Medicare Reimbursement for CPT 20838

This page covers a specific CPT procedure code (the official AMA descriptor is not reproduced here due to licensing). It shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for local geographic differences, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2494.05	$2494.05
ALASKA* (AK)	$3110.32	$3110.32
ALABAMA (AL)	$2264.69	$2264.69
ARKANSAS (AR)	$2236.69	$2236.69
ARIZONA (AZ)	$2426.32	$2426.32
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2782.91	$2782.91
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2821.09	$2821.09
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2566.17	$2566.17
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2597.35	$2597.35
NAPA (CA)	$2689.45	$2689.45
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2793.05	$2793.05
VALLEJO (CA)	$2674.83	$2674.83
BAKERSFIELD (CA)	$2480.69	$2480.69
CHICO (CA)	$2456.12	$2456.12
FRESNO (CA)	$2456.12	$2456.12
HANFORD-CORCORAN (CA)	$2456.12	$2456.12
MADERA (CA)	$2456.12	$2456.12
MERCED (CA)	$2456.12	$2456.12
MODESTO (CA)	$2456.12	$2456.12
REDDING (CA)	$2456.12	$2456.12
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2552.07	$2552.07
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2536.20	$2536.20
SALINAS (CA)	$2526.03	$2526.03
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2862.55	$2862.55
SANTA CRUZ-WATSONVILLE (CA)	$2556.82	$2556.82
SANTA ROSA-PETALUMA (CA)	$2579.78	$2579.78
STOCKTON (CA)	$2456.12	$2456.12
VISALIA (CA)	$2456.12	$2456.12
YUBA CITY (CA)	$2456.12	$2456.12
EL CENTRO (CA)	$2457.61	$2457.61
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2555.99	$2555.99
SAN LUIS OBISPO-PASO ROBLES (CA)	$2490.49	$2490.49
SANTA MARIA-SANTA BARBARA (CA)	$2527.43	$2527.43
REST OF CALIFORNIA (CA)	$2456.12	$2456.12
COLORADO (CO)	$2496.64	$2496.64
CONNECTICUT (CT)	$2646.16	$2646.16
DC + MD/VA SUBURBS (DC)	$2745.43	$2745.43
DELAWARE (DE)	$2461.31	$2461.31
FORT LAUDERDALE (FL)	$2745.44	$2745.44
MIAMI (FL)	$2982.87	$2982.87
REST OF FLORIDA (FL)	$2608.91	$2608.91
ATLANTA (GA)	$2570.98	$2570.98
REST OF GEORGIA (GA)	$2464.99	$2464.99
HAWAII, GUAM (HI)	$2477.98	$2477.98
IOWA (IA)	$2246.25	$2246.25
IDAHO (ID)	$2272.91	$2272.91
EAST ST. LOUIS (IL)	$2732.55	$2732.55
SUBURBAN CHICAGO (IL)	$2755.67	$2755.67
CHICAGO (IL)	$2894.08	$2894.08
REST OF ILLINOIS (IL)	$2592.43	$2592.43
INDIANA (IN)	$2282.39	$2282.39
KANSAS (KS)	$2269.37	$2269.37
KENTUCKY (KY)	$2379.97	$2379.97
NEW ORLEANS (LA)	$2487.45	$2487.45
REST OF LOUISIANA (LA)	$2389.60	$2389.60
METROPOLITAN BOSTON (MA)	$2673.55	$2673.55
REST OF MASSACHUSETTS (MA)	$2498.20	$2498.20
BALTIMORE/SURR. CNTYS (MD)	$2645.43	$2645.43
REST OF MARYLAND (MD)	$2493.14	$2493.14
SOUTHERN MAINE (ME)	$2376.79	$2376.79
REST OF MAINE (ME)	$2317.36	$2317.36
DETROIT (MI)	$2670.68	$2670.68
REST OF MICHIGAN (MI)	$2462.98	$2462.98
MINNESOTA (MN)	$2307.24	$2307.24
METROPOLITAN ST. LOUIS (MO)	$2456.28	$2456.28
METROPOLITAN KANSAS CITY (MO)	$2438.43	$2438.43
REST OF MISSOURI (MO)	$2375.99	$2375.99
MISSISSIPPI (MS)	$2305.10	$2305.10
MONTANA** (MT)	$2493.45	$2493.45
NORTH CAROLINA (NC)	$2332.82	$2332.82
NORTH DAKOTA** (ND)	$2316.87	$2316.87
NEBRASKA (NE)	$2246.98	$2246.98
NEW HAMPSHIRE (NH)	$2489.53	$2489.53
NORTHERN NJ (NJ)	$2730.19	$2730.19
REST OF NEW JERSEY (NJ)	$2652.37	$2652.37
NEW MEXICO (NM)	$2487.66	$2487.66
NEVADA** (NV)	$2445.03	$2445.03
MANHATTAN (NY)	$2887.69	$2887.69
NYC SUBURBS/LONG ISLAND (NY)	$2990.10	$2990.10
POUGHKPSIE/N NYC SUBURBS (NY)	$2695.46	$2695.46
QUEENS (NY)	$2860.73	$2860.73
REST OF NEW YORK (NY)	$2365.49	$2365.49
OHIO (OH)	$2426.89	$2426.89
OKLAHOMA (OK)	$2342.01	$2342.01
PORTLAND (OR)	$2528.75	$2528.75
REST OF OREGON (OR)	$2402.26	$2402.26
METROPOLITAN PHILADELPHIA (PA)	$2609.52	$2609.52
REST OF PENNSYLVANIA (PA)	$2412.10	$2412.10
PUERTO RICO (PR)	$2498.36	$2498.36
RHODE ISLAND (RI)	$2514.74	$2514.74
SOUTH CAROLINA (SC)	$2388.56	$2388.56
SOUTH DAKOTA** (SD)	$2295.99	$2295.99
TENNESSEE (TN)	$2283.21	$2283.21
BRAZORIA (TX)	$2432.40	$2432.40
DALLAS (TX)	$2461.06	$2461.06
GALVESTON (TX)	$2448.32	$2448.32
HOUSTON (TX)	$2611.77	$2611.77
BEAUMONT (TX)	$2400.93	$2400.93
FORT WORTH (TX)	$2456.95	$2456.95
AUSTIN (TX)	$2509.19	$2509.19
REST OF TEXAS (TX)	$2424.35	$2424.35
UTAH (UT)	$2415.66	$2415.66
VIRGINIA (VA)	$2392.77	$2392.77
VIRGIN ISLANDS (VI)	$2498.36	$2498.36
VERMONT (VT)	$2338.71	$2338.71
SEATTLE (KING CNTY) (WA)	$2690.72	$2690.72
REST OF WASHINGTON (WA)	$2483.28	$2483.28
WISCONSIN (WI)	$2254.07	$2254.07
WEST VIRGINIA (WV)	$2517.89	$2517.89
WYOMING** (WY)	$2416.49	$2416.49

