Medicare Reimbursement for CPT 20922

CPT 20922 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and, where available, 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)	$657.33	$470.62
ALASKA* (AK)	$772.35	$573.50
ALABAMA (AL)	$587.80	$424.43
ARKANSAS (AR)	$579.13	$418.75
ARIZONA (AZ)	$638.25	$457.33
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$806.03	$542.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$820.20	$550.96
OXNARD-THOUSAND OAKS-VENTURA (CA)	$714.00	$493.31
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$719.38	$498.50
NAPA (CA)	$767.93	$521.85
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$807.75	$544.48
VALLEJO (CA)	$765.46	$519.37
BAKERSFIELD (CA)	$678.49	$473.85
CHICO (CA)	$674.35	$469.72
FRESNO (CA)	$674.35	$469.72
HANFORD-CORCORAN (CA)	$674.35	$469.72
MADERA (CA)	$674.35	$469.72
MERCED (CA)	$674.35	$469.72
MODESTO (CA)	$674.35	$469.72
REDDING (CA)	$674.35	$469.72
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$690.57	$485.93
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$704.18	$487.03
SALINAS (CA)	$701.52	$485.12
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$827.21	$557.98
SANTA CRUZ-WATSONVILLE (CA)	$720.61	$493.75
SANTA ROSA-PETALUMA (CA)	$727.59	$498.31
STOCKTON (CA)	$674.35	$469.72
VISALIA (CA)	$674.35	$469.72
YUBA CITY (CA)	$674.35	$469.72
EL CENTRO (CA)	$674.60	$469.97
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$715.70	$492.39
SAN LUIS OBISPO-PASO ROBLES (CA)	$690.74	$478.08
SANTA MARIA-SANTA BARBARA (CA)	$703.51	$485.81
REST OF CALIFORNIA (CA)	$674.35	$469.72
COLORADO (CO)	$673.38	$474.72
CONNECTICUT (CT)	$701.78	$500.69
DC + MD/VA SUBURBS (DC)	$743.06	$523.11
DELAWARE (DE)	$648.79	$464.32
FORT LAUDERDALE (FL)	$703.04	$513.90
MIAMI (FL)	$750.07	$555.70
REST OF FLORIDA (FL)	$665.93	$487.43
ATLANTA (GA)	$674.24	$484.54
REST OF GEORGIA (GA)	$625.85	$459.31
HAWAII, GUAM (HI)	$688.31	$476.02
IOWA (IA)	$594.52	$423.68
IDAHO (ID)	$600.26	$428.49
EAST ST. LOUIS (IL)	$677.98	$506.21
SUBURBAN CHICAGO (IL)	$708.14	$516.38
CHICAGO (IL)	$726.13	$538.48
REST OF ILLINOIS (IL)	$652.57	$482.10
INDIANA (IN)	$603.59	$430.50
KANSAS (KS)	$595.73	$426.94
KENTUCKY (KY)	$610.74	$444.75
NEW ORLEANS (LA)	$641.70	$466.01
REST OF LOUISIANA (LA)	$611.38	$446.15
METROPOLITAN BOSTON (MA)	$734.97	$512.04
REST OF MASSACHUSETTS (MA)	$670.90	$474.30
BALTIMORE/SURR. CNTYS (MD)	$700.72	$500.38
REST OF MARYLAND (MD)	$660.03	$471.07
SOUTHERN MAINE (ME)	$635.29	$450.26
REST OF MAINE (ME)	$607.78	$436.00
DETROIT (MI)	$678.59	$498.41
REST OF MICHIGAN (MI)	$630.68	$460.21
MINNESOTA (MN)	$632.88	$440.75
METROPOLITAN ST. LOUIS (MO)	$639.14	$461.39
METROPOLITAN KANSAS CITY (MO)	$632.92	$457.60
REST OF MISSOURI (MO)	$603.43	$442.48
MISSISSIPPI (MS)	$591.19	$430.43
MONTANA** (MT)	$657.23	$470.52
NORTH CAROLINA (NC)	$613.59	$439.39
NORTH DAKOTA** (ND)	$627.37	$440.66
NEBRASKA (NE)	$596.61	$424.28
NEW HAMPSHIRE (NH)	$666.65	$472.28
NORTHERN NJ (NJ)	$735.96	$519.38
REST OF NEW JERSEY (NJ)	$706.32	$502.43
NEW MEXICO (NM)	$635.84	$464.62
NEVADA** (NV)	$649.29	$462.39
MANHATTAN (NY)	$763.07	$546.12
NYC SUBURBS/LONG ISLAND (NY)	$787.03	$565.03
POUGHKPSIE/N NYC SUBURBS (NY)	$714.29	$509.84
QUEENS (NY)	$763.43	$542.74
REST OF NEW YORK (NY)	$623.30	$445.92
OHIO (OH)	$624.58	$454.11
OKLAHOMA (OK)	$605.30	$438.57
PORTLAND (OR)	$690.33	$482.90
REST OF OREGON (OR)	$640.83	$454.86
METROPOLITAN PHILADELPHIA (PA)	$686.75	$492.39
REST OF PENNSYLVANIA (PA)	$623.31	$451.90
PUERTO RICO (PR)	$660.77	$472.00
RHODE ISLAND (RI)	$668.75	$475.88
SOUTH CAROLINA (SC)	$620.80	$448.28
SOUTH DAKOTA** (SD)	$623.84	$437.13
TENNESSEE (TN)	$599.30	$429.58
BRAZORIA (TX)	$644.61	$459.58
DALLAS (TX)	$650.68	$464.71
GALVESTON (TX)	$647.79	$462.39
HOUSTON (TX)	$675.43	$490.03
BEAUMONT (TX)	$619.45	$449.54
FORT WORTH (TX)	$647.52	$463.42
AUSTIN (TX)	$674.14	$476.60
REST OF TEXAS (TX)	$633.00	$455.81
UTAH (UT)	$629.32	$453.81
VIRGINIA (VA)	$636.02	$452.49
VIRGIN ISLANDS (VI)	$660.77	$472.00
VERMONT (VT)	$628.60	$443.76
SEATTLE (KING CNTY) (WA)	$745.90	$516.81
REST OF WASHINGTON (WA)	$668.41	$471.80
WISCONSIN (WI)	$606.42	$427.55
WEST VIRGINIA (WV)	$629.14	$466.89
WYOMING** (WY)	$644.22	$457.51

