Medicare Reimbursement for CPT 20957

CPT 20957 is a procedure code defined by the American Medical Association; because CPT descriptors are proprietary, this page refers to it generically rather than restating the official description. Below you'll find the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, shown nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2456.30	$2456.30
ALASKA* (AK)	$3067.40	$3067.40
ALABAMA (AL)	$2231.26	$2231.26
ARKANSAS (AR)	$2203.80	$2203.80
ARIZONA (AZ)	$2389.73	$2389.73
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2734.84	$2734.84
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2772.10	$2772.10
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2524.25	$2524.25
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2555.20	$2555.20
NAPA (CA)	$2643.90	$2643.90
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2744.90	$2744.90
VALLEJO (CA)	$2629.40	$2629.40
BAKERSFIELD (CA)	$2441.15	$2441.15
CHICO (CA)	$2416.77	$2416.77
FRESNO (CA)	$2416.77	$2416.77
HANFORD-CORCORAN (CA)	$2416.77	$2416.77
MADERA (CA)	$2416.77	$2416.77
MERCED (CA)	$2416.77	$2416.77
MODESTO (CA)	$2416.77	$2416.77
REDDING (CA)	$2416.77	$2416.77
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2511.97	$2511.97
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2494.92	$2494.92
SALINAS (CA)	$2484.89	$2484.89
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2813.23	$2813.23
SANTA CRUZ-WATSONVILLE (CA)	$2514.30	$2514.30
SANTA ROSA-PETALUMA (CA)	$2536.83	$2536.83
STOCKTON (CA)	$2416.77	$2416.77
VISALIA (CA)	$2416.77	$2416.77
YUBA CITY (CA)	$2416.77	$2416.77
EL CENTRO (CA)	$2418.25	$2418.25
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2513.88	$2513.88
SAN LUIS OBISPO-PASO ROBLES (CA)	$2450.01	$2450.01
SANTA MARIA-SANTA BARBARA (CA)	$2486.14	$2486.14
REST OF CALIFORNIA (CA)	$2416.77	$2416.77
COLORADO (CO)	$2457.61	$2457.61
CONNECTICUT (CT)	$2605.71	$2605.71
DC + MD/VA SUBURBS (DC)	$2702.24	$2702.24
DELAWARE (DE)	$2424.08	$2424.08
FORT LAUDERDALE (FL)	$2705.46	$2705.46
MIAMI (FL)	$2940.47	$2940.47
REST OF FLORIDA (FL)	$2571.15	$2571.15
ATLANTA (GA)	$2532.31	$2532.31
REST OF GEORGIA (GA)	$2429.65	$2429.65
HAWAII, GUAM (HI)	$2437.60	$2437.60
IOWA (IA)	$2212.16	$2212.16
IDAHO (ID)	$2238.51	$2238.51
EAST ST. LOUIS (IL)	$2694.55	$2694.55
SUBURBAN CHICAGO (IL)	$2715.34	$2715.34
CHICAGO (IL)	$2853.11	$2853.11
REST OF ILLINOIS (IL)	$2555.67	$2555.67
INDIANA (IN)	$2247.77	$2247.77
KANSAS (KS)	$2235.32	$2235.32
KENTUCKY (KY)	$2345.36	$2345.36
NEW ORLEANS (LA)	$2450.95	$2450.95
REST OF LOUISIANA (LA)	$2354.99	$2354.99
METROPOLITAN BOSTON (MA)	$2630.58	$2630.58
REST OF MASSACHUSETTS (MA)	$2459.39	$2459.39
BALTIMORE/SURR. CNTYS (MD)	$2605.06	$2605.06
REST OF MARYLAND (MD)	$2455.19	$2455.19
SOUTHERN MAINE (ME)	$2340.15	$2340.15
REST OF MAINE (ME)	$2282.61	$2282.61
DETROIT (MI)	$2632.26	$2632.26
REST OF MICHIGAN (MI)	$2427.24	$2427.24
MINNESOTA (MN)	$2270.38	$2270.38
METROPOLITAN ST. LOUIS (MO)	$2419.80	$2419.80
METROPOLITAN KANSAS CITY (MO)	$2402.35	$2402.35
REST OF MISSOURI (MO)	$2341.95	$2341.95
MISSISSIPPI (MS)	$2271.63	$2271.63
MONTANA** (MT)	$2455.71	$2455.71
NORTH CAROLINA (NC)	$2297.69	$2297.69
NORTH DAKOTA** (ND)	$2280.52	$2280.52
NEBRASKA (NE)	$2212.72	$2212.72
NEW HAMPSHIRE (NH)	$2451.00	$2451.00
NORTHERN NJ (NJ)	$2687.50	$2687.50
REST OF NEW JERSEY (NJ)	$2611.61	$2611.61
NEW MEXICO (NM)	$2451.63	$2451.63
NEVADA** (NV)	$2407.65	$2407.65
MANHATTAN (NY)	$2843.73	$2843.73
NYC SUBURBS/LONG ISLAND (NY)	$2944.79	$2944.79
POUGHKPSIE/N NYC SUBURBS (NY)	$2654.31	$2654.31
QUEENS (NY)	$2816.57	$2816.57
REST OF NEW YORK (NY)	$2329.77	$2329.77
OHIO (OH)	$2391.43	$2391.43
OKLAHOMA (OK)	$2307.61	$2307.61
PORTLAND (OR)	$2488.53	$2488.53
REST OF OREGON (OR)	$2365.32	$2365.32
METROPOLITAN PHILADELPHIA (PA)	$2570.08	$2570.08
REST OF PENNSYLVANIA (PA)	$2376.65	$2376.65
PUERTO RICO (PR)	$2460.37	$2460.37
RHODE ISLAND (RI)	$2476.21	$2476.21
SOUTH CAROLINA (SC)	$2353.17	$2353.17
SOUTH DAKOTA** (SD)	$2259.80	$2259.80
TENNESSEE (TN)	$2248.95	$2248.95
BRAZORIA (TX)	$2395.34	$2395.34
DALLAS (TX)	$2423.68	$2423.68
GALVESTON (TX)	$2411.09	$2411.09
HOUSTON (TX)	$2573.26	$2573.26
BEAUMONT (TX)	$2365.73	$2365.73
FORT WORTH (TX)	$2419.79	$2419.79
AUSTIN (TX)	$2470.17	$2470.17
REST OF TEXAS (TX)	$2388.18	$2388.18
UTAH (UT)	$2379.74	$2379.74
VIRGINIA (VA)	$2356.16	$2356.16
VIRGIN ISLANDS (VI)	$2460.37	$2460.37
VERMONT (VT)	$2302.38	$2302.38
SEATTLE (KING CNTY) (WA)	$2646.97	$2646.97
REST OF WASHINGTON (WA)	$2444.58	$2444.58
WISCONSIN (WI)	$2219.06	$2219.06
WEST VIRGINIA (WV)	$2482.60	$2482.60
WYOMING** (WY)	$2379.36	$2379.36

