Medicare Reimbursement for CPT 20920
CPT 20920 is a procedure code billed to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount for this code nationally and adjusted by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $357.72 | $357.72 |
| ALASKA* (AK) | $445.44 | $445.44 |
| ALABAMA (AL) | $327.28 | $327.28 |
| ARKANSAS (AR) | $323.50 | $323.50 |
| ARIZONA (AZ) | $349.21 | $349.21 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $421.90 | $421.90 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $428.71 | $428.71 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $380.46 | $380.46 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $384.02 | $384.02 |
| NAPA (CA) | $404.37 | $404.37 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $422.80 | $422.80 |
| VALLEJO (CA) | $403.08 | $403.08 |
| BAKERSFIELD (CA) | $365.40 | $365.40 |
| CHICO (CA) | $363.12 | $363.12 |
| FRESNO (CA) | $363.12 | $363.12 |
| HANFORD-CORCORAN (CA) | $363.12 | $363.12 |
| MADERA (CA) | $363.12 | $363.12 |
| MERCED (CA) | $363.12 | $363.12 |
| MODESTO (CA) | $363.12 | $363.12 |
| REDDING (CA) | $363.12 | $363.12 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $371.66 | $371.66 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $376.71 | $376.71 |
| SALINAS (CA) | $375.20 | $375.20 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $432.38 | $432.38 |
| SANTA CRUZ-WATSONVILLE (CA) | $381.92 | $381.92 |
| SANTA ROSA-PETALUMA (CA) | $385.51 | $385.51 |
| STOCKTON (CA) | $363.12 | $363.12 |
| VISALIA (CA) | $363.12 | $363.12 |
| YUBA CITY (CA) | $363.12 | $363.12 |
| EL CENTRO (CA) | $363.25 | $363.25 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $380.81 | $380.81 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $369.65 | $369.65 |
| SANTA MARIA-SANTA BARBARA (CA) | $375.73 | $375.73 |
| REST OF CALIFORNIA (CA) | $363.12 | $363.12 |
| COLORADO (CO) | $363.82 | $363.82 |
| CONNECTICUT (CT) | $378.55 | $378.55 |
| DC + MD/VA SUBURBS (DC) | $397.44 | $397.44 |
| DELAWARE (DE) | $354.13 | $354.13 |
| FORT LAUDERDALE (FL) | $381.02 | $381.02 |
| MIAMI (FL) | $404.30 | $404.30 |
| REST OF FLORIDA (FL) | $364.31 | $364.31 |
| ATLANTA (GA) | $366.00 | $366.00 |
| REST OF GEORGIA (GA) | $346.38 | $346.38 |
| HAWAII, GUAM (HI) | $367.44 | $367.44 |
| IOWA (IA) | $328.89 | $328.89 |
| IDAHO (ID) | $331.66 | $331.66 |
| EAST ST. LOUIS (IL) | $372.32 | $372.32 |
| SUBURBAN CHICAGO (IL) | $383.45 | $383.45 |
| CHICAGO (IL) | $393.91 | $393.91 |
| REST OF ILLINOIS (IL) | $359.36 | $359.36 |
| INDIANA (IN) | $333.07 | $333.07 |
| KANSAS (KS) | $330.05 | $330.05 |
| KENTUCKY (KY) | $338.61 | $338.61 |
| NEW ORLEANS (LA) | $352.35 | $352.35 |
| REST OF LOUISIANA (LA) | $339.14 | $339.14 |
| METROPOLITAN BOSTON (MA) | $391.66 | $391.66 |
| REST OF MASSACHUSETTS (MA) | $363.29 | $363.29 |
| BALTIMORE/SURR. CNTYS (MD) | $377.94 | $377.94 |
| REST OF MARYLAND (MD) | $359.18 | $359.18 |
| SOUTHERN MAINE (ME) | $346.62 | $346.62 |
| REST OF MAINE (ME) | $335.59 | $335.59 |
| DETROIT (MI) | $370.51 | $370.51 |
| REST OF MICHIGAN (MI) | $347.91 | $347.91 |
| MINNESOTA (MN) | $343.55 | $343.55 |
| METROPOLITAN ST. LOUIS (MO) | $350.48 | $350.48 |
| METROPOLITAN KANSAS CITY (MO) | $347.85 | $347.85 |
| REST OF MISSOURI (MO) | $336.07 | $336.07 |
| MISSISSIPPI (MS) | $329.71 | $329.71 |
| MONTANA** (MT) | $357.67 | $357.67 |
| NORTH CAROLINA (NC) | $338.02 | $338.02 |
| NORTH DAKOTA** (ND) | $342.05 | $342.05 |
| NEBRASKA (NE) | $329.61 | $329.61 |
| NEW HAMPSHIRE (NH) | $360.66 | $360.66 |
| NORTHERN NJ (NJ) | $395.13 | $395.13 |
