Medicare Reimbursement for CPT 20527

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code. Because CPT descriptors are licensed by the AMA, we refer to it generically here rather than reproducing the official code description. The figures shown reflect the national 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)	$94.19	$58.45
ALASKA* (AK)	$111.29	$73.23
ALABAMA (AL)	$84.55	$53.28
ARKANSAS (AR)	$83.34	$52.64
ARIZONA (AZ)	$91.57	$56.94
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$116.25	$65.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$118.32	$66.79
OXNARD-THOUSAND OAKS-VENTURA (CA)	$102.74	$60.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$103.49	$61.21
NAPA (CA)	$110.66	$63.55
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$116.46	$66.07
VALLEJO (CA)	$110.34	$63.24
BAKERSFIELD (CA)	$97.62	$58.45
CHICO (CA)	$97.09	$57.92
FRESNO (CA)	$97.09	$57.92
HANFORD-CORCORAN (CA)	$97.09	$57.92
MADERA (CA)	$97.09	$57.92
MERCED (CA)	$97.09	$57.92
MODESTO (CA)	$97.09	$57.92
REDDING (CA)	$97.09	$57.92
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$99.14	$59.97
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$101.41	$59.84
SALINAS (CA)	$101.02	$59.60
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$119.21	$67.67
SANTA CRUZ-WATSONVILLE (CA)	$103.78	$60.36
SANTA ROSA-PETALUMA (CA)	$104.79	$60.91
STOCKTON (CA)	$97.09	$57.92
VISALIA (CA)	$97.09	$57.92
YUBA CITY (CA)	$97.09	$57.92
EL CENTRO (CA)	$97.12	$57.95
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$103.07	$60.32
SAN LUIS OBISPO-PASO ROBLES (CA)	$99.46	$58.76
SANTA MARIA-SANTA BARBARA (CA)	$101.31	$59.64
REST OF CALIFORNIA (CA)	$97.09	$57.92
COLORADO (CO)	$96.72	$58.69
CONNECTICUT (CT)	$100.42	$61.93
DC + MD/VA SUBURBS (DC)	$106.49	$64.38
DELAWARE (DE)	$93.05	$57.74
FORT LAUDERDALE (FL)	$100.03	$63.83
MIAMI (FL)	$106.15	$68.95
REST OF FLORIDA (FL)	$94.96	$60.79
ATLANTA (GA)	$96.45	$60.14
REST OF GEORGIA (GA)	$89.46	$57.58
HAWAII, GUAM (HI)	$99.07	$58.43
IOWA (IA)	$85.68	$52.98
IDAHO (ID)	$86.44	$53.56
EAST ST. LOUIS (IL)	$96.22	$63.34
SUBURBAN CHICAGO (IL)	$100.81	$64.10
CHICAGO (IL)	$102.91	$67.00
REST OF ILLINOIS (IL)	$92.97	$60.34
INDIANA (IN)	$86.91	$53.78
KANSAS (KS)	$85.75	$53.44
KENTUCKY (KY)	$87.53	$55.76
NEW ORLEANS (LA)	$91.80	$58.17
REST OF LOUISIANA (LA)	$87.59	$55.96
METROPOLITAN BOSTON (MA)	$105.53	$62.85
REST OF MASSACHUSETTS (MA)	$96.35	$58.71
BALTIMORE/SURR. CNTYS (MD)	$100.24	$61.89
REST OF MARYLAND (MD)	$94.66	$58.49
SOUTHERN MAINE (ME)	$91.35	$55.94
REST OF MAINE (ME)	$87.38	$54.50
DETROIT (MI)	$96.62	$62.13
REST OF MICHIGAN (MI)	$90.21	$57.58
MINNESOTA (MN)	$91.32	$54.55
METROPOLITAN ST. LOUIS (MO)	$91.56	$57.53
METROPOLITAN KANSAS CITY (MO)	$90.68	$57.12
REST OF MISSOURI (MO)	$86.42	$55.61
MISSISSIPPI (MS)	$84.87	$54.10
MONTANA** (MT)	$94.18	$58.44
NORTH CAROLINA (NC)	$88.21	$54.86
NORTH DAKOTA** (ND)	$90.42	$54.68
NEBRASKA (NE)	$86.00	$53.01
NEW HAMPSHIRE (NH)	$95.66	$58.45
NORTHERN NJ (NJ)	$105.50	$64.04
REST OF NEW JERSEY (NJ)	$101.19	$62.16
NEW MEXICO (NM)	$90.89	$58.12
NEVADA** (NV)	$93.19	$57.41
MANHATTAN (NY)	$108.93	$67.40
NYC SUBURBS/LONG ISLAND (NY)	$112.14	$69.65
POUGHKPSIE/N NYC SUBURBS (NY)	$102.23	$63.10
QUEENS (NY)	$109.12	$66.88
REST OF NEW YORK (NY)	$89.55	$55.60
OHIO (OH)	$89.45	$56.82
OKLAHOMA (OK)	$86.88	$54.96
PORTLAND (OR)	$99.21	$59.50
REST OF OREGON (OR)	$92.09	$56.49
METROPOLITAN PHILADELPHIA (PA)	$98.26	$61.06
REST OF PENNSYLVANIA (PA)	$89.32	$56.51
PUERTO RICO (PR)	$94.70	$58.57
RHODE ISLAND (RI)	$95.95	$59.03
SOUTH CAROLINA (SC)	$89.05	$56.03
SOUTH DAKOTA** (SD)	$89.98	$54.24
TENNESSEE (TN)	$86.24	$53.75
BRAZORIA (TX)	$92.56	$57.14
DALLAS (TX)	$93.36	$57.77
GALVESTON (TX)	$92.98	$57.49
HOUSTON (TX)	$96.45	$60.96
BEAUMONT (TX)	$88.78	$56.26
FORT WORTH (TX)	$92.89	$57.66
AUSTIN (TX)	$96.73	$58.92
REST OF TEXAS (TX)	$90.76	$56.85
UTAH (UT)	$90.24	$56.64
VIRGINIA (VA)	$91.39	$56.26
VIRGIN ISLANDS (VI)	$94.70	$58.57
VERMONT (VT)	$90.50	$55.12
SEATTLE (KING CNTY) (WA)	$107.18	$63.32
REST OF WASHINGTON (WA)	$96.02	$58.39
WISCONSIN (WI)	$87.48	$53.25
WEST VIRGINIA (WV)	$89.71	$58.65
WYOMING** (WY)	$92.54	$56.80

