Medicare Reimbursement for CPT 20912

CPT 20912 is a surgical procedure code reported to Medicare for reimbursement purposes; the full clinical descriptor is licensed by the AMA and not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted for your locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$435.21	$435.21
ALASKA* (AK)	$539.03	$539.03
ALABAMA (AL)	$397.13	$397.13
ARKANSAS (AR)	$392.41	$392.41
ARIZONA (AZ)	$424.55	$424.55
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$513.63	$513.63
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$521.93	$521.93
OXNARD-THOUSAND OAKS-VENTURA (CA)	$462.93	$462.93
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$467.26	$467.26
NAPA (CA)	$492.22	$492.22
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$514.76	$514.76
VALLEJO (CA)	$490.58	$490.58
BAKERSFIELD (CA)	$444.32	$444.32
CHICO (CA)	$441.46	$441.46
FRESNO (CA)	$441.46	$441.46
HANFORD-CORCORAN (CA)	$441.46	$441.46
MADERA (CA)	$441.46	$441.46
MERCED (CA)	$441.46	$441.46
MODESTO (CA)	$441.46	$441.46
REDDING (CA)	$441.46	$441.46
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$452.26	$452.26
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$458.15	$458.15
SALINAS (CA)	$456.33	$456.33
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$526.57	$526.57
SANTA CRUZ-WATSONVILLE (CA)	$464.76	$464.76
SANTA ROSA-PETALUMA (CA)	$469.14	$469.14
STOCKTON (CA)	$441.46	$441.46
VISALIA (CA)	$441.46	$441.46
YUBA CITY (CA)	$441.46	$441.46
EL CENTRO (CA)	$441.62	$441.62
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$463.30	$463.30
SAN LUIS OBISPO-PASO ROBLES (CA)	$449.57	$449.57
SANTA MARIA-SANTA BARBARA (CA)	$457.01	$457.01
REST OF CALIFORNIA (CA)	$441.46	$441.46
COLORADO (CO)	$442.53	$442.53
CONNECTICUT (CT)	$461.02	$461.02
DC + MD/VA SUBURBS (DC)	$484.09	$484.09
DELAWARE (DE)	$430.64	$430.64
FORT LAUDERDALE (FL)	$464.65	$464.65
MIAMI (FL)	$494.02	$494.02
REST OF FLORIDA (FL)	$443.71	$443.71
ATLANTA (GA)	$445.59	$445.59
REST OF GEORGIA (GA)	$421.25	$421.25
HAWAII, GUAM (HI)	$447.01	$447.01
IOWA (IA)	$399.03	$399.03
IDAHO (ID)	$402.51	$402.51
EAST ST. LOUIS (IL)	$453.99	$453.99
SUBURBAN CHICAGO (IL)	$467.59	$467.59
CHICAGO (IL)	$480.90	$480.90
REST OF ILLINOIS (IL)	$437.60	$437.60
INDIANA (IN)	$404.27	$404.27
KANSAS (KS)	$400.53	$400.53
KENTUCKY (KY)	$411.43	$411.43
NEW ORLEANS (LA)	$428.62	$428.62
REST OF LOUISIANA (LA)	$412.11	$412.11
METROPOLITAN BOSTON (MA)	$476.89	$476.89
REST OF MASSACHUSETTS (MA)	$441.84	$441.84
BALTIMORE/SURR. CNTYS (MD)	$460.32	$460.32
REST OF MARYLAND (MD)	$436.87	$436.87
SOUTHERN MAINE (ME)	$421.19	$421.19
REST OF MAINE (ME)	$407.49	$407.49
DETROIT (MI)	$451.52	$451.52
REST OF MICHIGAN (MI)	$423.10	$423.10
MINNESOTA (MN)	$417.17	$417.17
METROPOLITAN ST. LOUIS (MO)	$426.22	$426.22
METROPOLITAN KANSAS CITY (MO)	$422.93	$422.93
REST OF MISSOURI (MO)	$408.30	$408.30
MISSISSIPPI (MS)	$400.26	$400.26
MONTANA** (MT)	$435.15	$435.15
NORTH CAROLINA (NC)	$410.51	$410.51
NORTH DAKOTA** (ND)	$415.37	$415.37
NEBRASKA (NE)	$399.91	$399.91
NEW HAMPSHIRE (NH)	$438.78	$438.78
NORTHERN NJ (NJ)	$481.10	$481.10
REST OF NEW JERSEY (NJ)	$464.34	$464.34
NEW MEXICO (NM)	$426.26	$426.26
NEVADA** (NV)	$429.82	$429.82
MANHATTAN (NY)	$499.00	$499.00
NYC SUBURBS/LONG ISLAND (NY)	$513.14	$513.14
POUGHKPSIE/N NYC SUBURBS (NY)	$469.75	$469.75
QUEENS (NY)	$497.96	$497.96
REST OF NEW YORK (NY)	$415.86	$415.86
OHIO (OH)	$419.06	$419.06
OKLAHOMA (OK)	$407.57	$407.57
PORTLAND (OR)	$451.02	$451.02
REST OF OREGON (OR)	$424.54	$424.54
METROPOLITAN PHILADELPHIA (PA)	$453.23	$453.23
REST OF PENNSYLVANIA (PA)	$417.90	$417.90
PUERTO RICO (PR)	$436.79	$436.79
RHODE ISLAND (RI)	$441.88	$441.88
SOUTH CAROLINA (SC)	$415.86	$415.86
SOUTH DAKOTA** (SD)	$413.04	$413.04
TENNESSEE (TN)	$402.58	$402.58
BRAZORIA (TX)	$427.87	$427.87
DALLAS (TX)	$431.63	$431.63
GALVESTON (TX)	$429.85	$429.85
HOUSTON (TX)	$448.16	$448.16
BEAUMONT (TX)	$415.86	$415.86
FORT WORTH (TX)	$430.18	$430.18
AUSTIN (TX)	$442.78	$442.78
REST OF TEXAS (TX)	$422.35	$422.35
UTAH (UT)	$420.48	$420.48
VIRGINIA (VA)	$422.19	$422.19
VIRGIN ISLANDS (VI)	$436.79	$436.79
VERMONT (VT)	$416.83	$416.83
SEATTLE (KING CNTY) (WA)	$482.59	$482.59
REST OF WASHINGTON (WA)	$440.00	$440.00
WISCONSIN (WI)	$404.17	$404.17
WEST VIRGINIA (WV)	$424.89	$424.89
WYOMING** (WY)	$426.53	$426.53

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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: 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 — assigned to each code. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished, reflecting differences in local costs. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can use different practice-expense RVUs, which is why the two allowed amounts may differ for some codes, though for others they end up equal.

RVUs — work 6.38, practice expense 5.65 (non-facility) / 5.65 (facility), malpractice 1 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment or coverage.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Always verify the current fee and any applicable edits with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the amount differ by locality?

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

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

When the practice-expense RVU is identical for both settings, the calculated allowed amount will also be the same, even though the two settings are generally priced separately.

Does this page show what Medicare will actually pay?

No. It shows the estimated allowed amount under the PFS formula. Actual payment depends on patient deductible status, secondary coverage, modifiers used, and any claim-specific adjustments.

Where can I confirm the official rate?

Check the current year's Medicare Physician Fee Schedule lookup tool or contact your MAC, since rates are updated annually and can be affected by mid-year changes.

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.