Medicare Reimbursement for CPT 20802
CPT 20802 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $2452.29 | $2452.29 |
| ALASKA* (AK) | $3063.28 | $3063.28 |
| ALABAMA (AL) | $2227.79 | $2227.79 |
| ARKANSAS (AR) | $2200.40 | $2200.40 |
| ARIZONA (AZ) | $2385.85 | $2385.85 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $2729.08 | $2729.08 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $2766.21 | $2766.21 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $2519.46 | $2519.46 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $2550.41 | $2550.41 |
| NAPA (CA) | $2638.53 | $2638.53 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $2739.14 | $2739.14 |
| VALLEJO (CA) | $2624.03 | $2624.03 |
| BAKERSFIELD (CA) | $2436.73 | $2436.73 |
| CHICO (CA) | $2412.36 | $2412.36 |
| FRESNO (CA) | $2412.36 | $2412.36 |
| HANFORD-CORCORAN (CA) | $2412.36 | $2412.36 |
| MADERA (CA) | $2412.36 | $2412.36 |
| MERCED (CA) | $2412.36 | $2412.36 |
| MODESTO (CA) | $2412.36 | $2412.36 |
| REDDING (CA) | $2412.36 | $2412.36 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $2507.55 | $2507.55 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $2490.22 | $2490.22 |
| SALINAS (CA) | $2480.20 | $2480.20 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $2807.34 | $2807.34 |
| SANTA CRUZ-WATSONVILLE (CA) | $2509.36 | $2509.36 |
| SANTA ROSA-PETALUMA (CA) | $2531.85 | $2531.85 |
| STOCKTON (CA) | $2412.36 | $2412.36 |
| VISALIA (CA) | $2412.36 | $2412.36 |
| YUBA CITY (CA) | $2412.36 | $2412.36 |
| EL CENTRO (CA) | $2413.84 | $2413.84 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $2509.03 | $2509.03 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $2445.40 | $2445.40 |
| SANTA MARIA-SANTA BARBARA (CA) | $2481.42 | $2481.42 |
| REST OF CALIFORNIA (CA) | $2412.36 | $2412.36 |
| COLORADO (CO) | $2453.33 | $2453.33 |
| CONNECTICUT (CT) | $2601.37 | $2601.37 |
| DC + MD/VA SUBURBS (DC) | $2697.48 | $2697.48 |
| DELAWARE (DE) | $2420.12 | $2420.12 |
| FORT LAUDERDALE (FL) | $2701.40 | $2701.40 |
| MIAMI (FL) | $2936.28 | $2936.28 |
| REST OF FLORIDA (FL) | $2567.33 | $2567.33 |
| ATLANTA (GA) | $2528.24 | $2528.24 |
| REST OF GEORGIA (GA) | $2426.11 | $2426.11 |
| HAWAII, GUAM (HI) | $2433.00 | $2433.00 |
| IOWA (IA) | $2208.52 | $2208.52 |
| IDAHO (ID) | $2234.85 | $2234.85 |
| EAST ST. LOUIS (IL) | $2690.88 | $2690.88 |
| SUBURBAN CHICAGO (IL) | $2711.22 | $2711.22 |
| CHICAGO (IL) | $2849.08 | $2849.08 |
| REST OF ILLINOIS (IL) | $2552.04 | $2552.04 |
| INDIANA (IN) | $2244.08 | $2244.08 |
| KANSAS (KS) | $2231.73 | $2231.73 |
| KENTUCKY (KY) | $2341.83 | $2341.83 |
| NEW ORLEANS (LA) | $2447.20 | $2447.20 |
| REST OF LOUISIANA (LA) | $2351.48 | $2351.48 |
| METROPOLITAN BOSTON (MA) | $2625.74 | $2625.74 |
| REST OF MASSACHUSETTS (MA) | $2455.16 | $2455.16 |
| BALTIMORE/SURR. CNTYS (MD) | $2600.74 | $2600.74 |
| REST OF MARYLAND (MD) | $2451.13 | $2451.13 |
| SOUTHERN MAINE (ME) | $2336.18 | $2336.18 |
| REST OF MAINE (ME) | $2278.95 | $2278.95 |
| DETROIT (MI) | $2628.40 | $2628.40 |
| REST OF MICHIGAN (MI) | $2423.61 | $2423.61 |
| MINNESOTA (MN) | $2266.25 | $2266.25 |
| METROPOLITAN ST. LOUIS (MO) | $2416.00 | $2416.00 |
| METROPOLITAN KANSAS CITY (MO) | $2398.61 | $2398.61 |
| REST OF MISSOURI (MO) | $2338.54 | $2338.54 |
| MISSISSIPPI (MS) | $2268.23 | $2268.23 |
| MONTANA** (MT) | $2451.70 | $2451.70 |
| NORTH CAROLINA (NC) | $2293.97 | $2293.97 |
| NORTH DAKOTA** (ND) | $2276.51 | $2276.51 |
| NEBRASKA (NE) | $2209.05 | $2209.05 |
