Medicare Reimbursement for CPT 20805

CPT 20805 is a physician procedure code reported on Medicare claims under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, comparing non-facility and facility settings. Amounts are illustrative estimates derived from published rate components, not a guarantee of payment.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2899.20	$2899.20
ALASKA* (AK)	$3632.54	$3632.54
ALABAMA (AL)	$2635.62	$2635.62
ARKANSAS (AR)	$2603.52	$2603.52
ARIZONA (AZ)	$2820.81	$2820.81
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$3207.33	$3207.33
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$3250.13	$3250.13
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2968.64	$2968.64
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$3005.97	$3005.97
NAPA (CA)	$3103.81	$3103.81
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$3219.50	$3219.50
VALLEJO (CA)	$3086.26	$3086.26
BAKERSFIELD (CA)	$2874.12	$2874.12
CHICO (CA)	$2844.63	$2844.63
FRESNO (CA)	$2844.63	$2844.63
HANFORD-CORCORAN (CA)	$2844.63	$2844.63
MADERA (CA)	$2844.63	$2844.63
MERCED (CA)	$2844.63	$2844.63
MODESTO (CA)	$2844.63	$2844.63
REDDING (CA)	$2844.63	$2844.63
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2959.81	$2959.81
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2934.45	$2934.45
SALINAS (CA)	$2922.61	$2922.61
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$3299.90	$3299.90
SANTA CRUZ-WATSONVILLE (CA)	$2954.31	$2954.31
SANTA ROSA-PETALUMA (CA)	$2980.65	$2980.65
STOCKTON (CA)	$2844.63	$2844.63
VISALIA (CA)	$2844.63	$2844.63
YUBA CITY (CA)	$2844.63	$2844.63
EL CENTRO (CA)	$2846.42	$2846.42
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2955.10	$2955.10
SAN LUIS OBISPO-PASO ROBLES (CA)	$2881.84	$2881.84
SANTA MARIA-SANTA BARBARA (CA)	$2923.64	$2923.64
REST OF CALIFORNIA (CA)	$2844.63	$2844.63
COLORADO (CO)	$2896.28	$2896.28
CONNECTICUT (CT)	$3074.54	$3074.54
DC + MD/VA SUBURBS (DC)	$3184.19	$3184.19
DELAWARE (DE)	$2861.03	$2861.03
FORT LAUDERDALE (FL)	$3199.76	$3199.76
MIAMI (FL)	$3482.15	$3482.15
REST OF FLORIDA (FL)	$3041.22	$3041.22
ATLANTA (GA)	$2990.04	$2990.04
REST OF GEORGIA (GA)	$2874.48	$2874.48
HAWAII, GUAM (HI)	$2867.02	$2867.02
IOWA (IA)	$2609.73	$2609.73
IDAHO (ID)	$2641.27	$2641.27
EAST ST. LOUIS (IL)	$3193.04	$3193.04
SUBURBAN CHICAGO (IL)	$3210.71	$3210.71
CHICAGO (IL)	$3378.94	$3378.94
REST OF ILLINOIS (IL)	$3025.49	$3025.49
INDIANA (IN)	$2651.98	$2651.98
KANSAS (KS)	$2638.52	$2638.52
KENTUCKY (KY)	$2772.70	$2772.70
NEW ORLEANS (LA)	$2896.83	$2896.83
REST OF LOUISIANA (LA)	$2784.64	$2784.64
METROPOLITAN BOSTON (MA)	$3096.41	$3096.41
REST OF MASSACHUSETTS (MA)	$2899.19	$2899.19
BALTIMORE/SURR. CNTYS (MD)	$3074.04	$3074.04
REST OF MARYLAND (MD)	$2896.98	$2896.98
SOUTHERN MAINE (ME)	$2759.29	$2759.29
REST OF MAINE (ME)	$2694.62	$2694.62
DETROIT (MI)	$3114.54	$3114.54
REST OF MICHIGAN (MI)	$2870.10	$2870.10
MINNESOTA (MN)	$2672.22	$2672.22
METROPOLITAN ST. LOUIS (MO)	$2858.37	$2858.37
METROPOLITAN KANSAS CITY (MO)	$2838.17	$2838.17
REST OF MISSOURI (MO)	$2770.46	$2770.46
MISSISSIPPI (MS)	$2685.45	$2685.45
MONTANA** (MT)	$2898.48	$2898.48
NORTH CAROLINA (NC)	$2711.96	$2711.96
NORTH DAKOTA** (ND)	$2686.51	$2686.51
NEBRASKA (NE)	$2609.85	$2609.85
NEW HAMPSHIRE (NH)	$2889.92	$2889.92
NORTHERN NJ (NJ)	$3167.58	$3167.58
REST OF NEW JERSEY (NJ)	$3080.58	$3080.58
NEW MEXICO (NM)	$2899.34	$2899.34
NEVADA** (NV)	$2840.27	$2840.27
MANHATTAN (NY)	$3356.46	$3356.46
NYC SUBURBS/LONG ISLAND (NY)	$3476.86	$3476.86
POUGHKPSIE/N NYC SUBURBS (NY)	$3132.01	$3132.01
QUEENS (NY)	$3322.21	$3322.21
REST OF NEW YORK (NY)	$2749.58	$2749.58
OHIO (OH)	$2826.77	$2826.77
OKLAHOMA (OK)	$2726.75	$2726.75
PORTLAND (OR)	$2930.41	$2930.41
REST OF OREGON (OR)	$2789.39	$2789.39
METROPOLITAN PHILADELPHIA (PA)	$3033.95	$3033.95
REST OF PENNSYLVANIA (PA)	$2808.54	$2808.54
PUERTO RICO (PR)	$2903.35	$2903.35
RHODE ISLAND (RI)	$2920.93	$2920.93
SOUTH CAROLINA (SC)	$2779.72	$2779.72
SOUTH DAKOTA** (SD)	$2661.45	$2661.45
TENNESSEE (TN)	$2654.66	$2654.66
BRAZORIA (TX)	$2826.04	$2826.04
DALLAS (TX)	$2859.97	$2859.97
GALVESTON (TX)	$2844.96	$2844.96
HOUSTON (TX)	$3041.18	$3041.18
BEAUMONT (TX)	$2795.89	$2795.89
FORT WORTH (TX)	$2855.97	$2855.97
AUSTIN (TX)	$2911.93	$2911.93
REST OF TEXAS (TX)	$2820.33	$2820.33
UTAH (UT)	$2810.75	$2810.75
VIRGINIA (VA)	$2779.22	$2779.22
VIRGIN ISLANDS (VI)	$2903.35	$2903.35
VERMONT (VT)	$2713.66	$2713.66
SEATTLE (KING CNTY) (WA)	$3113.91	$3113.91
REST OF WASHINGTON (WA)	$2881.27	$2881.27
WISCONSIN (WI)	$2615.07	$2615.07
WEST VIRGINIA (WV)	$2940.15	$2940.15
WYOMING** (WY)	$2806.10	$2806.10

