Medicare Reimbursement for CPT 20611

CPT 20611 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 nationally and adjusted for your locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$104.21	$50.10
ALASKA* (AK)	$124.13	$66.50
ALABAMA (AL)	$94.21	$46.86
ARKANSAS (AR)	$92.95	$46.47
ARIZONA (AZ)	$101.56	$49.13
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$131.07	$54.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$133.52	$55.49
OXNARD-THOUSAND OAKS-VENTURA (CA)	$115.06	$51.10
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$115.78	$51.77
NAPA (CA)	$124.45	$53.13
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$131.23	$54.94
VALLEJO (CA)	$124.22	$52.90
BAKERSFIELD (CA)	$109.19	$49.88
CHICO (CA)	$108.77	$49.47
FRESNO (CA)	$108.77	$49.47
HANFORD-CORCORAN (CA)	$108.77	$49.47
MADERA (CA)	$108.77	$49.47
MERCED (CA)	$108.77	$49.47
MODESTO (CA)	$108.77	$49.47
REDDING (CA)	$108.77	$49.47
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$110.29	$50.99
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$113.73	$50.80
SALINAS (CA)	$113.29	$50.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$134.17	$56.14
SANTA CRUZ-WATSONVILLE (CA)	$116.51	$50.76
SANTA ROSA-PETALUMA (CA)	$117.66	$51.21
STOCKTON (CA)	$108.77	$49.47
VISALIA (CA)	$108.77	$49.47
YUBA CITY (CA)	$108.77	$49.47
EL CENTRO (CA)	$108.80	$49.49
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$115.65	$50.93
SAN LUIS OBISPO-PASO ROBLES (CA)	$111.52	$49.89
SANTA MARIA-SANTA BARBARA (CA)	$113.63	$50.54
REST OF CALIFORNIA (CA)	$108.77	$49.47
COLORADO (CO)	$107.70	$50.13
CONNECTICUT (CT)	$110.82	$52.54
DC + MD/VA SUBURBS (DC)	$118.02	$54.28
DELAWARE (DE)	$103.15	$49.69
FORT LAUDERDALE (FL)	$108.82	$54.01
MIAMI (FL)	$113.98	$57.65
REST OF FLORIDA (FL)	$103.76	$52.03
ATLANTA (GA)	$106.28	$51.30
REST OF GEORGIA (GA)	$98.22	$49.95
HAWAII, GUAM (HI)	$110.98	$49.46
IOWA (IA)	$95.97	$46.46
IDAHO (ID)	$96.64	$46.86
EAST ST. LOUIS (IL)	$103.85	$54.07
SUBURBAN CHICAGO (IL)	$109.79	$54.22
CHICAGO (IL)	$110.84	$56.46
REST OF ILLINOIS (IL)	$101.29	$51.89
INDIANA (IN)	$97.15	$46.99
KANSAS (KS)	$95.77	$46.85
KENTUCKY (KY)	$96.73	$48.63
NEW ORLEANS (LA)	$101.08	$50.17
REST OF LOUISIANA (LA)	$96.68	$48.79
METROPOLITAN BOSTON (MA)	$117.54	$52.93
REST OF MASSACHUSETTS (MA)	$107.21	$50.24
BALTIMORE/SURR. CNTYS (MD)	$110.55	$52.49
REST OF MARYLAND (MD)	$104.95	$50.19
SOUTHERN MAINE (ME)	$101.91	$48.29
REST OF MAINE (ME)	$97.34	$47.56
DETROIT (MI)	$105.19	$52.97
REST OF MICHIGAN (MI)	$99.26	$49.86
MINNESOTA (MN)	$102.77	$47.09
METROPOLITAN ST. LOUIS (MO)	$101.16	$49.65
METROPOLITAN KANSAS CITY (MO)	$100.21	$49.40
REST OF MISSOURI (MO)	$95.29	$48.64
MISSISSIPPI (MS)	$94.12	$47.53
MONTANA** (MT)	$104.20	$50.09
NORTH CAROLINA (NC)	$98.25	$47.76
NORTH DAKOTA** (ND)	$101.43	$47.32
NEBRASKA (NE)	$96.39	$46.45
NEW HAMPSHIRE (NH)	$106.24	$49.91
NORTHERN NJ (NJ)	$116.99	$54.22
REST OF NEW JERSEY (NJ)	$111.96	$52.88
NEW MEXICO (NM)	$99.86	$50.24
NEVADA** (NV)	$103.49	$49.33
MANHATTAN (NY)	$119.57	$56.70
NYC SUBURBS/LONG ISLAND (NY)	$122.56	$58.23
POUGHKPSIE/N NYC SUBURBS (NY)	$112.86	$53.61
QUEENS (NY)	$120.18	$56.22
REST OF NEW YORK (NY)	$99.63	$48.23
OHIO (OH)	$98.70	$49.30
OKLAHOMA (OK)	$96.34	$48.02
PORTLAND (OR)	$110.67	$50.55
REST OF OREGON (OR)	$102.57	$48.67
METROPOLITAN PHILADELPHIA (PA)	$108.37	$52.04
REST OF PENNSYLVANIA (PA)	$98.72	$49.05
PUERTO RICO (PR)	$104.84	$50.14
RHODE ISLAND (RI)	$106.49	$50.60
SOUTH CAROLINA (SC)	$98.66	$48.66
SOUTH DAKOTA** (SD)	$101.11	$47.00
TENNESSEE (TN)	$96.24	$47.05
BRAZORIA (TX)	$102.89	$49.27
DALLAS (TX)	$103.61	$49.72
GALVESTON (TX)	$103.25	$49.52
HOUSTON (TX)	$105.81	$52.08
BEAUMONT (TX)	$98.14	$48.90
FORT WORTH (TX)	$103.04	$49.68
AUSTIN (TX)	$107.45	$50.20
REST OF TEXAS (TX)	$100.50	$49.15
UTAH (UT)	$99.91	$49.04
VIRGINIA (VA)	$101.75	$48.56
VIRGIN ISLANDS (VI)	$104.84	$50.14
VERMONT (VT)	$101.26	$47.69
SEATTLE (KING CNTY) (WA)	$119.62	$53.23
REST OF WASHINGTON (WA)	$106.94	$49.96
WISCONSIN (WI)	$98.30	$46.46
WEST VIRGINIA (WV)	$97.87	$50.85
WYOMING** (WY)	$103.00	$48.89

