Medicare Reimbursement for CPT 20938
CPT 20938 is a physician procedure code reported to Medicare for payment purposes; the full descriptor is omitted here because CPT codes are copyrighted by the AMA. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $163.33 | $163.33 |
| ALASKA* (AK) | $200.18 | $200.18 |
| ALABAMA (AL) | $145.28 | $145.28 |
| ARKANSAS (AR) | $143.12 | $143.12 |
| ARIZONA (AZ) | $157.69 | $157.69 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $167.78 | $167.78 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $169.41 | $169.41 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $160.01 | $160.01 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $162.63 | $162.63 |
| NAPA (CA) | $164.26 | $164.26 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $168.87 | $168.87 |
| VALLEJO (CA) | $162.69 | $162.69 |
| BAKERSFIELD (CA) | $155.83 | $155.83 |
| CHICO (CA) | $153.30 | $153.30 |
| FRESNO (CA) | $153.30 | $153.30 |
| HANFORD-CORCORAN (CA) | $153.30 | $153.30 |
| MADERA (CA) | $153.30 | $153.30 |
| MERCED (CA) | $153.30 | $153.30 |
| MODESTO (CA) | $153.30 | $153.30 |
| REDDING (CA) | $153.30 | $153.30 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $163.56 | $163.56 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $157.38 | $157.38 |
| SALINAS (CA) | $156.75 | $156.75 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $173.87 | $173.87 |
| SANTA CRUZ-WATSONVILLE (CA) | $157.62 | $157.62 |
| SANTA ROSA-PETALUMA (CA) | $158.94 | $158.94 |
| STOCKTON (CA) | $153.30 | $153.30 |
| VISALIA (CA) | $153.30 | $153.30 |
| YUBA CITY (CA) | $153.30 | $153.30 |
| EL CENTRO (CA) | $153.46 | $153.46 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $158.07 | $158.07 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $154.72 | $154.72 |
| SANTA MARIA-SANTA BARBARA (CA) | $156.69 | $156.69 |
| REST OF CALIFORNIA (CA) | $153.30 | $153.30 |
| COLORADO (CO) | $159.60 | $159.60 |
| CONNECTICUT (CT) | $174.57 | $174.57 |
| DC + MD/VA SUBURBS (DC) | $178.14 | $178.14 |
| DELAWARE (DE) | $160.19 | $160.19 |
| FORT LAUDERDALE (FL) | $189.67 | $189.67 |
| MIAMI (FL) | $213.71 | $213.71 |
| REST OF FLORIDA (FL) | $178.00 | $178.00 |
| ATLANTA (GA) | $170.60 | $170.60 |
| REST OF GEORGIA (GA) | $165.92 | $165.92 |
| HAWAII, GUAM (HI) | $154.36 | $154.36 |
| IOWA (IA) | $141.18 | $141.18 |
| IDAHO (ID) | $143.79 | $143.79 |
| EAST ST. LOUIS (IL) | $193.20 | $193.20 |
| SUBURBAN CHICAGO (IL) | $189.66 | $189.66 |
| CHICAGO (IL) | $205.71 | $205.71 |
| REST OF ILLINOIS (IL) | $178.51 | $178.51 |
| INDIANA (IN) | $144.44 | $144.44 |
| KANSAS (KS) | $144.25 | $144.25 |
| KENTUCKY (KY) | $156.93 | $156.93 |
| NEW ORLEANS (LA) | $165.74 | $165.74 |
| REST OF LOUISIANA (LA) | $158.18 | $158.18 |
| METROPOLITAN BOSTON (MA) | $170.24 | $170.24 |
| REST OF MASSACHUSETTS (MA) | $160.14 | $160.14 |
| BALTIMORE/SURR. CNTYS (MD) | $174.91 | $174.91 |
| REST OF MARYLAND (MD) | $162.08 | $162.08 |
| SOUTHERN MAINE (ME) | $151.20 | $151.20 |
| REST OF MAINE (ME) | $148.56 | $148.56 |
| DETROIT (MI) | $184.17 | $184.17 |
| REST OF MICHIGAN (MI) | $164.59 | $164.59 |
| MINNESOTA (MN) | $141.72 | $141.72 |
| METROPOLITAN ST. LOUIS (MO) | $161.81 | $161.81 |
| METROPOLITAN KANSAS CITY (MO) | $160.58 | $160.58 |
| REST OF MISSOURI (MO) | $157.93 | $157.93 |
| MISSISSIPPI (MS) | $150.37 | $150.37 |
| MONTANA** (MT) | $163.27 | $163.27 |
| NORTH CAROLINA (NC) | $149.54 | $149.54 |