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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 PFS amounts are 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 billing locality, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because the resources assumed to be supplied by the practice differ, which is why the two settings typically show different allowed amounts. The conversion factor and GPCI values are updated annually and can shift payment year over year even if the RVUs stay the same.

RVUs — work 0.98, practice expense 1.65 (non-facility) / 0.58 (facility), malpractice 0.19 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual claim payment can differ.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Modifiers, bilateral or multiple-procedure rules, sequestration, and place-of-service reporting can all change the final paid amount.
Annual budget-neutrality adjustments and conversion factor updates mean amounts can change from year to year.
Always verify current rates and local policies with your Medicare Administrative Contractor (MAC).

Frequently asked

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

In the facility setting, Medicare assumes the hospital or facility — not the billing practice — supplies most of the overhead (staff, equipment, supplies), so the practice-expense RVU used in the calculation is lower, resulting in a lower allowed amount for the practice.

Does this amount reflect what Medicare will actually pay?

It reflects the PFS allowed amount before the standard payment reduction. Medicare generally pays 80% of this allowed amount after the deductible is met, and actual payment can be affected by modifiers, locality, and other claim-specific factors.

Why do amounts vary by locality?

Medicare adjusts each RVU component using locality-specific Geographic Practice Cost Indices to account for regional differences in wages, rent, and malpractice costs, so the same code can pay differently depending on where the service is billed.

Will this amount stay the same next year?

Not necessarily. The conversion factor, GPCIs, and sometimes the RVUs themselves are updated annually, so the allowed amount can change even if the code description stays the same.

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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.