Medicare Reimbursement for CPT 20552

CPT 20552 is a physician procedure code reported on Medicare claims; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, nationally and by locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$51.77	$35.74
ALASKA* (AK)	$63.23	$46.16
ALABAMA (AL)	$47.25	$33.22
ARKANSAS (AR)	$46.68	$32.91
ARIZONA (AZ)	$50.56	$35.03
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$63.96	$41.36
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$65.11	$42.00
OXNARD-THOUSAND OAKS-VENTURA (CA)	$56.59	$37.64
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$57.00	$38.03
NAPA (CA)	$60.89	$39.76
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$64.04	$41.43
VALLEJO (CA)	$60.78	$39.64
BAKERSFIELD (CA)	$53.96	$36.39
CHICO (CA)	$53.74	$36.17
FRESNO (CA)	$53.74	$36.17
HANFORD-CORCORAN (CA)	$53.74	$36.17
MADERA (CA)	$53.74	$36.17
MERCED (CA)	$53.74	$36.17
MODESTO (CA)	$53.74	$36.17
REDDING (CA)	$53.74	$36.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$54.51	$36.93
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$56.03	$37.38
SALINAS (CA)	$55.81	$37.23
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$65.44	$42.32
SANTA CRUZ-WATSONVILLE (CA)	$57.17	$37.69
SANTA ROSA-PETALUMA (CA)	$57.72	$38.04
STOCKTON (CA)	$53.74	$36.17
VISALIA (CA)	$53.74	$36.17
YUBA CITY (CA)	$53.74	$36.17
EL CENTRO (CA)	$53.76	$36.18
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$56.84	$37.67
SAN LUIS OBISPO-PASO ROBLES (CA)	$54.95	$36.69
SANTA MARIA-SANTA BARBARA (CA)	$55.94	$37.25
REST OF CALIFORNIA (CA)	$53.74	$36.17
COLORADO (CO)	$53.31	$36.25
CONNECTICUT (CT)	$54.85	$37.58
DC + MD/VA SUBURBS (DC)	$58.18	$39.30
DELAWARE (DE)	$51.31	$35.47
FORT LAUDERDALE (FL)	$54.03	$37.78
MIAMI (FL)	$56.50	$39.81
REST OF FLORIDA (FL)	$51.71	$36.39
ATLANTA (GA)	$52.75	$36.47
REST OF GEORGIA (GA)	$49.19	$34.89
HAWAII, GUAM (HI)	$54.63	$36.40
IOWA (IA)	$47.98	$33.31
IDAHO (ID)	$48.29	$33.54
EAST ST. LOUIS (IL)	$51.90	$37.15
SUBURBAN CHICAGO (IL)	$54.48	$38.02
CHICAGO (IL)	$55.09	$38.98
REST OF ILLINOIS (IL)	$50.65	$36.01
INDIANA (IN)	$48.52	$33.66
KANSAS (KS)	$47.92	$33.42
KENTUCKY (KY)	$48.46	$34.21
NEW ORLEANS (LA)	$50.43	$35.35
REST OF LOUISIANA (LA)	$48.45	$34.26
METROPOLITAN BOSTON (MA)	$57.83	$38.69
REST OF MASSACHUSETTS (MA)	$53.13	$36.24
BALTIMORE/SURR. CNTYS (MD)	$54.72	$37.51
REST OF MARYLAND (MD)	$52.13	$35.91
SOUTHERN MAINE (ME)	$50.66	$34.77
REST OF MAINE (ME)	$48.64	$33.89
DETROIT (MI)	$52.39	$36.92
REST OF MICHIGAN (MI)	$49.63	$34.99
MINNESOTA (MN)	$50.94	$34.44
METROPOLITAN ST. LOUIS (MO)	$50.43	$35.17
METROPOLITAN KANSAS CITY (MO)	$50.01	$34.95
REST OF MISSOURI (MO)	$47.84	$34.02
MISSISSIPPI (MS)	$47.26	$33.46
MONTANA** (MT)	$51.77	$35.73
NORTH CAROLINA (NC)	$49.05	$34.09
NORTH DAKOTA** (ND)	$50.38	$34.35
NEBRASKA (NE)	$48.16	$33.36
NEW HAMPSHIRE (NH)	$52.63	$35.94
NORTHERN NJ (NJ)	$57.77	$39.17
REST OF NEW JERSEY (NJ)	$55.43	$37.93
NEW MEXICO (NM)	$49.91	$35.21
NEVADA** (NV)	$51.41	$35.36
MANHATTAN (NY)	$59.05	$40.43
NYC SUBURBS/LONG ISLAND (NY)	$60.45	$41.38
POUGHKPSIE/N NYC SUBURBS (NY)	$55.89	$38.33
QUEENS (NY)	$59.28	$40.33
REST OF NEW YORK (NY)	$49.67	$34.44
OHIO (OH)	$49.35	$34.71
OKLAHOMA (OK)	$48.25	$33.93
PORTLAND (OR)	$54.63	$36.82
REST OF OREGON (OR)	$50.96	$35.00
METROPOLITAN PHILADELPHIA (PA)	$53.76	$37.07
REST OF PENNSYLVANIA (PA)	$49.34	$34.62
PUERTO RICO (PR)	$52.04	$35.84
RHODE ISLAND (RI)	$52.85	$36.29
SOUTH CAROLINA (SC)	$49.29	$34.47
SOUTH DAKOTA** (SD)	$50.22	$34.19
TENNESSEE (TN)	$48.14	$33.56
BRAZORIA (TX)	$51.18	$35.29
DALLAS (TX)	$51.52	$35.55
GALVESTON (TX)	$51.34	$35.42
HOUSTON (TX)	$52.63	$36.70
BEAUMONT (TX)	$49.08	$34.49
FORT WORTH (TX)	$51.27	$35.46
AUSTIN (TX)	$53.17	$36.21
REST OF TEXAS (TX)	$50.11	$34.90
UTAH (UT)	$49.85	$34.78
VIRGINIA (VA)	$50.61	$34.85
VIRGIN ISLANDS (VI)	$52.04	$35.84
VERMONT (VT)	$50.34	$34.46
SEATTLE (KING CNTY) (WA)	$58.78	$39.11
REST OF WASHINGTON (WA)	$52.98	$36.10
WISCONSIN (WI)	$48.98	$33.62
WEST VIRGINIA (WV)	$49.10	$35.17
WYOMING** (WY)	$51.16	$35.13