| REST OF NEW JERSEY (NJ) | $381.44 | $381.44 |
| NEW MEXICO (NM) | $350.41 | $350.41 |
| NEVADA** (NV) | $353.47 | $353.47 |
| MANHATTAN (NY) | $409.29 | $409.29 |
| NYC SUBURBS/LONG ISLAND (NY) | $420.54 | $420.54 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $385.77 | $385.77 |
| QUEENS (NY) | $408.53 | $408.53 |
| REST OF NEW YORK (NY) | $342.29 | $342.29 |
| OHIO (OH) | $344.71 | $344.71 |
| OKLAHOMA (OK) | $335.58 | $335.58 |
| PORTLAND (OR) | $370.71 | $370.71 |
| REST OF OREGON (OR) | $349.28 | $349.28 |
| METROPOLITAN PHILADELPHIA (PA) | $372.28 | $372.28 |
| REST OF PENNSYLVANIA (PA) | $343.81 | $343.81 |
| PUERTO RICO (PR) | $359.00 | $359.00 |
| RHODE ISLAND (RI) | $363.30 | $363.30 |
| SOUTH CAROLINA (SC) | $342.22 | $342.22 |
| SOUTH DAKOTA** (SD) | $340.20 | $340.20 |
| TENNESSEE (TN) | $331.68 | $331.68 |
| BRAZORIA (TX) | $351.99 | $351.99 |
| DALLAS (TX) | $354.98 | $354.98 |
| GALVESTON (TX) | $353.56 | $353.56 |
| HOUSTON (TX) | $368.02 | $368.02 |
| BEAUMONT (TX) | $342.17 | $342.17 |
| FORT WORTH (TX) | $353.81 | $353.81 |
| AUSTIN (TX) | $363.89 | $363.89 |
| REST OF TEXAS (TX) | $347.41 | $347.41 |
| UTAH (UT) | $345.91 | $345.91 |
| VIRGINIA (VA) | $347.38 | $347.38 |
| VIRGIN ISLANDS (VI) | $359.00 | $359.00 |
| VERMONT (VT) | $343.17 | $343.17 |
| SEATTLE (KING CNTY) (WA) | $396.36 | $396.36 |
| REST OF WASHINGTON (WA) | $361.80 | $361.80 |
| WISCONSIN (WI) | $333.08 | $333.08 |
| WEST VIRGINIA (WV) | $349.19 | $349.19 |
| WYOMING** (WY) | $350.86 | $350.86 |
Look up another code or locality →
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 allowed amount is built from three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed, then the adjusted RVUs are summed and multiplied by the annual Conversion Factor set by CMS to produce a dollar amount. Practice expense RVUs typically differ between non-facility (office) and facility (hospital/ASC) settings because overhead costs differ, which is why the two amounts can diverge. The result is a national baseline that is then recalculated per locality using that area's specific GPCI values.
RVUs — work 5.37, practice expense 4.55 (non-facility) / 4.55 (facility), malpractice 0.79 — × 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 their Part B deductible; the patient or secondary payer is responsible for the remainder.
- Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
- Amounts vary by locality based on that area's GPCI values.
- Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does the amount differ between non-facility and facility settings?
The practice expense RVU component generally differs because overhead costs (staff, supplies, equipment) are treated differently when the service is performed in an office versus a hospital or ambulatory surgical center, where the facility itself absorbs some of those costs.
Why does the amount change by locality?
Each locality has its own Geographic Practice Cost Indices (GPCIs) 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.
Does this page show what Medicare will actually pay me?
No. It shows the estimated PFS allowed amount. Actual reimbursement depends on the beneficiary's deductible status, applicable modifiers, secondary payer coordination, and any claim-specific adjustments.
Where can I find the official rate for my MAC?
Consult the CMS Physician Fee Schedule Look-Up Tool or your specific Medicare Administrative Contractor (MAC) for the authoritative, locality-specific rate.
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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