Medicare Reimbursement for CPT Code 20694

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions). It displays the Medicare Physician Fee Schedule (PFS) allowed amount, nationally and adjustable by locality, for both non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$461.93	$328.33
ALASKA* (AK)	$538.98	$396.70
ALABAMA (AL)	$413.45	$296.55
ARKANSAS (AR)	$407.36	$292.60
ARIZONA (AZ)	$448.95	$319.49
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$581.46	$393.08
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$592.29	$399.64
OXNARD-THOUSAND OAKS-VENTURA (CA)	$509.81	$351.89
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$513.00	$354.94
NAPA (CA)	$551.94	$375.85
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$582.36	$393.98
VALLEJO (CA)	$550.65	$374.56
BAKERSFIELD (CA)	$482.71	$336.28
CHICO (CA)	$480.50	$334.07
FRESNO (CA)	$480.50	$334.07
HANFORD-CORCORAN (CA)	$480.50	$334.07
MADERA (CA)	$480.50	$334.07
MERCED (CA)	$480.50	$334.07
MODESTO (CA)	$480.50	$334.07
REDDING (CA)	$480.50	$334.07
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$489.00	$342.57
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$503.00	$347.62
SALINAS (CA)	$501.12	$346.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$595.96	$403.31
SANTA CRUZ-WATSONVILLE (CA)	$516.31	$353.98
SANTA ROSA-PETALUMA (CA)	$521.42	$357.35
STOCKTON (CA)	$480.50	$334.07
VISALIA (CA)	$480.50	$334.07
YUBA CITY (CA)	$480.50	$334.07
EL CENTRO (CA)	$480.63	$334.20
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$512.10	$352.31
SAN LUIS OBISPO-PASO ROBLES (CA)	$493.24	$341.07
SANTA MARIA-SANTA BARBARA (CA)	$502.77	$346.99
REST OF CALIFORNIA (CA)	$480.50	$334.07
COLORADO (CO)	$476.79	$334.63
CONNECTICUT (CT)	$493.07	$349.18
DC + MD/VA SUBURBS (DC)	$525.17	$367.79
DELAWARE (DE)	$456.41	$324.41
FORT LAUDERDALE (FL)	$487.11	$351.77
MIAMI (FL)	$514.43	$375.35
REST OF FLORIDA (FL)	$462.17	$334.45
ATLANTA (GA)	$472.40	$336.66
REST OF GEORGIA (GA)	$435.00	$315.83
HAWAII, GUAM (HI)	$491.41	$339.51
IOWA (IA)	$420.84	$298.59
IDAHO (ID)	$424.33	$301.41
EAST ST. LOUIS (IL)	$464.99	$342.07
SUBURBAN CHICAGO (IL)	$491.28	$354.07
CHICAGO (IL)	$498.56	$364.29
REST OF ILLINOIS (IL)	$451.02	$329.03
INDIANA (IN)	$426.74	$302.89
KANSAS (KS)	$420.41	$299.63
KENTUCKY (KY)	$426.81	$308.03
NEW ORLEANS (LA)	$448.04	$322.32
REST OF LOUISIANA (LA)	$426.76	$308.52
METROPOLITAN BOSTON (MA)	$522.22	$362.70
REST OF MASSACHUSETTS (MA)	$474.51	$333.82
BALTIMORE/SURR. CNTYS (MD)	$492.04	$348.69
REST OF MARYLAND (MD)	$464.72	$329.51
SOUTHERN MAINE (ME)	$449.53	$317.13
REST OF MAINE (ME)	$428.26	$305.34
DETROIT (MI)	$469.67	$340.74
REST OF MICHIGAN (MI)	$439.56	$317.58
MINNESOTA (MN)	$451.95	$314.47
METROPOLITAN ST. LOUIS (MO)	$447.77	$320.58
METROPOLITAN KANSAS CITY (MO)	$443.26	$317.80
REST OF MISSOURI (MO)	$420.36	$305.20
MISSISSIPPI (MS)	$413.87	$298.83
MONTANA** (MT)	$461.88	$328.28
NORTH CAROLINA (NC)	$432.56	$307.91
NORTH DAKOTA** (ND)	$446.26	$312.66
NEBRASKA (NE)	$422.71	$299.39
NEW HAMPSHIRE (NH)	$470.78	$331.70
NORTHERN NJ (NJ)	$519.91	$364.93
REST OF NEW JERSEY (NJ)	$497.32	$351.43
NEW MEXICO (NM)	$442.65	$320.13
NEVADA** (NV)	$457.82	$324.09
MANHATTAN (NY)	$534.31	$379.06
NYC SUBURBS/LONG ISLAND (NY)	$549.46	$390.60
POUGHKPSIE/N NYC SUBURBS (NY)	$501.89	$355.59
QUEENS (NY)	$536.43	$378.51
REST OF NEW YORK (NY)	$439.28	$312.36
OHIO (OH)	$436.37	$314.39
OKLAHOMA (OK)	$424.35	$305.04
PORTLAND (OR)	$490.29	$341.86
REST OF OREGON (OR)	$452.91	$319.84
METROPOLITAN PHILADELPHIA (PA)	$481.68	$342.60
REST OF PENNSYLVANIA (PA)	$436.19	$313.54
PUERTO RICO (PR)	$464.80	$329.72
RHODE ISLAND (RI)	$471.51	$333.50
SOUTH CAROLINA (SC)	$435.46	$312.01
SOUTH DAKOTA** (SD)	$444.41	$310.81
TENNESSEE (TN)	$422.76	$301.31
BRAZORIA (TX)	$454.58	$322.18
DALLAS (TX)	$458.26	$325.19
GALVESTON (TX)	$456.44	$323.77
HOUSTON (TX)	$470.90	$338.23
BEAUMONT (TX)	$433.40	$311.82
FORT WORTH (TX)	$455.64	$323.90
AUSTIN (TX)	$476.39	$335.04
REST OF TEXAS (TX)	$444.27	$317.48
UTAH (UT)	$441.47	$315.88
VIRGINIA (VA)	$449.14	$317.81
VIRGIN ISLANDS (VI)	$464.80	$329.72
VERMONT (VT)	$445.94	$313.67
SEATTLE (KING CNTY) (WA)	$531.32	$367.39
REST OF WASHINGTON (WA)	$473.14	$332.46
WISCONSIN (WI)	$431.23	$303.24
WEST VIRGINIA (WV)	$434.50	$318.39
WYOMING** (WY)	$455.07	$321.47

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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: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice expense RVUs differ between non-facility and facility settings because overhead costs vary depending on where the service is performed, which is why the two allowed amounts differ.

RVUs — work 4.17, practice expense 8.87 (non-facility) / 4.87 (facility), malpractice 0.79 — × 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 beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules 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?

The facility rate uses a lower practice expense RVU because Medicare assumes the facility (e.g., hospital) bears more of the overhead cost, whereas the non-facility rate reflects the full overhead typically borne by a physician's office.

Will my locality's payment match the national amount shown?

Not necessarily. The national amount uses a standardized set of GPCIs, while actual payment in your locality is adjusted using that area's specific GPCI values, which can raise or lower the final rate.

Does this amount already include the Medicare sequestration cut?

No. Displayed amounts reflect the standard PFS calculation before sequestration or other claim-specific adjustments, which are applied separately during claims processing.

Can modifiers change this amount?

Yes. Modifiers (e.g., for bilateral procedures, reduced services, or assistant surgeons) can increase or decrease the final allowed amount relative to the base PFS rate shown here.

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.