Medicare Reimbursement for CPT 20555

CPT 20555 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated national Medicare allowed amount for this code, as well as how that amount is built from its relative value units (RVUs), and notes where non-facility and facility rates apply.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$279.57	$279.57
ALASKA* (AK)	$374.84	$374.84
ALABAMA (AL)	$264.30	$264.30
ARKANSAS (AR)	$262.41	$262.41
ARIZONA (AZ)	$275.22	$275.22
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$317.50	$317.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$322.21	$322.21
OXNARD-THOUSAND OAKS-VENTURA (CA)	$291.77	$291.77
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$295.01	$295.01
NAPA (CA)	$306.20	$306.20
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$318.03	$318.03
VALLEJO (CA)	$305.44	$305.44
BAKERSFIELD (CA)	$283.88	$283.88
CHICO (CA)	$282.36	$282.36
FRESNO (CA)	$282.36	$282.36
HANFORD-CORCORAN (CA)	$282.36	$282.36
MADERA (CA)	$282.36	$282.36
MERCED (CA)	$282.36	$282.36
MODESTO (CA)	$282.36	$282.36
REDDING (CA)	$282.36	$282.36
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$287.43	$287.43
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$290.69	$290.69
SALINAS (CA)	$289.43	$289.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$324.34	$324.34
SANTA CRUZ-WATSONVILLE (CA)	$291.33	$291.33
SANTA ROSA-PETALUMA (CA)	$293.99	$293.99
STOCKTON (CA)	$282.36	$282.36
VISALIA (CA)	$282.36	$282.36
YUBA CITY (CA)	$282.36	$282.36
EL CENTRO (CA)	$282.44	$282.44
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$291.88	$291.88
SAN LUIS OBISPO-PASO ROBLES (CA)	$285.32	$285.32
SANTA MARIA-SANTA BARBARA (CA)	$289.33	$289.33
REST OF CALIFORNIA (CA)	$282.36	$282.36
COLORADO (CO)	$282.95	$282.95
CONNECTICUT (CT)	$292.00	$292.00
DC + MD/VA SUBURBS (DC)	$304.10	$304.10
DELAWARE (DE)	$278.17	$278.17
FORT LAUDERDALE (FL)	$292.87	$292.87
MIAMI (FL)	$305.88	$305.88
REST OF FLORIDA (FL)	$284.27	$284.27
ATLANTA (GA)	$284.34	$284.34
REST OF GEORGIA (GA)	$275.08	$275.08
HAWAII, GUAM (HI)	$282.52	$282.52
IOWA (IA)	$264.45	$264.45
IDAHO (ID)	$265.96	$265.96
EAST ST. LOUIS (IL)	$289.64	$289.64
SUBURBAN CHICAGO (IL)	$294.65	$294.65
CHICAGO (IL)	$301.17	$301.17
REST OF ILLINOIS (IL)	$282.23	$282.23
INDIANA (IN)	$266.65	$266.65
KANSAS (KS)	$265.34	$265.34
KENTUCKY (KY)	$270.62	$270.62
NEW ORLEANS (LA)	$277.60	$277.60
REST OF LOUISIANA (LA)	$271.01	$271.01
METROPOLITAN BOSTON (MA)	$299.23	$299.23
REST OF MASSACHUSETTS (MA)	$283.22	$283.22
BALTIMORE/SURR. CNTYS (MD)	$291.36	$291.36
REST OF MARYLAND (MD)	$281.09	$281.09
SOUTHERN MAINE (ME)	$273.28	$273.28
REST OF MAINE (ME)	$268.25	$268.25
DETROIT (MI)	$287.70	$287.70
REST OF MICHIGAN (MI)	$275.56	$275.56
MINNESOTA (MN)	$270.74	$270.74
METROPOLITAN ST. LOUIS (MO)	$276.29	$276.29
METROPOLITAN KANSAS CITY (MO)	$275.01	$275.01
REST OF MISSOURI (MO)	$269.67	$269.67
MISSISSIPPI (MS)	$265.99	$265.99
MONTANA** (MT)	$279.53	$279.53
NORTH CAROLINA (NC)	$269.41	$269.41
NORTH DAKOTA** (ND)	$270.44	$270.44
NEBRASKA (NE)	$264.71	$264.71
NEW HAMPSHIRE (NH)	$280.47	$280.47
NORTHERN NJ (NJ)	$303.93	$303.93
REST OF NEW JERSEY (NJ)	$295.20	$295.20
NEW MEXICO (NM)	$276.94	$276.94
NEVADA** (NV)	$277.07	$277.07
MANHATTAN (NY)	$312.22	$312.22
NYC SUBURBS/LONG ISLAND (NY)	$318.24	$318.24
POUGHKPSIE/N NYC SUBURBS (NY)	$298.12	$298.12
QUEENS (NY)	$311.38	$311.38
REST OF NEW YORK (NY)	$271.56	$271.56
OHIO (OH)	$273.70	$273.70
OKLAHOMA (OK)	$268.78	$268.78
PORTLAND (OR)	$286.40	$286.40
REST OF OREGON (OR)	$274.73	$274.73
METROPOLITAN PHILADELPHIA (PA)	$288.87	$288.87
REST OF PENNSYLVANIA (PA)	$273.08	$273.08
PUERTO RICO (PR)	$280.09	$280.09
RHODE ISLAND (RI)	$283.89	$283.89
SOUTH CAROLINA (SC)	$272.03	$272.03
SOUTH DAKOTA** (SD)	$269.36	$269.36
TENNESSEE (TN)	$266.19	$266.19
BRAZORIA (TX)	$277.13	$277.13
DALLAS (TX)	$278.87	$278.87
GALVESTON (TX)	$278.00	$278.00
HOUSTON (TX)	$286.42	$286.42
BEAUMONT (TX)	$272.28	$272.28
FORT WORTH (TX)	$278.38	$278.38
AUSTIN (TX)	$282.20	$282.20
REST OF TEXAS (TX)	$274.57	$274.57
UTAH (UT)	$273.87	$273.87
VIRGINIA (VA)	$273.88	$273.88
VIRGIN ISLANDS (VI)	$280.09	$280.09
VERMONT (VT)	$271.29	$271.29
SEATTLE (KING CNTY) (WA)	$302.14	$302.14
REST OF WASHINGTON (WA)	$282.08	$282.08
WISCONSIN (WI)	$266.04	$266.04
WEST VIRGINIA (WV)	$277.17	$277.17
WYOMING** (WY)	$275.57	$275.57