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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 pricing starts with three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (e.g., supplies, staff, equipment) are higher when the physician's office bears those costs directly, versus when the procedure is performed in a facility that bills separately for overhead. This is why the same code can show two different allowed amounts depending on place of service.

RVUs — work 6.76, practice expense 11.41 (non-facility) / 5.82 (facility), malpractice 1.51 — × 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 deductible; the patient or secondary payer is responsible for the remainder.
Actual payment can vary based on modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments.
Locality-specific GPCI values can shift the allowed amount up or down from the national figure.
Always verify the final allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does CPT 20922 show two different Medicare amounts?

The non-facility amount applies when the procedure is performed in a setting like a physician's office where the practice bears the overhead costs; the facility amount applies when performed in a hospital or other facility that bills overhead separately. The practice-expense RVU component differs between the two.

Is the amount shown what Medicare will actually pay?

No. The figure is an estimate based on national RVUs and the conversion factor. Actual payment depends on the patient's specific locality GPCIs, applicable modifiers, deductible status, and any sequestration or budget-neutrality adjustments in effect.

Why don't you show the CPT code description?

CPT code descriptors are copyrighted and licensed by the American Medical Association (AMA), so this page refers to the code generically rather than reproducing the official descriptor.

How is the patient's share calculated?

After the Part B deductible is met, Medicare generally pays 80% of the allowed amount, and the patient (or a secondary payer) is responsible for the remaining 20% coinsurance, subject to any applicable modifiers or adjustments.

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.