Medicare Reimbursement for CPT 20956

CPT 20956 is a physician procedure code reported under Medicare's Physician Fee Schedule (PFS). This page shows the estimated PFS allowed amount nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2355.43	$2355.43
ALASKA* (AK)	$2944.59	$2944.59
ALABAMA (AL)	$2140.08	$2140.08
ARKANSAS (AR)	$2113.82	$2113.82
ARIZONA (AZ)	$2291.60	$2291.60
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2616.45	$2616.45
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2651.83	$2651.83
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2417.40	$2417.40
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2447.31	$2447.31
NAPA (CA)	$2530.36	$2530.36
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2626.19	$2626.19
VALLEJO (CA)	$2516.32	$2516.32
BAKERSFIELD (CA)	$2338.73	$2338.73
CHICO (CA)	$2315.13	$2315.13
FRESNO (CA)	$2315.13	$2315.13
HANFORD-CORCORAN (CA)	$2315.13	$2315.13
MADERA (CA)	$2315.13	$2315.13
MERCED (CA)	$2315.13	$2315.13
MODESTO (CA)	$2315.13	$2315.13
REDDING (CA)	$2315.13	$2315.13
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2407.31	$2407.31
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2389.37	$2389.37
SALINAS (CA)	$2379.75	$2379.75
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2691.66	$2691.66
SANTA CRUZ-WATSONVILLE (CA)	$2407.10	$2407.10
SANTA ROSA-PETALUMA (CA)	$2428.63	$2428.63
STOCKTON (CA)	$2315.13	$2315.13
VISALIA (CA)	$2315.13	$2315.13
YUBA CITY (CA)	$2315.13	$2315.13
EL CENTRO (CA)	$2316.56	$2316.56
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2407.06	$2407.06
SAN LUIS OBISPO-PASO ROBLES (CA)	$2346.42	$2346.42
SANTA MARIA-SANTA BARBARA (CA)	$2380.82	$2380.82
REST OF CALIFORNIA (CA)	$2315.13	$2315.13
COLORADO (CO)	$2355.34	$2355.34
CONNECTICUT (CT)	$2498.48	$2498.48
DC + MD/VA SUBURBS (DC)	$2589.78	$2589.78
DELAWARE (DE)	$2324.46	$2324.46
FORT LAUDERDALE (FL)	$2596.45	$2596.45
MIAMI (FL)	$2823.45	$2823.45
REST OF FLORIDA (FL)	$2467.56	$2467.56
ATLANTA (GA)	$2428.70	$2428.70
REST OF GEORGIA (GA)	$2331.85	$2331.85
HAWAII, GUAM (HI)	$2334.49	$2334.49
IOWA (IA)	$2120.76	$2120.76
IDAHO (ID)	$2146.18	$2146.18
EAST ST. LOUIS (IL)	$2587.80	$2587.80
SUBURBAN CHICAGO (IL)	$2605.71	$2605.71
CHICAGO (IL)	$2739.58	$2739.58
REST OF ILLINOIS (IL)	$2453.46	$2453.46
INDIANA (IN)	$2155.00	$2155.00
KANSAS (KS)	$2143.42	$2143.42
KENTUCKY (KY)	$2250.29	$2250.29
NEW ORLEANS (LA)	$2351.47	$2351.47
REST OF LOUISIANA (LA)	$2259.70	$2259.70
METROPOLITAN BOSTON (MA)	$2520.08	$2520.08
REST OF MASSACHUSETTS (MA)	$2357.29	$2357.29
BALTIMORE/SURR. CNTYS (MD)	$2497.94	$2497.94
REST OF MARYLAND (MD)	$2354.08	$2354.08
SOUTHERN MAINE (ME)	$2243.13	$2243.13
REST OF MAINE (ME)	$2188.88	$2188.88
DETROIT (MI)	$2526.55	$2526.55
REST OF MICHIGAN (MI)	$2329.08	$2329.08
MINNESOTA (MN)	$2174.79	$2174.79
METROPOLITAN ST. LOUIS (MO)	$2321.07	$2321.07
METROPOLITAN KANSAS CITY (MO)	$2304.44	$2304.44
REST OF MISSOURI (MO)	$2247.54	$2247.54
MISSISSIPPI (MS)	$2179.47	$2179.47
MONTANA** (MT)	$2354.86	$2354.86
NORTH CAROLINA (NC)	$2203.21	$2203.21
NORTH DAKOTA** (ND)	$2185.20	$2185.20
NEBRASKA (NE)	$2121.14	$2121.14
NEW HAMPSHIRE (NH)	$2349.45	$2349.45
NORTHERN NJ (NJ)	$2575.85	$2575.85
REST OF NEW JERSEY (NJ)	$2503.83	$2503.83
