Medicare Reimbursement for CPT 20931

This page covers CPT code 20931, a procedure code reported to Medicare for physician and outpatient services. It shows the Medicare Physician Fee Schedule (PFS) allowed amount at the national level and adjusted for your locality, broken out by non-facility and facility settings. Because CPT descriptors are licensed by the AMA, this code is referred to generically rather than described in detail.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$98.20	$98.20
ALASKA* (AK)	$120.02	$120.02
ALABAMA (AL)	$87.18	$87.18
ARKANSAS (AR)	$85.86	$85.86
ARIZONA (AZ)	$94.75	$94.75
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$100.53	$100.53
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$101.49	$101.49
OXNARD-THOUSAND OAKS-VENTURA (CA)	$96.00	$96.00
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$97.59	$97.59
NAPA (CA)	$98.47	$98.47
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$101.20	$101.20
VALLEJO (CA)	$97.51	$97.51
BAKERSFIELD (CA)	$93.50	$93.50
CHICO (CA)	$91.95	$91.95
FRESNO (CA)	$91.95	$91.95
HANFORD-CORCORAN (CA)	$91.95	$91.95
MADERA (CA)	$91.95	$91.95
MERCED (CA)	$91.95	$91.95
MODESTO (CA)	$91.95	$91.95
REDDING (CA)	$91.95	$91.95
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$98.25	$98.25
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$94.38	$94.38
SALINAS (CA)	$94.01	$94.01
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$104.23	$104.23
SANTA CRUZ-WATSONVILLE (CA)	$94.53	$94.53
SANTA ROSA-PETALUMA (CA)	$95.31	$95.31
STOCKTON (CA)	$91.95	$91.95
VISALIA (CA)	$91.95	$91.95
YUBA CITY (CA)	$91.95	$91.95
EL CENTRO (CA)	$92.04	$92.04
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$94.80	$94.80
SAN LUIS OBISPO-PASO ROBLES (CA)	$92.79	$92.79
SANTA MARIA-SANTA BARBARA (CA)	$93.97	$93.97
REST OF CALIFORNIA (CA)	$91.95	$91.95
COLORADO (CO)	$95.85	$95.85
CONNECTICUT (CT)	$105.03	$105.03
DC + MD/VA SUBURBS (DC)	$107.11	$107.11
DELAWARE (DE)	$96.27	$96.27
FORT LAUDERDALE (FL)	$114.38	$114.38
MIAMI (FL)	$129.14	$129.14
REST OF FLORIDA (FL)	$107.24	$107.24
ATLANTA (GA)	$102.65	$102.65
REST OF GEORGIA (GA)	$99.85	$99.85
HAWAII, GUAM (HI)	$92.60	$92.60
IOWA (IA)	$84.64	$84.64
IDAHO (ID)	$86.24	$86.24
EAST ST. LOUIS (IL)	$116.60	$116.60
SUBURBAN CHICAGO (IL)	$114.36	$114.36
CHICAGO (IL)	$124.23	$124.23
REST OF ILLINOIS (IL)	$107.58	$107.58
INDIANA (IN)	$86.63	$86.63
KANSAS (KS)	$86.53	$86.53
KENTUCKY (KY)	$94.34	$94.34
NEW ORLEANS (LA)	$99.72	$99.72
REST OF LOUISIANA (LA)	$95.10	$95.10
METROPOLITAN BOSTON (MA)	$102.26	$102.26
REST OF MASSACHUSETTS (MA)	$96.18	$96.18
BALTIMORE/SURR. CNTYS (MD)	$105.25	$105.25
REST OF MARYLAND (MD)	$97.41	$97.41
SOUTHERN MAINE (ME)	$90.75	$90.75
REST OF MAINE (ME)	$89.17	$89.17
DETROIT (MI)	$111.03	$111.03
REST OF MICHIGAN (MI)	$99.03	$99.03
MINNESOTA (MN)	$84.90	$84.90
METROPOLITAN ST. LOUIS (MO)	$97.29	$97.29
METROPOLITAN KANSAS CITY (MO)	$96.54	$96.54
REST OF MISSOURI (MO)	$94.97	$94.97
MISSISSIPPI (MS)	$90.32	$90.32
MONTANA** (MT)	$98.16	$98.16
NORTH CAROLINA (NC)	$89.76	$89.76
NORTH DAKOTA** (ND)	$86.49	$86.49
NEBRASKA (NE)	$84.42	$84.42
NEW HAMPSHIRE (NH)	$96.54	$96.54
NORTHERN NJ (NJ)	$106.40	$106.40
REST OF NEW JERSEY (NJ)	$104.27	$104.27
NEW MEXICO (NM)	$100.52	$100.52
NEVADA** (NV)	$94.93	$94.93
MANHATTAN (NY)	$116.70	$116.70
NYC SUBURBS/LONG ISLAND (NY)	$122.57	$122.57
POUGHKPSIE/N NYC SUBURBS (NY)	$106.85	$106.85
QUEENS (NY)	$114.26	$114.26
REST OF NEW YORK (NY)	$91.36	$91.36
OHIO (OH)	$96.64	$96.64
OKLAHOMA (OK)	$91.70	$91.70
PORTLAND (OR)	$96.28	$96.28
REST OF OREGON (OR)	$92.27	$92.27
METROPOLITAN PHILADELPHIA (PA)	$103.87	$103.87
REST OF PENNSYLVANIA (PA)	$95.50	$95.50
PUERTO RICO (PR)	$98.12	$98.12
RHODE ISLAND (RI)	$97.84	$97.84
SOUTH CAROLINA (SC)	$93.74	$93.74
SOUTH DAKOTA** (SD)	$85.11	$85.11
TENNESSEE (TN)	$87.28	$87.28
BRAZORIA (TX)	$94.16	$94.16
DALLAS (TX)	$95.85	$95.85
GALVESTON (TX)	$95.14	$95.14
HOUSTON (TX)	$105.94	$105.94
BEAUMONT (TX)	$95.03	$95.03
FORT WORTH (TX)	$95.91	$95.91
AUSTIN (TX)	$97.21	$97.21
REST OF TEXAS (TX)	$95.28	$95.28
UTAH (UT)	$95.01	$95.01
VIRGINIA (VA)	$92.07	$92.07
VIRGIN ISLANDS (VI)	$98.12	$98.12
VERMONT (VT)	$88.27	$88.27
SEATTLE (KING CNTY) (WA)	$102.01	$102.01
REST OF WASHINGTON (WA)	$95.30	$95.30
WISCONSIN (WI)	$83.73	$83.73
WEST VIRGINIA (WV)	$104.11	$104.11
WYOMING** (WY)	$93.07	$93.07

