Medicare Reimbursement for CPT 20605

CPT 20605 is a procedure code defined by the American Medical Association; its descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both nationally and adjustable by locality, and separately for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$57.12	$32.06
ALASKA* (AK)	$69.04	$42.37
ALABAMA (AL)	$51.91	$29.99
ARKANSAS (AR)	$51.25	$29.73
ARIZONA (AZ)	$55.73	$31.45
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$70.96	$35.64
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$72.25	$36.13
OXNARD-THOUSAND OAKS-VENTURA (CA)	$62.62	$33.01
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$63.05	$33.42
NAPA (CA)	$67.49	$34.48
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$71.05	$35.73
VALLEJO (CA)	$67.36	$34.34
BAKERSFIELD (CA)	$59.60	$32.14
CHICO (CA)	$59.36	$31.91
FRESNO (CA)	$59.36	$31.91
HANFORD-CORCORAN (CA)	$59.36	$31.91
MADERA (CA)	$59.36	$31.91
MERCED (CA)	$59.36	$31.91
MODESTO (CA)	$59.36	$31.91
REDDING (CA)	$59.36	$31.91
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$60.23	$32.77
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$61.95	$32.82
SALINAS (CA)	$61.71	$32.68
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$72.62	$36.50
SANTA CRUZ-WATSONVILLE (CA)	$63.30	$32.87
SANTA ROSA-PETALUMA (CA)	$63.92	$33.16
STOCKTON (CA)	$59.36	$31.91
VISALIA (CA)	$59.36	$31.91
YUBA CITY (CA)	$59.36	$31.91
EL CENTRO (CA)	$59.37	$31.92
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$62.90	$32.94
SAN LUIS OBISPO-PASO ROBLES (CA)	$60.75	$32.22
SANTA MARIA-SANTA BARBARA (CA)	$61.87	$32.66
REST OF CALIFORNIA (CA)	$59.36	$31.91
COLORADO (CO)	$58.87	$32.21
CONNECTICUT (CT)	$60.61	$33.63
DC + MD/VA SUBURBS (DC)	$64.37	$34.87
DELAWARE (DE)	$56.57	$31.82
FORT LAUDERDALE (FL)	$59.70	$34.32
MIAMI (FL)	$62.53	$36.45
REST OF FLORIDA (FL)	$57.03	$33.09
ATLANTA (GA)	$58.24	$32.79
REST OF GEORGIA (GA)	$54.13	$31.78
HAWAII, GUAM (HI)	$60.43	$31.95
IOWA (IA)	$52.75	$29.83
IDAHO (ID)	$53.12	$30.07
EAST ST. LOUIS (IL)	$57.23	$34.19
SUBURBAN CHICAGO (IL)	$60.21	$34.48
CHICAGO (IL)	$60.89	$35.72
REST OF ILLINOIS (IL)	$55.80	$32.93
INDIANA (IN)	$53.38	$30.16
KANSAS (KS)	$52.68	$30.03
KENTUCKY (KY)	$53.29	$31.02
NEW ORLEANS (LA)	$55.57	$31.99
REST OF LOUISIANA (LA)	$53.28	$31.11
METROPOLITAN BOSTON (MA)	$64.01	$34.10
REST OF MASSACHUSETTS (MA)	$58.64	$32.26
BALTIMORE/SURR. CNTYS (MD)	$60.47	$33.59
REST OF MARYLAND (MD)	$57.51	$32.15
SOUTHERN MAINE (ME)	$55.84	$31.01
REST OF MAINE (ME)	$53.51	$30.47
DETROIT (MI)	$57.81	$33.64
REST OF MICHIGAN (MI)	$54.64	$31.77
MINNESOTA (MN)	$56.17	$30.40
METROPOLITAN ST. LOUIS (MO)	$55.57	$31.72
METROPOLITAN KANSAS CITY (MO)	$55.08	$31.56
REST OF MISSOURI (MO)	$52.58	$30.98
MISSISSIPPI (MS)	$51.91	$30.35
MONTANA** (MT)	$57.11	$32.06
NORTH CAROLINA (NC)	$53.98	$30.61
NORTH DAKOTA** (ND)	$55.53	$30.48
NEBRASKA (NE)	$52.96	$29.84
NEW HAMPSHIRE (NH)	$58.11	$32.03
NORTHERN NJ (NJ)	$63.87	$34.81
REST OF NEW JERSEY (NJ)	$61.24	$33.88
NEW MEXICO (NM)	$54.96	$31.99
NEVADA** (NV)	$56.70	$31.63
MANHATTAN (NY)	$65.34	$36.23
NYC SUBURBS/LONG ISLAND (NY)	$66.94	$37.15
POUGHKPSIE/N NYC SUBURBS (NY)	$61.75	$34.32
QUEENS (NY)	$65.60	$35.99
REST OF NEW YORK (NY)	$54.70	$30.90
OHIO (OH)	$54.32	$31.45
OKLAHOMA (OK)	$53.05	$30.68
PORTLAND (OR)	$60.38	$32.55
REST OF OREGON (OR)	$56.19	$31.24
METROPOLITAN PHILADELPHIA (PA)	$59.36	$33.28
REST OF PENNSYLVANIA (PA)	$54.31	$31.32
PUERTO RICO (PR)	$57.43	$32.11
RHODE ISLAND (RI)	$58.31	$32.44
SOUTH CAROLINA (SC)	$54.25	$31.11
SOUTH DAKOTA** (SD)	$55.34	$30.29
TENNESSEE (TN)	$52.93	$30.16
BRAZORIA (TX)	$56.41	$31.59
DALLAS (TX)	$56.80	$31.85
GALVESTON (TX)	$56.61	$31.73
HOUSTON (TX)	$58.07	$33.19
BEAUMONT (TX)	$54.01	$31.21
FORT WORTH (TX)	$56.52	$31.82
AUSTIN (TX)	$58.73	$32.23
REST OF TEXAS (TX)	$55.20	$31.43
UTAH (UT)	$54.90	$31.35
VIRGINIA (VA)	$55.78	$31.15
VIRGIN ISLANDS (VI)	$57.43	$32.11
VERMONT (VT)	$55.47	$30.67
SEATTLE (KING CNTY) (WA)	$65.08	$34.35
REST OF WASHINGTON (WA)	$58.48	$32.10
WISCONSIN (WI)	$53.91	$29.91
WEST VIRGINIA (WV)	$54.02	$32.25
WYOMING** (WY)	$56.42	$31.37

