Medicare Reimbursement for CPT 20937

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for CPT code 20937, a procedure code defined by the American Medical Association. It shows the national estimated payment as well as how the amount can vary by locality, and compares non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$147.30	$147.30
ALASKA* (AK)	$182.83	$182.83
ALABAMA (AL)	$132.09	$132.09
ARKANSAS (AR)	$130.26	$130.26
ARIZONA (AZ)	$142.57	$142.57
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$153.08	$153.08
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$154.67	$154.67
OXNARD-THOUSAND OAKS-VENTURA (CA)	$145.37	$145.37
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$147.66	$147.66
NAPA (CA)	$149.60	$149.60
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$153.98	$153.98
VALLEJO (CA)	$148.31	$148.31
BAKERSFIELD (CA)	$141.59	$141.59
CHICO (CA)	$139.48	$139.48
FRESNO (CA)	$139.48	$139.48
HANFORD-CORCORAN (CA)	$139.48	$139.48
MADERA (CA)	$139.48	$139.48
MERCED (CA)	$139.48	$139.48
MODESTO (CA)	$139.48	$139.48
REDDING (CA)	$139.48	$139.48
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$147.94	$147.94
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$143.23	$143.23
SALINAS (CA)	$142.65	$142.65
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$158.33	$158.33
SANTA CRUZ-WATSONVILLE (CA)	$143.43	$143.43
SANTA ROSA-PETALUMA (CA)	$144.63	$144.63
STOCKTON (CA)	$139.48	$139.48
VISALIA (CA)	$139.48	$139.48
YUBA CITY (CA)	$139.48	$139.48
EL CENTRO (CA)	$139.62	$139.62
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$143.83	$143.83
SAN LUIS OBISPO-PASO ROBLES (CA)	$140.78	$140.78
SANTA MARIA-SANTA BARBARA (CA)	$142.59	$142.59
REST OF CALIFORNIA (CA)	$139.48	$139.48
COLORADO (CO)	$144.53	$144.53
CONNECTICUT (CT)	$156.97	$156.97
DC + MD/VA SUBURBS (DC)	$160.54	$160.54
DELAWARE (DE)	$144.73	$144.73
FORT LAUDERDALE (FL)	$169.01	$169.01
MIAMI (FL)	$188.88	$188.88
REST OF FLORIDA (FL)	$159.25	$159.25
ATLANTA (GA)	$153.36	$153.36
REST OF GEORGIA (GA)	$149.12	$149.12
HAWAII, GUAM (HI)	$140.31	$140.31
IOWA (IA)	$128.83	$128.83
IDAHO (ID)	$130.99	$130.99
EAST ST. LOUIS (IL)	$171.65	$171.65
SUBURBAN CHICAGO (IL)	$169.12	$169.12
CHICAGO (IL)	$182.26	$182.26
REST OF ILLINOIS (IL)	$159.54	$159.54
INDIANA (IN)	$131.54	$131.54
KANSAS (KS)	$131.32	$131.32
KENTUCKY (KY)	$141.72	$141.72
NEW ORLEANS (LA)	$149.11	$149.11
REST OF LOUISIANA (LA)	$142.73	$142.73
METROPOLITAN BOSTON (MA)	$153.95	$153.95
REST OF MASSACHUSETTS (MA)	$144.99	$144.99
BALTIMORE/SURR. CNTYS (MD)	$157.20	$157.20
REST OF MARYLAND (MD)	$146.40	$146.40
SOUTHERN MAINE (ME)	$137.29	$137.29
REST OF MAINE (ME)	$134.92	$134.92
DETROIT (MI)	$164.35	$164.35
REST OF MICHIGAN (MI)	$148.09	$148.09
MINNESOTA (MN)	$129.59	$129.59
METROPOLITAN ST. LOUIS (MO)	$145.91	$145.91
METROPOLITAN KANSAS CITY (MO)	$144.86	$144.86
REST OF MISSOURI (MO)	$142.46	$142.46
MISSISSIPPI (MS)	$136.23	$136.23
MONTANA** (MT)	$147.25	$147.25
NORTH CAROLINA (NC)	$135.76	$135.76
NORTH DAKOTA** (ND)	$131.62	$131.62
NEBRASKA (NE)	$128.57	$128.57
NEW HAMPSHIRE (NH)	$145.23	$145.23
NORTHERN NJ (NJ)	$159.63	$159.63
REST OF NEW JERSEY (NJ)	$156.26	$156.26
NEW MEXICO (NM)	$150.11	$150.11
NEVADA** (NV)	$142.92	$142.92
MANHATTAN (NY)	$173.44	$173.44
NYC SUBURBS/LONG ISLAND (NY)	$181.41	$181.41
POUGHKPSIE/N NYC SUBURBS (NY)	$159.78	$159.78
QUEENS (NY)	$170.25	$170.25
REST OF NEW YORK (NY)	$137.96	$137.96
OHIO (OH)	$144.89	$144.89
OKLAHOMA (OK)	$138.20	$138.20
PORTLAND (OR)	$145.33	$145.33
REST OF OREGON (OR)	$139.34	$139.34
METROPOLITAN PHILADELPHIA (PA)	$155.26	$155.26
REST OF PENNSYLVANIA (PA)	$143.38	$143.38
PUERTO RICO (PR)	$147.23	$147.23
RHODE ISLAND (RI)	$147.17	$147.17
SOUTH CAROLINA (SC)	$141.06	$141.06
SOUTH DAKOTA** (SD)	$129.78	$129.78
TENNESSEE (TN)	$132.35	$132.35
BRAZORIA (TX)	$141.95	$141.95
DALLAS (TX)	$144.25	$144.25
GALVESTON (TX)	$143.28	$143.28
HOUSTON (TX)	$157.74	$157.74
BEAUMONT (TX)	$142.72	$142.72
FORT WORTH (TX)	$144.29	$144.29
AUSTIN (TX)	$146.22	$146.22
REST OF TEXAS (TX)	$143.21	$143.21
UTAH (UT)	$142.80	$142.80
VIRGINIA (VA)	$139.03	$139.03
VIRGIN ISLANDS (VI)	$147.23	$147.23
VERMONT (VT)	$133.96	$133.96
SEATTLE (KING CNTY) (WA)	$153.84	$153.84
REST OF WASHINGTON (WA)	$143.77	$143.77
WISCONSIN (WI)	$127.78	$127.78
WEST VIRGINIA (WV)	$154.73	$154.73
WYOMING** (WY)	$140.44	$140.44

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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 formula combines three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the service locality. These geographically adjusted RVUs are summed and multiplied by the annual conversion factor to produce the allowed amount. Practice expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, which is why payment amounts can differ depending on place of service. The conversion factor and RVU values are updated annually by CMS and can shift due to budget-neutrality adjustments.

RVUs — work 2.72, practice expense 0.9 (non-facility) / 0.9 (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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean actual payment can differ from the national average shown here.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the non-facility and facility amount the same for this code?

When the practice expense RVU is identical in both settings, the resulting allowed amounts will also be the same, since work and malpractice RVUs don't change by setting.

Why might my local Medicare payment differ from the national amount shown?

The national figure uses a standardized GPCI; actual payments are adjusted using the GPCIs of the specific locality where the service was performed.

Does this amount include the patient's share?

No. The amount shown is the total Medicare-allowed amount; Medicare generally pays 80% after the deductible, with the patient or secondary payer covering the rest.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple procedures can increase or decrease the final payment from the base PFS 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.