (WA)	$89.96	$49.17
WISCONSIN (WI)	$82.07	$44.96
WEST VIRGINIA (WV)	$83.84	$50.17
WYOMING** (WY)	$86.70	$47.96

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. 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) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (equipment, supplies, staff time) are treated differently depending on where the service is performed, which is why the two allowed amounts differ.

RVUs — work 0.92, practice expense 1.55 (non-facility) / 0.39 (facility), malpractice 0.17 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates based on the current-year PFS formula, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, site-of-service differentials, sequestration reductions, and annual budget-neutrality adjustments.
Always verify the current allowed amount and any edits or coverage policies with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 20526?

The practice-expense RVU component is lower in the facility setting because Medicare assumes the facility (not the billing practice) absorbs certain overhead costs, such as space and equipment, when the service is performed there.

Does this amount reflect what my practice will actually be paid?

No. This is a PFS-based estimate before deductible, coinsurance, modifiers, and locality-specific adjustments are applied. Your actual remittance may differ.

Why do allowed amounts change from one locality to another?

Each locality has its own GPCIs for work, practice expense, and malpractice, which adjust the RVUs to reflect regional cost-of-living and practice-cost differences before the conversion factor is applied.

Will this amount change next year?

Yes. The conversion factor, RVUs, and GPCIs are updated annually (and sometimes more often) through CMS rulemaking, so allowed amounts can change year to year.

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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.