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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 this procedure code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished, to reflect local cost differences. The locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs, since facility settings (like hospitals) typically have lower physician overhead costs built into the code's valuation. For this code, the non-facility and facility practice-expense RVUs shown are equal, so the resulting allowed amounts are the same in both settings.

RVUs — work 50.17, practice expense 25.91 (non-facility) / 25.91 (facility), malpractice 10.72 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on standard PFS formula inputs — not a payment guarantee.
Medicare typically pays 80% of the allowed amount after the Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality adjustments.
Always verify the final allowed amount and payment policy with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the allowed amount differ by locality?

Each locality has its own Geographic Practice Cost Index (GPCI) values for work, practice expense, and malpractice, which adjust the RVUs to reflect local cost-of-living and practice cost differences before the conversion factor is applied.

Why are non-facility and facility amounts sometimes the same?

When the practice-expense RVU is the same in both settings, as shown for this code, the calculated allowed amount will also be the same, since work and malpractice RVUs don't change by setting.

Does this amount include what Medicare actually pays?

No. The figure shown is the full Medicare-allowed amount before cost-sharing. Medicare generally pays 80% after the deductible, with the remaining 20% owed by the patient or a secondary payer.

Can modifiers change this amount?

Yes. Modifiers (e.g., for bilateral procedures, multiple procedures, or professional/technical component splits) can increase or decrease the final payment relative to the base PFS amount 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.