Medicare Reimbursement for CPT 20692
This page covers a CPT procedure code (descriptor not shown here due to AMA licensing restrictions). It displays the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, and shows the non-facility and facility rates.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $1047.12 | $1047.12 |
| ALASKA* (AK) | $1295.31 | $1295.31 |
| ALABAMA (AL) | $952.21 | $952.21 |
| ARKANSAS (AR) | $940.50 | $940.50 |
| ARIZONA (AZ) | $1020.02 | $1020.02 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $1213.17 | $1213.17 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $1231.80 | $1231.80 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $1101.41 | $1101.41 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $1112.73 | $1112.73 |
| NAPA (CA) | $1165.75 | $1165.75 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $1216.50 | $1216.50 |
| VALLEJO (CA) | $1160.95 | $1160.95 |
| BAKERSFIELD (CA) | $1059.19 | $1059.19 |
| CHICO (CA) | $1050.99 | $1050.99 |
| FRESNO (CA) | $1050.99 | $1050.99 |
| HANFORD-CORCORAN (CA) | $1050.99 | $1050.99 |
| MADERA (CA) | $1050.99 | $1050.99 |
| MERCED (CA) | $1050.99 | $1050.99 |
| MODESTO (CA) | $1050.99 | $1050.99 |
| REDDING (CA) | $1050.99 | $1050.99 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $1082.54 | $1082.54 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $1089.16 | $1089.16 |
| SALINAS (CA) | $1084.83 | $1084.83 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $1245.41 | $1245.41 |
| SANTA CRUZ-WATSONVILLE (CA) | $1103.03 | $1103.03 |
| SANTA ROSA-PETALUMA (CA) | $1113.25 | $1113.25 |
| STOCKTON (CA) | $1050.99 | $1050.99 |
| VISALIA (CA) | $1050.99 | $1050.99 |
| YUBA CITY (CA) | $1050.99 | $1050.99 |
| EL CENTRO (CA) | $1051.48 | $1051.48 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $1100.41 | $1100.41 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $1069.03 | $1069.03 |
| SANTA MARIA-SANTA BARBARA (CA) | $1086.18 | $1086.18 |
| REST OF CALIFORNIA (CA) | $1050.99 | $1050.99 |
| COLORADO (CO) | $1058.89 | $1058.89 |
| CONNECTICUT (CT) | $1110.57 | $1110.57 |
| DC + MD/VA SUBURBS (DC) | $1161.46 | $1161.46 |
| DELAWARE (DE) | $1034.85 | $1034.85 |
| FORT LAUDERDALE (FL) | $1131.65 | $1131.65 |
| MIAMI (FL) | $1213.95 | $1213.95 |
| REST OF FLORIDA (FL) | $1077.89 | $1077.89 |
| ATLANTA (GA) | $1075.09 | $1075.09 |
| REST OF GEORGIA (GA) | $1020.60 | $1020.60 |
| HAWAII, GUAM (HI) | $1063.39 | $1063.39 |
| IOWA (IA) | $952.45 | $952.45 |
| IDAHO (ID) | $961.98 | $961.98 |
| EAST ST. LOUIS (IL) | $1112.79 | $1112.79 |
| SUBURBAN CHICAGO (IL) | $1137.70 | $1137.70 |
| CHICAGO (IL) | $1179.66 | $1179.66 |
| REST OF ILLINOIS (IL) | $1065.72 | $1065.72 |
| INDIANA (IN) | $966.19 | $966.19 |
| KANSAS (KS) | $958.30 | $958.30 |
| KENTUCKY (KY) | $992.23 | $992.23 |
| NEW ORLEANS (LA) | $1035.68 | $1035.68 |
| REST OF LOUISIANA (LA) | $994.76 | $994.76 |
| METROPOLITAN BOSTON (MA) | $1139.46 | $1139.46 |
| REST OF MASSACHUSETTS (MA) | $1057.96 | $1057.96 |
| BALTIMORE/SURR. CNTYS (MD) | $1109.41 | $1109.41 |
| REST OF MARYLAND (MD) | $1049.42 | $1049.42 |
| SOUTHERN MAINE (ME) | $1007.23 | $1007.23 |
| REST OF MAINE (ME) | $976.56 | $976.56 |
| DETROIT (MI) | $1099.57 | $1099.57 |
| REST OF MICHIGAN (MI) | $1023.24 | $1023.24 |
| MINNESOTA (MN) | $990.39 | $990.39 |
| METROPOLITAN ST. LOUIS (MO) | $1027.18 | $1027.18 |
| METROPOLITAN KANSAS CITY (MO) | $1019.28 | $1019.28 |
| REST OF MISSOURI (MO) | $986.68 | $986.68 |
| MISSISSIPPI (MS) | $963.26 | $963.26 |
| MONTANA** (MT) | $1046.92 | $1046.92 |
| NORTH CAROLINA (NC) | $983.68 | $983.68 |
| NORTH DAKOTA** (ND) | $988.99 | $988.99 |
| NEBRASKA (NE) | $953.94 | $953.94 |
| NEW HAMPSHIRE (NH) | $1052.09 | $1052.09 |
| NORTHERN NJ (NJ) | $1154.27 | $1154.27 |
| REST OF NEW JERSEY (NJ) | $1116.40 | $1116.40 |
| NEW MEXICO (NM) | $1031.97 | $1031.97 |
| NEVADA** (NV) | $1031.19 | $1031.19 |
| MANHATTAN (NY) | $1206.33 | $1206.33 |
| NYC SUBURBS/LONG ISLAND (NY) | $1244.18 | $1244.18 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $1131.36 | $1131.36 |