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units 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 amount is built from three Relative Value Units (RVUs): physician work, practice expense (PE), and malpractice (MP). Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility PE RVUs reflect costs when the service is performed in a physician office setting, while facility PE RVUs are lower because the facility (e.g., hospital) absorbs overhead costs separately. This is why the same code can show two different national or locality-adjusted rates depending on place of service.

RVUs — work 0.66, practice expense 0.97 (non-facility) / 0.22 (facility), malpractice 0.08 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual Medicare payment may differ.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the remaining 20% is patient or secondary-insurer responsibility.
Amounts vary by locality GPCIs, applicable modifiers, and place of service (non-facility vs facility).
Sequestration reductions and annual budget-neutrality adjustments can change the final paid amount.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why are there two different amounts for this code?

Medicare publishes separate allowed amounts for non-facility (e.g., physician office) and facility (e.g., hospital outpatient) settings because practice expense costs differ based on where the service is performed.

Does this amount reflect what I'll actually be paid?

No — it's an estimate based on national RVUs and the conversion factor. Your locality's GPCIs, any modifiers billed, and sequestration can change the final reimbursement.

How is the conversion factor used?

The conversion factor is a dollar multiplier applied to the sum of GPCI-adjusted work, practice expense, and malpractice RVUs to calculate the PFS amount for a given year.

What does Medicare actually pay versus the allowed amount?

Medicare generally pays 80% of the allowed amount after the annual Part B deductible is met; the patient or supplemental insurance typically covers the remaining 20%.

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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.