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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 each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, reflecting local cost-of-living and practice cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar allowed amount. Non-facility and facility amounts can differ because the practice-expense RVU component is calculated differently depending on where the service is performed (e.g., physician office versus hospital or ambulatory surgical center).

RVUs — work 41.81, practice expense 23.93 (non-facility) / 23.93 (facility), malpractice 8.93 — × 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 can differ.
Medicare typically pays 80% of the allowed amount after the patient has met their deductible; the remaining portion is patient or secondary-payer responsibility.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Local Medicare Administrative Contractor (MAC) policies, coverage determinations, and locality-specific GPCI values may affect the actual amount billed and paid.
Rates shown are for the stated fee schedule year and may change in future updates.

Frequently asked

Why is the national amount different from what I see in my locality?

The national figure uses standard GPCI values, while your locality's actual GPCIs (which reflect local labor, rent, and malpractice costs) can raise or lower the final allowed amount.

Why do non-facility and facility amounts sometimes differ?

The practice-expense RVU component is calculated differently depending on site of service, since overhead costs borne by the provider differ between an office setting and a facility setting.

Does this amount reflect what Medicare actually pays?

No — this is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible is met, with modifiers and other adjustments potentially changing the final payment.

Where can I get the exact amount for my claim?

Contact your Medicare Administrative Contractor (MAC) or consult the current year's PFS lookup tool, since local adjustments, modifiers, and policy updates can affect the final reimbursement.

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.