| QUEENS (NY) | $1200.63 | $1200.63 |
| REST OF NEW YORK (NY) | $997.08 | $997.08 |
| OHIO (OH) | $1011.40 | $1011.40 |
| OKLAHOMA (OK) | $980.41 | $980.41 |
| PORTLAND (OR) | $1077.11 | $1077.11 |
| REST OF OREGON (OR) | $1016.37 | $1016.37 |
| METROPOLITAN PHILADELPHIA (PA) | $1092.74 | $1092.74 |
| REST OF PENNSYLVANIA (PA) | $1007.34 | $1007.34 |
| PUERTO RICO (PR) | $1050.26 | $1050.26 |
| RHODE ISLAND (RI) | $1060.46 | $1060.46 |
| SOUTH CAROLINA (SC) | $1000.56 | $1000.56 |
| SOUTH DAKOTA** (SD) | $982.14 | $982.14 |
| TENNESSEE (TN) | $963.63 | $963.63 |
| BRAZORIA (TX) | $1026.05 | $1026.05 |
| DALLAS (TX) | $1036.31 | $1036.31 |
| GALVESTON (TX) | $1031.59 | $1031.59 |
| HOUSTON (TX) | $1085.22 | $1085.22 |
| BEAUMONT (TX) | $1002.41 | $1002.41 |
| FORT WORTH (TX) | $1033.39 | $1033.39 |
| AUSTIN (TX) | $1061.35 | $1061.35 |
| REST OF TEXAS (TX) | $1016.23 | $1016.23 |
| UTAH (UT) | $1011.97 | $1011.97 |
| VIRGINIA (VA) | $1011.21 | $1011.21 |
| VIRGIN ISLANDS (VI) | $1050.26 | $1050.26 |
| VERMONT (VT) | $994.58 | $994.58 |
| SEATTLE (KING CNTY) (WA) | $1150.93 | $1150.93 |
| REST OF WASHINGTON (WA) | $1052.85 | $1052.85 |
| WISCONSIN (WI) | $961.78 | $961.78 |
| WEST VIRGINIA (WV) | $1034.34 | $1034.34 |
| WYOMING** (WY) | $1021.67 | $1021.67 |
Look up another code or locality →
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
The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, which account for regional differences in cost of living and practice costs. The adjusted RVUs are summed and then multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates differ when the practice-expense RVU differs between settings (e.g., office vs. hospital); for this code those practice-expense values are the same, so the non-facility and facility national amounts shown are equal. Because GPCIs vary by locality, the final estimate will differ across different parts of the country even though the national average is a single reference point.
RVUs — work 15.86, practice expense 12.56 (non-facility) / 12.56 (facility), malpractice 2.93 — × 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 depends on claim-specific factors.
- Medicare typically pays 80% of the allowed amount after the patient meets the annual Part B deductible; the beneficiary or secondary payer is responsible for the remainder.
- Modifiers (e.g., bilateral, multiple procedure, assistant surgeon) can increase or decrease the final paid amount.
- Annual budget-neutrality adjustments and sequestration reductions may change the amount actually paid in a given year.
- Locality-adjusted amounts shown here are calculated using the published GPCIs; always confirm the exact locality and current year's figures with your Medicare Administrative Contractor (MAC).
Frequently asked
Why don't you show the CPT code description?
CPT code descriptors are copyrighted by the American Medical Association (AMA) and cannot be republished without a license. We reference the code generically as 'this procedure code' instead.
Why is the facility amount the same as the non-facility amount for this code?
The Medicare PFS uses different practice-expense RVUs for facility versus non-facility settings when the cost of performing the service differs by site of service. For this code, the practice-expense RVU is identical in both settings, so the computed amounts are the same.
Will my actual payment match the amount shown?
Not necessarily. The figure shown is a national or locality-level estimate based on standard PFS inputs. Actual claim payment can differ due to modifiers, secondary payer coordination, sequestration, and annual fee schedule updates.
How often does the conversion factor change?
The Medicare conversion factor is updated annually (and sometimes mid-year by legislation), so the dollar amount for the same RVUs can change from year to year even if the RVUs themselves stay constant.
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.
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