Medicare Reimbursement for CPT 20650

This page covers CPT code 20650, a physician procedure code billed under the Medicare Physician Fee Schedule (PFS). It shows the estimated Medicare allowed amount nationally and lets you compare locality-adjusted figures, as well as how the rate differs when the service is performed in a non-facility (e.g., office) versus a facility (e.g., hospital) setting.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$249.50	$159.99
ALASKA* (AK)	$291.45	$196.12
ALABAMA (AL)	$223.66	$145.34
ARKANSAS (AR)	$220.41	$143.52
ARIZONA (AZ)	$242.63	$155.90
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$315.94	$189.73
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$321.90	$192.82
OXNARD-THOUSAND OAKS-VENTURA (CA)	$276.40	$170.59
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$278.05	$172.15
NAPA (CA)	$299.66	$181.68
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$316.37	$190.16
VALLEJO (CA)	$299.04	$181.06
BAKERSFIELD (CA)	$261.57	$163.46
CHICO (CA)	$260.49	$162.38
FRESNO (CA)	$260.49	$162.38
HANFORD-CORCORAN (CA)	$260.49	$162.38
MADERA (CA)	$260.49	$162.38
MERCED (CA)	$260.49	$162.38
MODESTO (CA)	$260.49	$162.38
REDDING (CA)	$260.49	$162.38
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$264.59	$166.48
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$272.80	$168.69
SALINAS (CA)	$271.78	$168.03
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$323.67	$194.59
SANTA CRUZ-WATSONVILLE (CA)	$280.15	$171.39
SANTA ROSA-PETALUMA (CA)	$282.93	$173.00
STOCKTON (CA)	$260.49	$162.38
VISALIA (CA)	$260.49	$162.38
YUBA CITY (CA)	$260.49	$162.38
EL CENTRO (CA)	$260.56	$162.45
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$277.80	$170.74
SAN LUIS OBISPO-PASO ROBLES (CA)	$267.49	$165.53
SANTA MARIA-SANTA BARBARA (CA)	$272.69	$168.32
REST OF CALIFORNIA (CA)	$260.49	$162.38
COLORADO (CO)	$258.03	$162.78
CONNECTICUT (CT)	$266.18	$169.77
DC + MD/VA SUBURBS (DC)	$283.90	$178.45
DELAWARE (DE)	$246.64	$158.20
FORT LAUDERDALE (FL)	$261.87	$171.20
MIAMI (FL)	$275.58	$182.40
REST OF FLORIDA (FL)	$248.73	$163.16
ATLANTA (GA)	$254.88	$163.93
REST OF GEORGIA (GA)	$234.37	$154.53
HAWAII, GUAM (HI)	$266.45	$164.67
IOWA (IA)	$228.02	$146.12
IDAHO (ID)	$229.80	$147.45
EAST ST. LOUIS (IL)	$249.36	$167.01
SUBURBAN CHICAGO (IL)	$264.21	$172.28
CHICAGO (IL)	$267.27	$177.31
REST OF ILLINOIS (IL)	$242.50	$160.77
INDIANA (IN)	$231.11	$148.13
KANSAS (KS)	$227.59	$146.67
KENTUCKY (KY)	$230.37	$150.79
NEW ORLEANS (LA)	$241.63	$157.40
REST OF LOUISIANA (LA)	$230.27	$151.05
METROPOLITAN BOSTON (MA)	$282.71	$175.83
REST OF MASSACHUSETTS (MA)	$256.74	$162.48
BALTIMORE/SURR. CNTYS (MD)	$265.57	$169.52
REST OF MARYLAND (MD)	$251.16	$160.57
SOUTHERN MAINE (ME)	$243.36	$154.65
REST OF MAINE (ME)	$231.69	$149.34
DETROIT (MI)	$252.52	$166.14
REST OF MICHIGAN (MI)	$236.99	$155.26
MINNESOTA (MN)	$245.29	$153.18
METROPOLITAN ST. LOUIS (MO)	$241.72	$156.50
METROPOLITAN KANSAS CITY (MO)	$239.29	$155.24
REST OF MISSOURI (MO)	$226.73	$149.57
MISSISSIPPI (MS)	$223.58	$146.51
MONTANA** (MT)	$249.48	$159.96
NORTH CAROLINA (NC)	$234.02	$150.51
NORTH DAKOTA** (ND)	$241.97	$152.45
NEBRASKA (NE)	$229.09	$146.46
NEW HAMPSHIRE (NH)	$254.59	$161.40
NORTHERN NJ (NJ)	$281.07	$177.23
REST OF NEW JERSEY (NJ)	$268.67	$170.92
NEW MEXICO (NM)	$238.55	$156.47
NEVADA** (NV)	$247.55	$157.94
MANHATTAN (NY)	$288.04	$184.02
NYC SUBURBS/LONG ISLAND (NY)	$295.87	$189.44
POUGHKPSIE/N NYC SUBURBS (NY)	$270.96	$172.94
QUEENS (NY)	$289.46	$183.66
REST OF NEW YORK (NY)	$237.60	$152.56
OHIO (OH)	$235.45	$153.73
OKLAHOMA (OK)	$229.27	$149.33
PORTLAND (OR)	$265.50	$166.05
REST OF OREGON (OR)	$245.08	$155.93
METROPOLITAN PHILADELPHIA (PA)	$259.96	$166.77
REST OF PENNSYLVANIA (PA)	$235.47	$153.29
PUERTO RICO (PR)	$251.10	$160.60
RHODE ISLAND (RI)	$254.91	$162.44
SOUTH CAROLINA (SC)	$235.24	$152.53
SOUTH DAKOTA** (SD)	$241.08	$151.56
TENNESSEE (TN)	$228.83	$147.46
BRAZORIA (TX)	$245.84	$157.13
DALLAS (TX)	$247.72	$158.56
GALVESTON (TX)	$246.78	$157.89
HOUSTON (TX)	$253.73	$164.84
BEAUMONT (TX)	$233.96	$152.51
FORT WORTH (TX)	$246.26	$158.00
AUSTIN (TX)	$257.64	$162.93
REST OF TEXAS (TX)	$239.98	$155.03
UTAH (UT)	$238.45	$154.31
VIRGINIA (VA)	$243.01	$155.02
VIRGIN ISLANDS (VI)	$251.10	$160.60
VERMONT (VT)	$241.61	$152.99
SEATTLE (KING CNTY) (WA)	$287.81	$177.98
REST OF WASHINGTON (WA)	$256.06	$161.80
WISCONSIN (WI)	$233.89	$148.13
WEST VIRGINIA (WV)	$233.67	$155.88
WYOMING** (WY)	$246.20	$156.69

