Medicare Reimbursement for CPT 20612

CPT 20612 is a procedure code used for billing Medicare Part B services; because CPT descriptors are proprietary to the AMA, this page refers to it generically. It shows the Medicare Physician Fee Schedule (PFS) allowed amount nationally and reflects how the amount differs between non-facility (e.g., office) and facility (e.g., hospital outpatient) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$67.80	$36.74
ALASKA* (AK)	$80.55	$47.46
ALABAMA (AL)	$61.24	$34.06
ARKANSAS (AR)	$60.41	$33.73
ARIZONA (AZ)	$66.07	$35.97
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$85.49	$41.69
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$87.09	$42.30
OXNARD-THOUSAND OAKS-VENTURA (CA)	$74.97	$38.25
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$75.43	$38.68
NAPA (CA)	$81.14	$40.20
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$85.59	$41.79
VALLEJO (CA)	$80.99	$40.05
BAKERSFIELD (CA)	$71.10	$37.06
CHICO (CA)	$70.84	$36.79
FRESNO (CA)	$70.84	$36.79
HANFORD-CORCORAN (CA)	$70.84	$36.79
MADERA (CA)	$70.84	$36.79
MERCED (CA)	$70.84	$36.79
MODESTO (CA)	$70.84	$36.79
REDDING (CA)	$70.84	$36.79
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$71.81	$37.77
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$74.09	$37.96
SALINAS (CA)	$73.80	$37.80
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$87.51	$42.72
SANTA CRUZ-WATSONVILLE (CA)	$75.93	$38.19
SANTA ROSA-PETALUMA (CA)	$76.69	$38.54
STOCKTON (CA)	$70.84	$36.79
VISALIA (CA)	$70.84	$36.79
YUBA CITY (CA)	$70.84	$36.79
EL CENTRO (CA)	$70.85	$36.81
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$75.36	$38.21
SAN LUIS OBISPO-PASO ROBLES (CA)	$72.64	$37.26
SANTA MARIA-SANTA BARBARA (CA)	$74.03	$37.81
REST OF CALIFORNIA (CA)	$70.84	$36.79
COLORADO (CO)	$70.11	$37.06
CONNECTICUT (CT)	$72.13	$38.68
DC + MD/VA SUBURBS (DC)	$76.86	$40.27
DELAWARE (DE)	$67.11	$36.42
FORT LAUDERDALE (FL)	$70.78	$39.31
MIAMI (FL)	$74.13	$41.79
REST OF FLORIDA (FL)	$67.46	$37.77
ATLANTA (GA)	$69.15	$37.59
REST OF GEORGIA (GA)	$63.84	$36.13
HAWAII, GUAM (HI)	$72.30	$36.99
IOWA (IA)	$62.41	$33.99
IDAHO (ID)	$62.85	$34.28
EAST ST. LOUIS (IL)	$67.49	$38.91
SUBURBAN CHICAGO (IL)	$71.42	$39.52
CHICAGO (IL)	$72.07	$40.85
REST OF ILLINOIS (IL)	$65.83	$37.47
INDIANA (IN)	$63.19	$34.39
KANSAS (KS)	$62.27	$34.19
KENTUCKY (KY)	$62.88	$35.26
NEW ORLEANS (LA)	$65.73	$36.50
REST OF LOUISIANA (LA)	$62.84	$35.35
METROPOLITAN BOSTON (MA)	$76.57	$39.48
REST OF MASSACHUSETTS (MA)	$69.79	$37.08
BALTIMORE/SURR. CNTYS (MD)	$71.95	$38.62
REST OF MARYLAND (MD)	$68.29	$36.85
SOUTHERN MAINE (ME)	$66.32	$35.53
REST OF MAINE (ME)	$63.30	$34.72
DETROIT (MI)	$68.39	$38.42
REST OF MICHIGAN (MI)	$64.53	$36.17
MINNESOTA (MN)	$66.91	$34.94
METROPOLITAN ST. LOUIS (MO)	$65.79	$36.22
METROPOLITAN KANSAS CITY (MO)	$65.17	$36.00
REST OF MISSOURI (MO)	$61.92	$35.14
MISSISSIPPI (MS)	$61.17	$34.42
MONTANA** (MT)	$67.80	$36.73
NORTH CAROLINA (NC)	$63.90	$34.92
NORTH DAKOTA** (ND)	$66.02	$34.96
NEBRASKA (NE)	$62.69	$34.02
NEW HAMPSHIRE (NH)	$69.15	$36.82
NORTHERN NJ (NJ)	$76.17	$40.14
