Medicare Reimbursement for CPT 20560
CPT 20560 is a physician procedure code billed under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for local cost differences, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $24.72 | $12.36 |
| ALASKA* (AK) | $30.66 | $17.49 |
| ALABAMA (AL) | $22.82 | $12.00 |
| ARKANSAS (AR) | $22.58 | $11.96 |
| ARIZONA (AZ) | $24.23 | $12.26 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $31.26 | $13.83 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $31.85 | $14.03 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $27.43 | $12.83 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $27.60 | $12.98 |
| NAPA (CA) | $29.67 | $13.38 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $31.27 | $13.85 |
| VALLEJO (CA) | $29.65 | $13.36 |
| BAKERSFIELD (CA) | $26.13 | $12.58 |
| CHICO (CA) | $26.08 | $12.54 |
| FRESNO (CA) | $26.08 | $12.54 |
| HANFORD-CORCORAN (CA) | $26.08 | $12.54 |
| MADERA (CA) | $26.08 | $12.54 |
| MERCED (CA) | $26.08 | $12.54 |
| MODESTO (CA) | $26.08 | $12.54 |
| REDDING (CA) | $26.08 | $12.54 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $26.20 | $12.66 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $27.22 | $12.85 |
| SALINAS (CA) | $27.11 | $12.79 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $31.90 | $14.08 |
| SANTA CRUZ-WATSONVILLE (CA) | $27.80 | $12.78 |
| SANTA ROSA-PETALUMA (CA) | $28.07 | $12.89 |
| STOCKTON (CA) | $26.08 | $12.54 |
| VISALIA (CA) | $26.08 | $12.54 |
| YUBA CITY (CA) | $26.08 | $12.54 |
| EL CENTRO (CA) | $26.09 | $12.54 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $27.62 | $12.84 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $26.69 | $12.61 |
| SANTA MARIA-SANTA BARBARA (CA) | $27.18 | $12.77 |
| REST OF CALIFORNIA (CA) | $26.08 | $12.54 |
| COLORADO (CO) | $25.67 | $12.52 |
| CONNECTICUT (CT) | $26.07 | $12.76 |
| DC + MD/VA SUBURBS (DC) | $27.81 | $13.25 |
| DELAWARE (DE) | $24.57 | $12.36 |
| FORT LAUDERDALE (FL) | $25.17 | $12.65 |
| MIAMI (FL) | $25.80 | $12.94 |
| REST OF FLORIDA (FL) | $24.27 | $12.45 |
| ATLANTA (GA) | $25.04 | $12.48 |
| REST OF GEORGIA (GA) | $23.27 | $12.24 |
| HAWAII, GUAM (HI) | $26.50 | $12.45 |
| IOWA (IA) | $23.32 | $12.01 |
| IDAHO (ID) | $23.42 | $12.05 |
| EAST ST. LOUIS (IL) | $23.93 | $12.56 |
| SUBURBAN CHICAGO (IL) | $25.43 | $12.73 |
| CHICAGO (IL) | $25.29 | $12.87 |
| REST OF ILLINOIS (IL) | $23.68 | $12.40 |
| INDIANA (IN) | $23.52 | $12.06 |
| KANSAS (KS) | $23.20 | $12.03 |
| KENTUCKY (KY) | $23.13 | $12.14 |
| NEW ORLEANS (LA) | $23.93 | $12.31 |
| REST OF LOUISIANA (LA) | $23.09 | $12.15 |
| METROPOLITAN BOSTON (MA) | $27.83 | $13.07 |
| REST OF MASSACHUSETTS (MA) | $25.56 | $12.54 |
| BALTIMORE/SURR. CNTYS (MD) | $25.99 | $12.73 |
| REST OF MARYLAND (MD) | $24.96 | $12.45 |
| SOUTHERN MAINE (ME) | $24.47 | $12.22 |
| REST OF MAINE (ME) | $23.47 | $12.10 |
| DETROIT (MI) | $24.45 | $12.53 |
| REST OF MICHIGAN (MI) | $23.54 | $12.26 |
| MINNESOTA (MN) | $24.89 | $12.17 |
| METROPOLITAN ST. LOUIS (MO) | $24.04 | $12.28 |
| METROPOLITAN KANSAS CITY (MO) | $23.85 | $12.25 |
| REST OF MISSOURI (MO) | $22.77 | $12.12 |
| MISSISSIPPI (MS) | $22.68 | $12.04 |
| MONTANA** (MT) | $24.72 | $12.36 |
| NORTH CAROLINA (NC) | $23.66 | $12.13 |
| NORTH DAKOTA** (ND) | $24.52 | $12.16 |
| NEBRASKA (NE) | $23.43 | $12.02 |
| NEW HAMPSHIRE (NH) | $25.25 | $12.39 |
| NORTHERN NJ (NJ) | $27.64 | $13.30 |
| REST OF NEW JERSEY (NJ) | $26.45 | $12.96 |
| NEW MEXICO (NM) | $23.62 | $12.29 |
| NEVADA** (NV) | $24.67 | $12.30 |
| MANHATTAN (NY) | $27.85 | $13.49 |
