Medicare Reimbursement for CPT 20561

CPT 20561 is a physician procedure code billed under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjusted for locality, and separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$38.08	$19.71
ALASKA* (AK)	$46.87	$27.30
ALABAMA (AL)	$34.97	$18.90
ARKANSAS (AR)	$34.58	$18.80
ARIZONA (AZ)	$37.27	$19.47
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$47.76	$21.85
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$48.65	$22.16
OXNARD-THOUSAND OAKS-VENTURA (CA)	$42.03	$20.32
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$42.30	$20.56
NAPA (CA)	$45.37	$21.16
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$47.79	$21.89
VALLEJO (CA)	$45.32	$21.11
BAKERSFIELD (CA)	$40.04	$19.90
CHICO (CA)	$39.93	$19.80
FRESNO (CA)	$39.93	$19.80
HANFORD-CORCORAN (CA)	$39.93	$19.80
MADERA (CA)	$39.93	$19.80
MERCED (CA)	$39.93	$19.80
MODESTO (CA)	$39.93	$19.80
REDDING (CA)	$39.93	$19.80
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$40.26	$20.13
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$41.66	$20.30
SALINAS (CA)	$41.50	$20.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$48.79	$22.30
SANTA CRUZ-WATSONVILLE (CA)	$42.54	$20.22
SANTA ROSA-PETALUMA (CA)	$42.96	$20.40
STOCKTON (CA)	$39.93	$19.80
VISALIA (CA)	$39.93	$19.80
YUBA CITY (CA)	$39.93	$19.80
EL CENTRO (CA)	$39.94	$19.80
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$42.28	$20.31
SAN LUIS OBISPO-PASO ROBLES (CA)	$40.85	$19.93
SANTA MARIA-SANTA BARBARA (CA)	$41.60	$20.18
REST OF CALIFORNIA (CA)	$39.93	$19.80
COLORADO (CO)	$39.41	$19.87
CONNECTICUT (CT)	$40.25	$20.46
DC + MD/VA SUBURBS (DC)	$42.84	$21.20
DELAWARE (DE)	$37.80	$19.65
FORT LAUDERDALE (FL)	$39.16	$20.56
MIAMI (FL)	$40.49	$21.36
REST OF FLORIDA (FL)	$37.64	$20.08
ATLANTA (GA)	$38.67	$20.00
REST OF GEORGIA (GA)	$35.96	$19.57
HAWAII, GUAM (HI)	$40.58	$19.70
IOWA (IA)	$35.66	$18.85
IDAHO (ID)	$35.84	$18.94
EAST ST. LOUIS (IL)	$37.38	$20.48
SUBURBAN CHICAGO (IL)	$39.54	$20.67
CHICAGO (IL)	$39.59	$21.13
REST OF ILLINOIS (IL)	$36.78	$20.01
INDIANA (IN)	$36.00	$18.97
KANSAS (KS)	$35.53	$18.92
KENTUCKY (KY)	$35.62	$19.29
NEW ORLEANS (LA)	$36.95	$19.67
REST OF LOUISIANA (LA)	$35.58	$19.32
METROPOLITAN BOSTON (MA)	$42.76	$20.82
REST OF MASSACHUSETTS (MA)	$39.26	$19.91
BALTIMORE/SURR. CNTYS (MD)	$40.13	$20.41
REST OF MARYLAND (MD)	$38.41	$19.82
SOUTHERN MAINE (ME)	$37.51	$19.31
REST OF MAINE (ME)	$35.99	$19.09
DETROIT (MI)	$38.02	$20.29
REST OF MICHIGAN (MI)	$36.35	$19.57
MINNESOTA (MN)	$37.99	$19.09
METROPOLITAN ST. LOUIS (MO)	$37.05	$19.56
METROPOLITAN KANSAS CITY (MO)	$36.75	$19.50
REST OF MISSOURI (MO)	$35.10	$19.27
MISSISSIPPI (MS)	$34.84	$19.03
MONTANA** (MT)	$38.08	$19.70
NORTH CAROLINA (NC)	$36.28	$19.14
NORTH DAKOTA** (ND)	$37.48	$19.11
NEBRASKA (NE)	$35.81	$18.85
NEW HAMPSHIRE (NH)	$38.83	$19.70
NORTHERN NJ (NJ)	$42.55	$21.24
REST OF NEW JERSEY (NJ)	$40.77	$20.71
NEW MEXICO (NM)	$36.50	$19.66
NEVADA** (NV)	$37.93	$19.54
MANHATTAN (NY)	$43.13	$21.79
NYC SUBURBS/LONG ISLAND (NY)	$43.98	$22.14
POUGHKPSIE/N NYC SUBURBS (NY)	$41.02	$20.91
QUEENS (NY)	$43.42	$21.70
REST OF NEW YORK (NY)	$36.71	$19.26
OHIO (OH)	$36.23	$19.45
OKLAHOMA (OK)	$35.57	$19.16
PORTLAND (OR)	$40.44	$20.03
REST OF OREGON (OR)	$37.69	$19.40
METROPOLITAN PHILADELPHIA (PA)	$39.43	$20.31
REST OF PENNSYLVANIA (PA)	$36.27	$19.40
PUERTO RICO (PR)	$38.30	$19.72
RHODE ISLAND (RI)	$38.97	$20.00
SOUTH CAROLINA (SC)	$36.30	$19.33
SOUTH DAKOTA** (SD)	$37.41	$19.04
TENNESSEE (TN)	$35.67	$18.97
BRAZORIA (TX)	$37.79	$19.58
DALLAS (TX)	$37.99	$19.69
GALVESTON (TX)	$37.88	$19.64
HOUSTON (TX)	$38.43	$20.19
BEAUMONT (TX)	$36.08	$19.36
FORT WORTH (TX)	$37.79	$19.68
AUSTIN (TX)	$39.23	$19.80
REST OF TEXAS (TX)	$36.89	$19.46
UTAH (UT)	$36.69	$19.42
VIRGINIA (VA)	$37.42	$19.36
VIRGIN ISLANDS (VI)	$38.30	$19.72
VERMONT (VT)	$37.37	$19.18
SEATTLE (KING CNTY) (WA)	$43.53	$20.99
REST OF WASHINGTON (WA)	$39.17	$19.83
WISCONSIN (WI)	$36.49	$18.89
WEST VIRGINIA (WV)	$35.71	$19.74
WYOMING** (WY)	$37.82	$19.45