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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) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowance. Non-facility (e.g., office) and facility (e.g., hospital) settings typically use different practice-expense RVUs, since overhead costs differ by site of service, which is why the two allowed amounts shown here are not the same. These figures update annually and can shift due to rule changes, even if the code itself is unchanged.

RVUs — work 0.64, practice expense 0.84 (non-facility) / 0.36 (facility), malpractice 0.07 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is generally responsible for the rest.
Modifiers, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs mean the real payment in your area may differ from the national figure.
Always confirm current rates and edits with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why do the non-facility and facility amounts differ for this code?

They use different practice-expense RVUs because overhead costs (staff, supplies, equipment) are assumed to be borne by the facility when the service is performed in a hospital or other facility setting, lowering the physician's practice-expense component there.

Does this amount reflect what Medicare will actually pay?

No. It reflects the PFS allowed amount before deductible, coinsurance, modifiers, and any locality or policy adjustments are applied, so actual payment may be lower.

Why can this fee change from year to year even if the code is unchanged?

RVUs, GPCIs, and the conversion factor are all updated annually by CMS, and budget-neutrality adjustments can shift the final allowed amount even without a change to the code's RVUs.

Where can I find the official descriptor for CPT 20552?

CPT codes and descriptors are copyrighted by the American Medical Association; consult your AMA CPT codebook or licensed coding software for the official language.

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.