Medicare Reimbursement for CPT 20553

CPT 20553 is a physician procedure code billable under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$59.79	$40.75
ALASKA* (AK)	$72.91	$52.63
ALABAMA (AL)	$54.54	$37.88
ARKANSAS (AR)	$53.88	$37.52
ARIZONA (AZ)	$58.39	$39.94
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$73.99	$47.14
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$75.33	$47.87
OXNARD-THOUSAND OAKS-VENTURA (CA)	$65.42	$42.92
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$65.88	$43.36
NAPA (CA)	$70.42	$45.33
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$74.08	$47.23
VALLEJO (CA)	$70.29	$45.19
BAKERSFIELD (CA)	$62.35	$41.48
CHICO (CA)	$62.10	$41.24
FRESNO (CA)	$62.10	$41.24
HANFORD-CORCORAN (CA)	$62.10	$41.24
MADERA (CA)	$62.10	$41.24
MERCED (CA)	$62.10	$41.24
MODESTO (CA)	$62.10	$41.24
REDDING (CA)	$62.10	$41.24
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$62.98	$42.11
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$64.76	$42.62
SALINAS (CA)	$64.51	$42.44
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$75.70	$48.24
SANTA CRUZ-WATSONVILLE (CA)	$66.10	$42.97
SANTA ROSA-PETALUMA (CA)	$66.74	$43.36
STOCKTON (CA)	$62.10	$41.24
VISALIA (CA)	$62.10	$41.24
YUBA CITY (CA)	$62.10	$41.24
EL CENTRO (CA)	$62.12	$41.25
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$65.71	$42.94
SAN LUIS OBISPO-PASO ROBLES (CA)	$63.51	$41.83
SANTA MARIA-SANTA BARBARA (CA)	$64.66	$42.47
REST OF CALIFORNIA (CA)	$62.10	$41.24
COLORADO (CO)	$61.59	$41.33
CONNECTICUT (CT)	$63.36	$42.85
DC + MD/VA SUBURBS (DC)	$67.23	$44.81
DELAWARE (DE)	$59.25	$40.44
FORT LAUDERDALE (FL)	$62.37	$43.09
MIAMI (FL)	$65.22	$45.40
REST OF FLORIDA (FL)	$59.69	$41.49
ATLANTA (GA)	$60.92	$41.58
REST OF GEORGIA (GA)	$56.77	$39.78
HAWAII, GUAM (HI)	$63.15	$41.50
IOWA (IA)	$55.39	$37.97
IDAHO (ID)	$55.76	$38.25
EAST ST. LOUIS (IL)	$59.88	$42.36
SUBURBAN CHICAGO (IL)	$62.90	$43.35
CHICAGO (IL)	$63.58	$44.45
REST OF ILLINOIS (IL)	$58.44	$41.06
INDIANA (IN)	$56.02	$38.38
KANSAS (KS)	$55.32	$38.11
KENTUCKY (KY)	$55.93	$39.00
NEW ORLEANS (LA)	$58.22	$40.30
REST OF LOUISIANA (LA)	$55.91	$39.06
METROPOLITAN BOSTON (MA)	$66.84	$44.11
REST OF MASSACHUSETTS (MA)	$61.37	$41.32
BALTIMORE/SURR. CNTYS (MD)	$63.20	$42.77
REST OF MARYLAND (MD)	$60.21	$40.94
SOUTHERN MAINE (ME)	$58.51	$39.64
REST OF MAINE (ME)	$56.16	$38.64
DETROIT (MI)	$60.48	$42.10
REST OF MICHIGAN (MI)	$57.28	$39.90
MINNESOTA (MN)	$58.86	$39.27
METROPOLITAN ST. LOUIS (MO)	$58.22	$40.10
METROPOLITAN KANSAS CITY (MO)	$57.73	$39.85
REST OF MISSOURI (MO)	$55.20	$38.79
MISSISSIPPI (MS)	$54.54	$38.15
MONTANA** (MT)	$59.78	$40.74
NORTH CAROLINA (NC)	$56.63	$38.87
NORTH DAKOTA** (ND)	$58.20	$39.16
NEBRASKA (NE)	$55.61	$38.03
NEW HAMPSHIRE (NH)	$60.80	$40.98
NORTHERN NJ (NJ)	$66.74	$44.66
REST OF NEW JERSEY (NJ)	$64.03	$43.24
NEW MEXICO (NM)	$57.61	$40.15
NEVADA** (NV)	$59.37	$40.32
MANHATTAN (NY)	$68.22	$46.09
NYC SUBURBS/LONG ISLAND (NY)	$69.82	$47.19
POUGHKPSIE/N NYC SUBURBS (NY)	$64.56	$43.71
QUEENS (NY)	$68.49	$45.98
REST OF NEW YORK (NY)	$57.36	$39.27
OHIO (OH)	$56.96	$39.58
OKLAHOMA (OK)	$55.69	$38.69
PORTLAND (OR)	$63.13	$41.98
REST OF OREGON (OR)	$58.86	$39.90
METROPOLITAN PHILADELPHIA (PA)	$62.08	$42.27
REST OF PENNSYLVANIA (PA)	$56.96	$39.48
PUERTO RICO (PR)	$60.11	$40.86
RHODE ISLAND (RI)	$61.04	$41.38
SOUTH CAROLINA (SC)	$56.90	$39.31
SOUTH DAKOTA** (SD)	$58.01	$38.97
TENNESSEE (TN)	$55.57	$38.27
BRAZORIA (TX)	$59.10	$40.23
DALLAS (TX)	$59.50	$40.53
GALVESTON (TX)	$59.29	$40.39
HOUSTON (TX)	$60.76	$41.85
BEAUMONT (TX)	$56.65	$39.33
FORT WORTH (TX)	$59.20	$40.43
AUSTIN (TX)	$61.43	$41.29
REST OF TEXAS (TX)	$57.86	$39.79
UTAH (UT)	$57.55	$39.65
VIRGINIA (VA)	$58.45	$39.73
VIRGIN ISLANDS (VI)	$60.11	$40.86
VERMONT (VT)	$58.14	$39.29
SEATTLE (KING CNTY) (WA)	$67.95	$44.59
REST OF WASHINGTON (WA)	$61.20	$41.15
WISCONSIN (WI)	$56.56	$38.32
WEST VIRGINIA (WV)	$56.65	$40.11
WYOMING** (WY)	$59.09	$40.05

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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 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 locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Practice expense RVUs differ between non-facility and facility settings because facility settings (e.g., hospitals) shift some overhead costs to the facility itself, typically resulting in a lower physician-side payment in facility settings than in non-facility settings.

RVUs — work 0.73, practice expense 0.98 (non-facility) / 0.41 (facility), malpractice 0.08 — × 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 annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-level adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify current rates and coverage rules 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?

The practice expense RVU is lower in facility settings because overhead costs like equipment and staff are billed separately by the facility rather than the physician.

Does this amount reflect what my specific MAC will actually pay?

Not exactly. Locality-specific GPCIs change the final amount, and your MAC may apply additional adjustments, so the actual payment can differ from the national figure shown.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple procedures can increase or decrease the final allowed amount relative to the base PFS rate.

Why might this rate change next year?

The conversion factor, RVUs, and GPCIs are updated annually and can shift due to legislative changes, budget-neutrality requirements, or CMS rulemaking.

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.