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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 — that reflect the resources typically needed to furnish a service. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is performed, 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, ASC) settings use different practice-expense RVUs because overhead costs differ, which is why the two amounts shown differ. The conversion factor and RVU values are updated annually by CMS and are subject to budget-neutrality adjustments.

RVUs — work 0.47, practice expense 0.64 (non-facility) / 0.09 (facility), malpractice 0.03 — × 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 approved amount after the patient has met the Part B deductible; the patient or secondary insurer is generally responsible for the rest.
Actual payment can vary based on locality, applicable modifiers, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The practice-expense RVU is lower in the facility setting because the facility (hospital or ASC) absorbs part of the overhead cost, whereas in the non-facility setting the physician's practice bears those costs.

Will my locality's payment match the national amount shown?

Not necessarily. The national amount uses a GPCI of 1.0 for all components; your actual locality-specific amount depends on the GPCI values for that area, which can raise or lower the payment relative to the national figure.

Does this amount include the patient's coinsurance?

No. The figures shown represent the full Medicare-approved amount; Medicare generally pays 80% of this after the deductible, with the remaining 20% typically owed by the patient or secondary coverage.

Can modifiers change this amount?

Yes. Modifiers (such as those indicating bilateral procedures, reduced services, or multiple procedure reductions) can increase or decrease the final payment relative to the base PFS amount shown here.

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.