Medicare Reimbursement for CPT 20816

CPT 20816 is a physician procedure code; this page does not reproduce the AMA-licensed descriptor. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, nationally and by locality, comparing non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1835.71	$1835.71
ALASKA* (AK)	$2293.80	$2293.80
ALABAMA (AL)	$1667.88	$1667.88
ARKANSAS (AR)	$1647.40	$1647.40
ARIZONA (AZ)	$1786.04	$1786.04
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2042.49	$2042.49
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2070.26	$2070.26
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1885.80	$1885.80
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1908.98	$1908.98
NAPA (CA)	$1974.79	$1974.79
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2050.02	$2050.02
VALLEJO (CA)	$1963.93	$1963.93
BAKERSFIELD (CA)	$1823.98	$1823.98
CHICO (CA)	$1805.74	$1805.74
FRESNO (CA)	$1805.74	$1805.74
HANFORD-CORCORAN (CA)	$1805.74	$1805.74
MADERA (CA)	$1805.74	$1805.74
MERCED (CA)	$1805.74	$1805.74
MODESTO (CA)	$1805.74	$1805.74
REDDING (CA)	$1805.74	$1805.74
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1876.98	$1876.98
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1863.95	$1863.95
SALINAS (CA)	$1856.45	$1856.45
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2101.04	$2101.04
SANTA CRUZ-WATSONVILLE (CA)	$1878.18	$1878.18
SANTA ROSA-PETALUMA (CA)	$1895.01	$1895.01
STOCKTON (CA)	$1805.74	$1805.74
VISALIA (CA)	$1805.74	$1805.74
YUBA CITY (CA)	$1805.74	$1805.74
EL CENTRO (CA)	$1806.84	$1806.84
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1877.97	$1877.97
SAN LUIS OBISPO-PASO ROBLES (CA)	$1830.41	$1830.41
SANTA MARIA-SANTA BARBARA (CA)	$1857.35	$1857.35
REST OF CALIFORNIA (CA)	$1805.74	$1805.74
COLORADO (CO)	$1836.43	$1836.43
CONNECTICUT (CT)	$1947.21	$1947.21
DC + MD/VA SUBURBS (DC)	$2019.06	$2019.06
DELAWARE (DE)	$1811.66	$1811.66
FORT LAUDERDALE (FL)	$2022.10	$2022.10
MIAMI (FL)	$2197.83	$2197.83
REST OF FLORIDA (FL)	$1921.85	$1921.85
ATLANTA (GA)	$1892.53	$1892.53
REST OF GEORGIA (GA)	$1816.26	$1816.26
HAWAII, GUAM (HI)	$1821.10	$1821.10
IOWA (IA)	$1653.41	$1653.41
IDAHO (ID)	$1673.10	$1673.10
EAST ST. LOUIS (IL)	$2014.36	$2014.36
SUBURBAN CHICAGO (IL)	$2029.45	$2029.45
CHICAGO (IL)	$2132.64	$2132.64
REST OF ILLINOIS (IL)	$1910.47	$1910.47
INDIANA (IN)	$1680.00	$1680.00
KANSAS (KS)	$1670.79	$1670.79
KENTUCKY (KY)	$1753.20	$1753.20
NEW ORLEANS (LA)	$1831.97	$1831.97
REST OF LOUISIANA (LA)	$1760.42	$1760.42
METROPOLITAN BOSTON (MA)	$1965.33	$1965.33
REST OF MASSACHUSETTS (MA)	$1837.82	$1837.82
BALTIMORE/SURR. CNTYS (MD)	$1946.73	$1946.73
REST OF MARYLAND (MD)	$1834.85	$1834.85
SOUTHERN MAINE (ME)	$1748.83	$1748.83
REST OF MAINE (ME)	$1706.10	$1706.10
DETROIT (MI)	$1967.54	$1967.54
REST OF MICHIGAN (MI)	$1814.36	$1814.36
MINNESOTA (MN)	$1696.46	$1696.46
METROPOLITAN ST. LOUIS (MO)	$1808.61	$1808.61
METROPOLITAN KANSAS CITY (MO)	$1795.62	$1795.62
REST OF MISSOURI (MO)	$1750.77	$1750.77
MISSISSIPPI (MS)	$1698.15	$1698.15
MONTANA** (MT)	$1835.27	$1835.27
NORTH CAROLINA (NC)	$1717.32	$1717.32
NORTH DAKOTA** (ND)	$1704.17	$1704.17
NEBRASKA (NE)	$1653.79	$1653.79
NEW HAMPSHIRE (NH)	$1831.56	$1831.56
NORTHERN NJ (NJ)	$2008.13	$2008.13