NEW MEXICO (NM)	$2352.63	$2352.63
NEVADA** (NV)	$2308.30	$2308.30
MANHATTAN (NY)	$2727.10	$2727.10
NYC SUBURBS/LONG ISLAND (NY)	$2824.41	$2824.41
POUGHKPSIE/N NYC SUBURBS (NY)	$2545.10	$2545.10
QUEENS (NY)	$2700.39	$2700.39
REST OF NEW YORK (NY)	$2233.93	$2233.93
OHIO (OH)	$2294.41	$2294.41
OKLAHOMA (OK)	$2213.65	$2213.65
PORTLAND (OR)	$2384.31	$2384.31
REST OF OREGON (OR)	$2267.41	$2267.41
METROPOLITAN PHILADELPHIA (PA)	$2464.72	$2464.72
REST OF PENNSYLVANIA (PA)	$2279.99	$2279.99
PUERTO RICO (PR)	$2359.14	$2359.14
RHODE ISLAND (RI)	$2373.98	$2373.98
SOUTH CAROLINA (SC)	$2257.13	$2257.13
SOUTH DAKOTA** (SD)	$2165.14	$2165.14
TENNESSEE (TN)	$2156.51	$2156.51
BRAZORIA (TX)	$2296.56	$2296.56
DALLAS (TX)	$2323.90	$2323.90
GALVESTON (TX)	$2311.77	$2311.77
HOUSTON (TX)	$2468.82	$2468.82
BEAUMONT (TX)	$2269.58	$2269.58
FORT WORTH (TX)	$2320.34	$2320.34
AUSTIN (TX)	$2367.66	$2367.66
REST OF TEXAS (TX)	$2290.52	$2290.52
UTAH (UT)	$2282.53	$2282.53
VIRGINIA (VA)	$2258.80	$2258.80
VIRGIN ISLANDS (VI)	$2359.14	$2359.14
VERMONT (VT)	$2206.58	$2206.58
SEATTLE (KING CNTY) (WA)	$2535.25	$2535.25
REST OF WASHINGTON (WA)	$2342.95	$2342.95
WISCONSIN (WI)	$2126.55	$2126.55
WEST VIRGINIA (WV)	$2383.60	$2383.60
WYOMING** (WY)	$2280.92	$2280.92

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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'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 the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and then multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility rates can differ because the practice-expense RVU often changes depending on whether the service is performed in a physician office (non-facility) versus a hospital or ambulatory surgical setting (facility); for this code the practice-expense RVU is the same in both settings, so the amounts shown align.

RVUs — work 40.15, practice expense 21.79 (non-facility) / 21.79 (facility), malpractice 8.58 — × 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 the annual 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.
Locality-specific GPCIs and the conversion factor are updated annually and may be revised mid-year by CMS.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the allowed amount differ by locality?

Medicare applies locality-specific Geographic Practice Cost Indices (GPCIs) to the work, practice-expense, and malpractice RVUs to account for regional differences in costs, so the same code can have different allowed amounts in different areas.

Why are the non-facility and facility amounts the same for this code?

The practice-expense RVU for CPT 20956 is identical in both non-facility and facility settings, so the calculated PFS amount does not differ between the two.

Does this amount reflect what the patient will owe?

No. The figure shown is the Medicare-allowed amount before cost-sharing. Patients generally owe 20% coinsurance after meeting the Part B deductible, unless they have supplemental coverage.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or assistant surgeon involvement can increase or decrease the final paid amount relative to the base PFS rate.

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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.