REST OF NEW JERSEY (NJ)	$72.88	$38.96
NEW MEXICO (NM)	$64.91	$36.43
NEVADA** (NV)	$67.34	$36.25
MANHATTAN (NY)	$77.84	$41.74
NYC SUBURBS/LONG ISLAND (NY)	$79.79	$42.85
POUGHKPSIE/N NYC SUBURBS (NY)	$73.46	$39.44
QUEENS (NY)	$78.25	$41.53
REST OF NEW YORK (NY)	$64.81	$35.30
OHIO (OH)	$64.17	$35.81
OKLAHOMA (OK)	$62.63	$34.89
PORTLAND (OR)	$72.07	$37.56
REST OF OREGON (OR)	$66.74	$35.80
METROPOLITAN PHILADELPHIA (PA)	$70.52	$38.18
REST OF PENNSYLVANIA (PA)	$64.19	$35.67
PUERTO RICO (PR)	$68.22	$36.82
RHODE ISLAND (RI)	$69.30	$37.21
SOUTH CAROLINA (SC)	$64.15	$35.45
SOUTH DAKOTA** (SD)	$65.81	$34.74
TENNESSEE (TN)	$62.58	$34.35
BRAZORIA (TX)	$66.95	$36.16
DALLAS (TX)	$67.41	$36.47
GALVESTON (TX)	$67.17	$36.33
HOUSTON (TX)	$68.82	$37.98
BEAUMONT (TX)	$63.80	$35.54
FORT WORTH (TX)	$67.03	$36.40
AUSTIN (TX)	$69.95	$37.08
REST OF TEXAS (TX)	$65.37	$35.89
UTAH (UT)	$64.97	$35.77
VIRGINIA (VA)	$66.20	$35.67
VIRGIN ISLANDS (VI)	$68.22	$36.82
VERMONT (VT)	$65.90	$35.15
SEATTLE (KING CNTY) (WA)	$77.94	$39.83
REST OF WASHINGTON (WA)	$69.61	$36.90
WISCONSIN (WI)	$63.96	$34.20
WEST VIRGINIA (WV)	$63.59	$36.59
WYOMING** (WY)	$67.02	$35.96

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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) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting local cost-of-living and practice cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher when the physician's office bears equipment, supply, and staff costs directly, versus lower when those costs are borne by a facility.

RVUs — work 0.68, practice expense 1.26 (non-facility) / 0.33 (facility), malpractice 0.09 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on national averages and standard GPCIs — actual payment may vary by locality.
Medicare Part B typically pays 80% of the allowed amount after the annual deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, bilateral/multiple procedure rules, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Always verify current rates and local adjustments with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount for this code?

The facility rate uses a lower practice-expense RVU because the facility, not the physician's office, absorbs costs like equipment and supplies; the non-facility rate reflects the full cost burden on the billing practice.

Does this amount reflect what Medicare will actually pay?

No — it's an estimated allowed amount. Medicare generally reimburses 80% of this amount after the deductible, and the actual payment can be affected by locality, modifiers, and sequestration.

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

Local Geographic Practice Cost Indices (GPCIs) adjust the RVUs for regional cost differences, so the same code can pay differently depending on where the service is billed.

Can this figure change during the year?

Yes — CMS can apply mid-year or annual budget-neutrality adjustments, and the conversion factor is updated yearly, which can alter the calculated amount.

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.