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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 pricing starts with three Relative Value Units (RVUs) assigned to the code — work, practice expense (PE), and malpractice (MP) — which reflect the physician effort, overhead costs, and liability risk associated with the service. Each RVU component is adjusted by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is performed, since costs vary by region. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings use different PE RVUs because overhead costs differ when the procedure is performed in a facility that bears some of those costs itself.

RVUs — work 1.07, practice expense 1.91 (non-facility) / 0.29 (facility), malpractice 0.14 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment; actual reimbursement may differ.
Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary insurer is responsible for the remainder.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the final paid amount.
Conversion factors and RVUs are updated annually and may be revised mid-year due to budget-neutrality adjustments.
Always confirm current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount?

In a facility setting, the facility itself absorbs some of the overhead costs (equipment, supplies, staff), so the practice expense RVU — and therefore the allowed amount — is lower for the billing physician than when the same service is performed in a non-facility setting like a private office.

Does this amount reflect what Medicare actually pays?

No. The figures shown are the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible is met, with the remaining 20% owed by the patient or a secondary payer.

Will my local Medicare payment match the national amount?

Not necessarily. The national amount uses a standard geographic adjustment, while your locality-specific payment reflects local wage, rent, and malpractice cost differences via the GPCIs.

Why might this amount change next year?

RVUs, GPCIs, and the conversion factor are reviewed and can be updated annually by CMS, and budget-neutrality requirements may further adjust the conversion factor even if RVUs stay the same.

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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.