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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: 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 payment is based on three RVU components — physician work, practice expense (PE), and malpractice (MP) — assigned to each code. Each component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished, reflecting local cost differences. The locality-adjusted RVUs are summed and multiplied by the annual national conversion factor (a dollar figure set by CMS) to produce the allowed amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the same code can have two different allowed amounts depending on place of service. For this code, the non-facility and facility PE RVUs are the same, so the national allowed amount is identical in both settings before any locality adjustment is applied.

RVUs — work 5.85, practice expense 2.06 (non-facility) / 2.06 (facility), malpractice 0.46 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national unadjusted RVUs and the current conversion factor — actual payment varies by locality.
Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify the current, locality-specific rate with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why might my local Medicare payment differ from the national amount shown here?

The national amount uses unadjusted RVUs. Actual payment applies your locality's GPCI values to the work, practice expense, and malpractice RVUs before multiplying by the conversion factor, which can raise or lower the result compared to the national figure.

Why is the allowed amount the same for facility and non-facility here?

Because this code's practice-expense RVU is identical in both settings, the non-facility and facility allowed amounts come out the same at the national level. Locality adjustments are applied the same way to both.

Does this amount reflect what the patient owes?

No. This is the Medicare-allowed amount. After the Part B deductible is met, Medicare generally pays 80% of this amount, and the patient (or a supplemental payer) is responsible for the remaining 20%, subject to any applicable adjustments.

Will this rate stay the same next year?

No. CMS updates RVUs, GPCIs, and the conversion factor annually (and sometimes mid-year), so the allowed amount can change from one year to the next.

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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.