| NYC SUBURBS/LONG ISLAND (NY) | $28.32 | $13.62 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $26.59 | $13.05 |
| QUEENS (NY) | $28.08 | $13.47 |
| REST OF NEW YORK (NY) | $23.92 | $12.18 |
| OHIO (OH) | $23.50 | $12.22 |
| OKLAHOMA (OK) | $23.14 | $12.11 |
| PORTLAND (OR) | $26.35 | $12.62 |
| REST OF OREGON (OR) | $24.56 | $12.25 |
| METROPOLITAN PHILADELPHIA (PA) | $25.54 | $12.68 |
| REST OF PENNSYLVANIA (PA) | $23.55 | $12.20 |
| PUERTO RICO (PR) | $24.87 | $12.37 |
| RHODE ISLAND (RI) | $25.34 | $12.57 |
| SOUTH CAROLINA (SC) | $23.60 | $12.18 |
| SOUTH DAKOTA** (SD) | $24.49 | $12.14 |
| TENNESSEE (TN) | $23.29 | $12.05 |
| BRAZORIA (TX) | $24.60 | $12.35 |
| DALLAS (TX) | $24.71 | $12.40 |
| GALVESTON (TX) | $24.64 | $12.37 |
| HOUSTON (TX) | $24.83 | $12.56 |
| BEAUMONT (TX) | $23.43 | $12.18 |
| FORT WORTH (TX) | $24.57 | $12.39 |
| AUSTIN (TX) | $25.51 | $12.44 |
| REST OF TEXAS (TX) | $23.97 | $12.24 |
| UTAH (UT) | $23.84 | $12.22 |
| VIRGINIA (VA) | $24.38 | $12.23 |
| VIRGIN ISLANDS (VI) | $24.87 | $12.37 |
| VERMONT (VT) | $24.41 | $12.18 |
| SEATTLE (KING CNTY) (WA) | $28.36 | $13.19 |
| REST OF WASHINGTON (WA) | $25.51 | $12.50 |
| WISCONSIN (WI) | $23.90 | $12.06 |
| WEST VIRGINIA (WV) | $23.02 | $12.28 |
| WYOMING** (WY) | $24.63 | $12.27 |
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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 allowed amount for this procedure code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality to reflect regional cost variation, then 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 outpatient, ASC) settings use different practice-expense RVUs because the resources required from the physician's practice differ when a facility also bills separately for overhead. This is why the same code can show two different national and locality-adjusted amounts depending on place of service.
RVUs — work 0.31, practice expense 0.42 (non-facility) / 0.05 (facility), malpractice 0.01 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This figure is an estimate only, not a guarantee of payment.
- 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, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
- Locality-adjusted amounts depend on the GPCI values for the specific Medicare locality and may differ from the national figures shown here.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.
Frequently asked
Why does CPT 20560 show two different amounts for non-facility and facility?
The practice-expense RVU differs by setting. In a non-facility setting (like a physician's office), the physician's practice absorbs more overhead cost, so the practice-expense RVU — and therefore the allowed amount — is typically higher than in a facility setting, where the facility bills separately for overhead.
Is the amount shown what Medicare will actually pay?
No. The figure represents the Medicare PFS allowed amount before adjustments. Actual payment is typically 80% of this amount after the deductible, and can be further affected by modifiers, sequestration, and locality-specific adjustments.
Why isn't the CPT code description shown?
CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so this page cannot reproduce the official descriptor text. The code is referenced generically as a procedure code.
How often do these rates change?
The Medicare conversion factor and RVUs are updated annually by CMS, typically effective January 1, and can also be revised mid-year through rulemaking, so amounts should be re-verified each year.
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.
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