| NEW HAMPSHIRE (NH) | $2446.81 | $2446.81 |
| NORTHERN NJ (NJ) | $2682.82 | $2682.82 |
| REST OF NEW JERSEY (NJ) | $2607.22 | $2607.22 |
| NEW MEXICO (NM) | $2447.99 | $2447.99 |
| NEVADA** (NV) | $2403.64 | $2403.64 |
| MANHATTAN (NY) | $2839.04 | $2839.04 |
| NYC SUBURBS/LONG ISLAND (NY) | $2939.98 | $2939.98 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $2649.90 | $2649.90 |
| QUEENS (NY) | $2811.79 | $2811.79 |
| REST OF NEW YORK (NY) | $2325.97 | $2325.97 |
| OHIO (OH) | $2387.80 | $2387.80 |
| OKLAHOMA (OK) | $2304.07 | $2304.07 |
| PORTLAND (OR) | $2484.05 | $2484.05 |
| REST OF OREGON (OR) | $2361.33 | $2361.33 |
| METROPOLITAN PHILADELPHIA (PA) | $2565.90 | $2565.90 |
| REST OF PENNSYLVANIA (PA) | $2373.00 | $2373.00 |
| PUERTO RICO (PR) | $2456.31 | $2456.31 |
| RHODE ISLAND (RI) | $2472.06 | $2472.06 |
| SOUTH CAROLINA (SC) | $2349.49 | $2349.49 |
| SOUTH DAKOTA** (SD) | $2255.80 | $2255.80 |
| TENNESSEE (TN) | $2245.34 | $2245.34 |
| BRAZORIA (TX) | $2391.37 | $2391.37 |
| DALLAS (TX) | $2419.69 | $2419.69 |
| GALVESTON (TX) | $2407.12 | $2407.12 |
| HOUSTON (TX) | $2569.29 | $2569.29 |
| BEAUMONT (TX) | $2362.11 | $2362.11 |
| FORT WORTH (TX) | $2415.85 | $2415.85 |
| AUSTIN (TX) | $2465.91 | $2465.91 |
| REST OF TEXAS (TX) | $2384.39 | $2384.39 |
| UTAH (UT) | $2376.00 | $2376.00 |
| VIRGINIA (VA) | $2352.22 | $2352.22 |
| VIRGIN ISLANDS (VI) | $2456.31 | $2456.31 |
| VERMONT (VT) | $2298.42 | $2298.42 |
| SEATTLE (KING CNTY) (WA) | $2641.99 | $2641.99 |
| REST OF WASHINGTON (WA) | $2440.34 | $2440.34 |
| WISCONSIN (WI) | $2215.23 | $2215.23 |
| WEST VIRGINIA (WV) | $2479.16 | $2479.16 |
| WYOMING** (WY) | $2375.35 | $2375.35 |
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Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. 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) — 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, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs (and therefore the total) can differ between non-facility (e.g., office) and facility (e.g., hospital) settings because overhead costs differ.
RVUs — work 41.55, practice expense 23.01 (non-facility) / 23.01 (facility), malpractice 8.86 — × 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 remainder.
- Actual payment can vary by locality, applicable modifiers, claim-specific circumstances, 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 amount differ between non-facility and facility settings?
The practice-expense RVU component reflects overhead costs, which are typically higher when a provider supplies the space and equipment (non-facility) versus when a hospital or facility absorbs those costs (facility).
Why might my locality's amount differ from the national figure?
Geographic Practice Cost Indices (GPCIs) adjust the RVUs for regional differences in wages, rent, and malpractice costs, so the same code can price differently across localities.
Does this amount reflect what Medicare will actually pay?
No. It's an estimated allowed amount before patient responsibility, deductible status, modifiers, and any claim-specific adjustments are applied.
Where can I find the official CPT descriptor for this code?
The full CPT code descriptor is licensed by the American Medical Association and must be obtained through an authorized CPT reference, such as the AMA's CPT codebook or a licensed coding tool.
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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