REST OF NEW JERSEY (NJ)	$1951.60	$1951.60
NEW MEXICO (NM)	$1832.60	$1832.60
NEVADA** (NV)	$1799.31	$1799.31
MANHATTAN (NY)	$2125.03	$2125.03
NYC SUBURBS/LONG ISLAND (NY)	$2200.54	$2200.54
POUGHKPSIE/N NYC SUBURBS (NY)	$1983.55	$1983.55
QUEENS (NY)	$2104.62	$2104.62
REST OF NEW YORK (NY)	$1741.25	$1741.25
OHIO (OH)	$1787.56	$1787.56
OKLAHOMA (OK)	$1724.93	$1724.93
PORTLAND (OR)	$1859.36	$1859.36
REST OF OREGON (OR)	$1767.65	$1767.65
METROPOLITAN PHILADELPHIA (PA)	$1920.71	$1920.71
REST OF PENNSYLVANIA (PA)	$1776.48	$1776.48
PUERTO RICO (PR)	$1838.70	$1838.70
RHODE ISLAND (RI)	$1850.50	$1850.50
SOUTH CAROLINA (SC)	$1758.89	$1758.89
SOUTH DAKOTA** (SD)	$1688.67	$1688.67
TENNESSEE (TN)	$1680.96	$1680.96
BRAZORIA (TX)	$1790.15	$1790.15
DALLAS (TX)	$1811.34	$1811.34
GALVESTON (TX)	$1801.93	$1801.93
HOUSTON (TX)	$1923.28	$1923.28
BEAUMONT (TX)	$1768.35	$1768.35
FORT WORTH (TX)	$1808.48	$1808.48
AUSTIN (TX)	$1845.83	$1845.83
REST OF TEXAS (TX)	$1784.97	$1784.97
UTAH (UT)	$1778.70	$1778.70
VIRGINIA (VA)	$1760.85	$1760.85
VIRGIN ISLANDS (VI)	$1838.70	$1838.70
VERMONT (VT)	$1720.58	$1720.58
SEATTLE (KING CNTY) (WA)	$1977.47	$1977.47
REST OF WASHINGTON (WA)	$1826.73	$1826.73
WISCONSIN (WI)	$1658.37	$1658.37
WEST VIRGINIA (WV)	$1855.99	$1855.99
WYOMING** (WY)	$1778.14	$1778.14

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality. The locality-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Practice-expense RVUs often differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why the two amounts can diverge. Work and malpractice RVUs are generally the same across settings for a given code.

RVUs — work 31.15, practice expense 17.18 (non-facility) / 17.18 (facility), malpractice 6.63 — × 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 patient meets the annual deductible; the beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary with locality, applicable modifiers, sequestration reductions, and yearly budget-neutrality adjustments to RVUs or the conversion factor.
Always confirm final allowed amounts and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the allowed amount differ by locality?

The PFS formula applies locality-specific GPCIs to the work, practice-expense, and malpractice RVUs before multiplying by the conversion factor, so costs of practicing medicine in different areas shift the final amount.

Why are the non-facility and facility amounts the same for this code?

When the practice-expense RVU is identical in both non-facility and facility settings, the calculated allowed amount will also be the same, since work and malpractice RVUs don't change by setting.

Does this amount reflect what the patient actually owes?

No. It reflects the Medicare-approved amount before cost-sharing. The patient (or secondary payer) is generally responsible for 20% after the deductible is met, subject to any applicable modifiers or additional adjustments.

Will this amount change next year?

Yes. CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments can shift the final payment amount even if the code's RVUs stay the same.

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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.