| NORTH DAKOTA** (ND) | $144.28 | $144.28 |
| NEBRASKA (NE) | $140.84 | $140.84 |
| NEW HAMPSHIRE (NH) | $160.68 | $160.68 |
| NORTHERN NJ (NJ) | $176.99 | $176.99 |
| REST OF NEW JERSEY (NJ) | $173.41 | $173.41 |
| NEW MEXICO (NM) | $167.03 | $167.03 |
| NEVADA** (NV) | $158.01 | $158.01 |
| MANHATTAN (NY) | $193.76 | $193.76 |
| NYC SUBURBS/LONG ISLAND (NY) | $203.34 | $203.34 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $177.62 | $177.62 |
| QUEENS (NY) | $189.81 | $189.81 |
| REST OF NEW YORK (NY) | $152.15 | $152.15 |
| OHIO (OH) | $160.71 | $160.71 |
| OKLAHOMA (OK) | $152.64 | $152.64 |
| PORTLAND (OR) | $160.36 | $160.36 |
| REST OF OREGON (OR) | $153.67 | $153.67 |
| METROPOLITAN PHILADELPHIA (PA) | $172.64 | $172.64 |
| REST OF PENNSYLVANIA (PA) | $158.86 | $158.86 |
| PUERTO RICO (PR) | $163.21 | $163.21 |
| RHODE ISLAND (RI) | $162.82 | $162.82 |
| SOUTH CAROLINA (SC) | $156.01 | $156.01 |
| SOUTH DAKOTA** (SD) | $142.04 | $142.04 |
| TENNESSEE (TN) | $145.48 | $145.48 |
| BRAZORIA (TX) | $156.76 | $156.76 |
| DALLAS (TX) | $159.53 | $159.53 |
| GALVESTON (TX) | $158.37 | $158.37 |
| HOUSTON (TX) | $175.94 | $175.94 |
| BEAUMONT (TX) | $158.08 | $158.08 |
| FORT WORTH (TX) | $159.61 | $159.61 |
| AUSTIN (TX) | $161.79 | $161.79 |
| REST OF TEXAS (TX) | $158.53 | $158.53 |
| UTAH (UT) | $158.08 | $158.08 |
| VIRGINIA (VA) | $153.34 | $153.34 |
| VIRGIN ISLANDS (VI) | $163.21 | $163.21 |
| VERMONT (VT) | $147.16 | $147.16 |
| SEATTLE (KING CNTY) (WA) | $169.88 | $169.88 |
| REST OF WASHINGTON (WA) | $158.70 | $158.70 |
| WISCONSIN (WI) | $139.75 | $139.75 |
| WEST VIRGINIA (WV) | $172.82 | $172.82 |
| WYOMING** (WY) | $154.99 | $154.99 |
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: 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 procedure 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 Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings, which is why the two amounts can differ even though work and malpractice RVUs stay the same.
RVUs — work 2.94, practice expense 0.99 (non-facility) / 0.99 (facility), malpractice 0.96 — × 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 rest.
- Actual payment can vary with modifiers, place of service, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments.
- Locality-specific GPCIs change the amount from the national average shown here.
- Always verify the current allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why does the facility amount differ from the non-facility amount?
Practice expense RVUs are lower in the facility setting because the facility (not the physician's office) absorbs certain overhead costs, so the facility rate reflects only the physician's professional component costs.
Why does the allowed 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 regional cost-of-living and practice cost differences.
Does this amount reflect what the patient owes?
No. The figure shown is the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% after the deductible, and the patient or supplemental insurance may be responsible for the remaining 20% plus any unmet deductible.
Can modifiers change this amount?
Yes. Modifiers such as bilateral, multiple-procedure, or assistant-at-surgery indicators can increase or decrease the final paid amount relative to the base PFS rate shown here.
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.
Bill accurately, get paid faster
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free