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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 — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. These locality-adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar figure set by CMS) to produce the allowed amount. Non-facility and facility rates differ mainly in the practice-expense RVU, reflecting whether overhead costs (like clinical staff and supplies) are borne by the billing provider or by a facility such as a hospital. For this code, the practice-expense RVU is the same in both settings, which is why the national non-facility and facility amounts shown are equal.

RVUs — work 41.54, practice expense 23.14 (non-facility) / 23.14 (facility), malpractice 8.86 — × 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 beneficiary or secondary insurer is responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always confirm current, locality-specific rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why do non-facility and facility amounts sometimes match for this code?

When the practice-expense RVU is the same for both settings, the calculated allowed amount comes out equal, even though facility and non-facility PE RVUs are generally priced separately to reflect different overhead responsibilities.

Will my locality's payment match the national amount shown here?

Not necessarily. The national figure uses a standard GPCI baseline; actual payment in a specific locality is adjusted up or down based on that area's wage, rent, and malpractice cost indices.

Does this amount include the patient's share?

No. The PFS allowed amount reflects the total approved payment; Medicare generally reimburses 80% of this after the deductible, with the remaining 20% owed by the patient or a secondary payer.

Why might my actual Medicare payment differ from this estimate?

Differences can result from applied modifiers, multiple-procedure payment reductions, sequestration, or mid-year/annual updates to the conversion factor and RVUs that aren't reflected in a static reference figure.

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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.