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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 performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs because facility settings assume the facility bears certain overhead costs, which can make the facility amount lower than the non-facility amount (or, for some codes, the same if no site-of-service differential applies).

RVUs — work 1.76, practice expense 0.59 (non-facility) / 0.59 (facility), malpractice 0.59 — × 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 meets their annual deductible; the patient or secondary insurer is generally responsible for the remainder.
Modifiers, bilateral/multiple procedure rules, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Fee schedule amounts can change each year and may be updated mid-year; always confirm the current amount and locality-specific GPCIs with your Medicare Administrative Contractor (MAC).
This page reflects the Medicare Physician Fee Schedule and may not apply to other payers or to facility-based OPPS/ASC payment methodologies.

Frequently asked

Why does the amount differ between non-facility and facility settings?

The practice-expense RVU component can differ by setting because, in a facility, the facility itself absorbs certain overhead and resource costs, which is reflected in a different (often lower) non-physician cost component for that setting.

Why might my locality's amount differ from the national amount?

Each RVU component is adjusted by locality-specific GPCIs that reflect differences in local labor, rent, and malpractice costs, so the same code can be paid differently across different geographic areas.

Does this amount include what the patient owes?

No. The figures shown represent the total Medicare-allowed amount. Medicare generally pays 80% after the deductible is met, with the patient or secondary coverage typically responsible for the remaining portion.

Will this amount stay the same all year?

Not necessarily. The conversion factor and RVUs can be updated annually, and mid-year adjustments or budget-neutrality changes can also affect the final allowed amount.

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.