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 4 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

Each CPT/HCPCS code is assigned three Relative Value Units (RVUs): physician work, practice expense (PE), and malpractice (MP). These RVUs are each multiplied by a Geographic Practice Cost Index (GPCI) specific to the locality where the service is performed, then summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice expense RVUs differ between non-facility (e.g., office) and facility (e.g., hospital, ASC) settings because overhead costs differ, which is why the same code can have two different allowed amounts. The conversion factor is set annually by CMS and applied uniformly nationwide, while GPCIs account for local cost-of-living and practice cost differences.

RVUs — work 2.22, practice expense 4.87 (non-facility) / 2.19 (facility), malpractice 0.38 — × 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 allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the rest.
Modifiers, place of service, multiple-procedure reductions, and sequestration can change the final paid amount.
Annual budget-neutrality adjustments and RVU updates mean amounts can shift year to year.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

The facility rate uses a lower practice expense RVU because Medicare assumes the hospital or facility is covering overhead (equipment, staff, supplies) separately, whereas the non-facility rate assumes the physician's practice bears those costs.

Why does the allowed amount vary by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to the work, practice expense, and malpractice RVUs to reflect regional differences in wages, rent, and other costs before applying the conversion factor.

Does this amount reflect what the patient will owe?

No. The figures shown are the total Medicare-allowed amount. After the deductible is met, Medicare generally pays 80%, leaving the patient or supplemental insurance responsible for the remaining 20%, subject to any applicable modifiers or adjustments.

Can modifiers change the payment for CPT 20650?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the allowed amount from the base figures shown here.

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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.