Medicare Reimbursement for CPT 20551

CPT 20551 is a procedure code used for billing purposes under Medicare Part B; the specific clinical descriptor is omitted here due to AMA 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 for non-facility and facility settings. Amounts reflect the total allowed payment before any patient cost-sharing is applied.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$60.46	$33.07
ALASKA* (AK)	$73.62	$44.45
ALABAMA (AL)	$55.12	$31.16
ARKANSAS (AR)	$54.45	$30.92
ARIZONA (AZ)	$59.04	$32.50
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$74.93	$36.31
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$76.29	$36.80
OXNARD-THOUSAND OAKS-VENTURA (CA)	$66.21	$33.84
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$66.67	$34.27
NAPA (CA)	$71.30	$35.20
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$75.02	$36.40
VALLEJO (CA)	$71.17	$35.07
BAKERSFIELD (CA)	$63.08	$33.06
CHICO (CA)	$62.84	$32.82
FRESNO (CA)	$62.84	$32.82
HANFORD-CORCORAN (CA)	$62.84	$32.82
MADERA (CA)	$62.84	$32.82
MERCED (CA)	$62.84	$32.82
MODESTO (CA)	$62.84	$32.82
REDDING (CA)	$62.84	$32.82
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$63.71	$33.69
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$65.54	$33.68
SALINAS (CA)	$65.28	$33.54
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$76.66	$37.17
SANTA CRUZ-WATSONVILLE (CA)	$66.91	$33.63
SANTA ROSA-PETALUMA (CA)	$67.56	$33.93
STOCKTON (CA)	$62.84	$32.82
VISALIA (CA)	$62.84	$32.82
YUBA CITY (CA)	$62.84	$32.82
EL CENTRO (CA)	$62.85	$32.83
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$66.51	$33.75
SAN LUIS OBISPO-PASO ROBLES (CA)	$64.27	$33.08
SANTA MARIA-SANTA BARBARA (CA)	$65.44	$33.51
REST OF CALIFORNIA (CA)	$62.84	$32.82
COLORADO (CO)	$62.30	$33.16
CONNECTICUT (CT)	$64.08	$34.58
DC + MD/VA SUBURBS (DC)	$68.02	$35.76
DELAWARE (DE)	$59.91	$32.85
FORT LAUDERDALE (FL)	$63.05	$35.30
MIAMI (FL)	$65.91	$37.40
REST OF FLORIDA (FL)	$60.33	$34.15
ATLANTA (GA)	$61.60	$33.77
REST OF GEORGIA (GA)	$57.36	$32.93
HAWAII, GUAM (HI)	$63.91	$32.77
IOWA (IA)	$56.01	$30.94
IDAHO (ID)	$56.38	$31.18
EAST ST. LOUIS (IL)	$60.49	$35.30
SUBURBAN CHICAGO (IL)	$63.59	$35.46
CHICAGO (IL)	$64.25	$36.73
REST OF ILLINOIS (IL)	$59.05	$34.05
INDIANA (IN)	$56.64	$31.25
KANSAS (KS)	$55.92	$31.16
KENTUCKY (KY)	$56.52	$32.17
NEW ORLEANS (LA)	$58.85	$33.08
REST OF LOUISIANA (LA)	$56.50	$32.26
METROPOLITAN BOSTON (MA)	$67.64	$34.94
REST OF MASSACHUSETTS (MA)	$62.07	$33.23
BALTIMORE/SURR. CNTYS (MD)	$63.92	$34.53
REST OF MARYLAND (MD)	$60.88	$33.16
SOUTHERN MAINE (ME)	$59.17	$32.03
REST OF MAINE (ME)	$56.77	$31.58
DETROIT (MI)	$61.12	$34.69
REST OF MICHIGAN (MI)	$57.89	$32.89
MINNESOTA (MN)	$59.54	$31.36
METROPOLITAN ST. LOUIS (MO)	$58.86	$32.78
METROPOLITAN KANSAS CITY (MO)	$58.36	$32.64
REST OF MISSOURI (MO)	$55.78	$32.17
MISSISSIPPI (MS)	$55.12	$31.53
MONTANA** (MT)	$60.45	$33.06
NORTH CAROLINA (NC)	$57.25	$31.70
NORTH DAKOTA** (ND)	$58.87	$31.48
NEBRASKA (NE)	$56.22	$30.94
NEW HAMPSHIRE (NH)	$61.49	$32.98
NORTHERN NJ (NJ)	$67.52	$35.75
REST OF NEW JERSEY (NJ)	$64.76	$34.85
NEW MEXICO (NM)	$58.22	$33.10
NEVADA** (NV)	$60.04	$32.63
MANHATTAN (NY)	$68.99	$37.17
NYC SUBURBS/LONG ISLAND (NY)	$70.62	$38.05
POUGHKPSIE/N NYC SUBURBS (NY)	$65.29	$35.30
QUEENS (NY)	$69.28	$36.90
REST OF NEW YORK (NY)	$57.99	$31.97
OHIO (OH)	$57.57	$32.57
OKLAHOMA (OK)	$56.29	$31.83
PORTLAND (OR)	$63.87	$33.44
REST OF OREGON (OR)	$59.53	$32.25
METROPOLITAN PHILADELPHIA (PA)	$62.78	$34.27
REST OF PENNSYLVANIA (PA)	$57.57	$32.43
PUERTO RICO (PR)	$60.78	$33.09
RHODE ISLAND (RI)	$61.73	$33.44
SOUTH CAROLINA (SC)	$57.52	$32.21
SOUTH DAKOTA** (SD)	$58.68	$31.29
TENNESSEE (TN)	$56.18	$31.28
BRAZORIA (TX)	$59.76	$32.62
DALLAS (TX)	$60.16	$32.88
GALVESTON (TX)	$59.96	$32.76
HOUSTON (TX)	$61.42	$34.22
BEAUMONT (TX)	$57.26	$32.34
FORT WORTH (TX)	$59.86	$32.86
AUSTIN (TX)	$62.14	$33.16
REST OF TEXAS (TX)	$58.49	$32.50
UTAH (UT)	$58.18	$32.43
VIRGINIA (VA)	$59.10	$32.18
VIRGIN ISLANDS (VI)	$60.78	$33.09
VERMONT (VT)	$58.80	$31.69
SEATTLE (KING CNTY) (WA)	$68.77	$35.16
REST OF WASHINGTON (WA)	$61.90	$33.06
WISCONSIN (WI)	$57.20	$30.97
WEST VIRGINIA (WV)	$57.23	$33.43
WYOMING** (WY)	$59.76	$32.37

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 5 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) — work, practice expense, and malpractice — that reflect the clinician effort, overhead, and liability risk associated with a service. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs, because overhead costs are assumed to be borne differently in each setting, which is why the two allowed amounts differ.

RVUs — work 0.73, practice expense 1 (non-facility) / 0.18 (facility), malpractice 0.08 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national averages and standard GPCI adjustments — actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral billing, and other claim-specific adjustments can change the final paid amount.
Annual updates to the conversion factor, RVUs, and budget-neutrality adjustments mean amounts change year to year.
Sequestration and MAC-specific processing rules may further reduce or adjust actual reimbursement.
Always verify the exact locality-adjusted amount and any applicable modifiers with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 20551?

The facility rate uses a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) — not the billing physician's office — bears most of the overhead costs for that setting.

Does this amount represent what Medicare will actually pay?

No. It represents the Medicare-allowed amount before the standard 80/20 split and before deductible, modifiers, or locality-specific adjustments are applied to a specific claim.

Why do allowed amounts vary by locality?

Each locality has its own Geographic Practice Cost Indices (GPCIs) that adjust the work, practice expense, and malpractice RVU components to reflect regional cost-of-living and practice cost differences.

What should I do if my claim was denied or paid differently than expected for this code?

Confirm the locality, place of service, and any applicable modifiers used on the claim, then contact your MAC to verify the specific allowed amount and reason for the payment difference.

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.