Medicare Reimbursement for CPT 20962

CPT 20962 is a procedure code reported to Medicare and other payers; the full clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both nationally and adjustable by locality, and compares non-facility versus facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2428.25	$2428.25
ALASKA* (AK)	$3001.62	$3001.62
ALABAMA (AL)	$2200.21	$2200.21
ARKANSAS (AR)	$2172.27	$2172.27
ARIZONA (AZ)	$2361.79	$2361.79
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2753.46	$2753.46
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2793.13	$2793.13
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2521.37	$2521.37
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2550.01	$2550.01
NAPA (CA)	$2654.32	$2654.32
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2762.72	$2762.72
VALLEJO (CA)	$2640.98	$2640.98
BAKERSFIELD (CA)	$2430.46	$2430.46
CHICO (CA)	$2408.04	$2408.04
FRESNO (CA)	$2408.04	$2408.04
HANFORD-CORCORAN (CA)	$2408.04	$2408.04
MADERA (CA)	$2408.04	$2408.04
MERCED (CA)	$2408.04	$2408.04
MODESTO (CA)	$2408.04	$2408.04
REDDING (CA)	$2408.04	$2408.04
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2495.61	$2495.61
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2491.20	$2491.20
SALINAS (CA)	$2481.30	$2481.30
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2830.96	$2830.96
SANTA CRUZ-WATSONVILLE (CA)	$2517.76	$2517.76
SANTA ROSA-PETALUMA (CA)	$2540.68	$2540.68
STOCKTON (CA)	$2408.04	$2408.04
VISALIA (CA)	$2408.04	$2408.04
YUBA CITY (CA)	$2408.04	$2408.04
EL CENTRO (CA)	$2409.40	$2409.40
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2514.18	$2514.18
SAN LUIS OBISPO-PASO ROBLES (CA)	$2445.84	$2445.84
SANTA MARIA-SANTA BARBARA (CA)	$2483.62	$2483.62
REST OF CALIFORNIA (CA)	$2408.04	$2408.04
COLORADO (CO)	$2440.22	$2440.22
CONNECTICUT (CT)	$2578.64	$2578.64
DC + MD/VA SUBURBS (DC)	$2684.44	$2684.44
DELAWARE (DE)	$2396.59	$2396.59
FORT LAUDERDALE (FL)	$2659.63	$2659.63
MIAMI (FL)	$2880.51	$2880.51
REST OF FLORIDA (FL)	$2526.49	$2526.49
ATLANTA (GA)	$2500.86	$2500.86
REST OF GEORGIA (GA)	$2385.57	$2385.57
HAWAII, GUAM (HI)	$2434.08	$2434.08
IOWA (IA)	$2189.37	$2189.37
IDAHO (ID)	$2214.46	$2214.46
EAST ST. LOUIS (IL)	$2633.94	$2633.94
SUBURBAN CHICAGO (IL)	$2671.07	$2671.07
CHICAGO (IL)	$2794.10	$2794.10
REST OF ILLINOIS (IL)	$2505.02	$2505.02
INDIANA (IN)	$2224.15	$2224.15
KANSAS (KS)	$2208.83	$2208.83
KENTUCKY (KY)	$2307.53	$2307.53
NEW ORLEANS (LA)	$2413.40	$2413.40
REST OF LOUISIANA (LA)	$2315.71	$2315.71
METROPOLITAN BOSTON (MA)	$2621.20	$2621.20
REST OF MASSACHUSETTS (MA)	$2440.01	$2440.01
BALTIMORE/SURR. CNTYS (MD)	$2577.37	$2577.37
REST OF MARYLAND (MD)	$2429.24	$2429.24
SOUTHERN MAINE (ME)	$2319.89	$2319.89
REST OF MAINE (ME)	$2255.02	$2255.02
DETROIT (MI)	$2584.22	$2584.22
REST OF MICHIGAN (MI)	$2386.88	$2386.88
MINNESOTA (MN)	$2262.10	$2262.10
METROPOLITAN ST. LOUIS (MO)	$2386.59	$2386.59
METROPOLITAN KANSAS CITY (MO)	$2368.36	$2368.36
REST OF MISSOURI (MO)	$2299.85	$2299.85
MISSISSIPPI (MS)	$2235.00	$2235.00
MONTANA** (MT)	$2427.70	$2427.70
NORTH CAROLINA (NC)	$2271.07	$2271.07
NORTH DAKOTA** (ND)	$2266.55	$2266.55
NEBRASKA (NE)	$2191.23	$2191.23
NEW HAMPSHIRE (NH)	$2430.26	$2430.26
NORTHERN NJ (NJ)	$2667.86	$2667.86
REST OF NEW JERSEY (NJ)	$2586.61	$2586.61
NEW MEXICO (NM)	$2409.99	$2409.99
NEVADA** (NV)	$2383.66	$2383.66
MANHATTAN (NY)	$2811.90	$2811.90
NYC SUBURBS/LONG ISLAND (NY)	$2909.41	$2909.41
POUGHKPSIE/N NYC SUBURBS (NY)	$2626.39	$2626.39
QUEENS (NY)	$2790.29	$2790.29
REST OF NEW YORK (NY)	$2303.44	$2303.44
OHIO (OH)	$2353.94	$2353.94
OKLAHOMA (OK)	$2273.48	$2273.48
PORTLAND (OR)	$2476.57	$2476.57
REST OF OREGON (OR)	$2343.88	$2343.88
METROPOLITAN PHILADELPHIA (PA)	$2539.81	$2539.81
REST OF PENNSYLVANIA (PA)	$2341.19	$2341.19
PUERTO RICO (PR)	$2433.83	$2433.83
RHODE ISLAND (RI)	$2452.12	$2452.12
SOUTH CAROLINA (SC)	$2320.60	$2320.60
SOUTH DAKOTA** (SD)	$2247.49	$2247.49
TENNESSEE (TN)	$2222.21	$2222.21
BRAZORIA (TX)	$2370.66	$2370.66
DALLAS (TX)	$2397.57	$2397.57
GALVESTON (TX)	$2385.49	$2385.49
HOUSTON (TX)	$2534.66	$2534.66
BEAUMONT (TX)	$2329.80	$2329.80
FORT WORTH (TX)	$2392.31	$2392.31
AUSTIN (TX)	$2450.75	$2450.75
REST OF TEXAS (TX)	$2357.01	$2357.01
UTAH (UT)	$2347.73	$2347.73
VIRGINIA (VA)	$2333.27	$2333.27
VIRGIN ISLANDS (VI)	$2433.83	$2433.83
VERMONT (VT)	$2284.98	$2284.98
SEATTLE (KING CNTY) (WA)	$2641.83	$2641.83
REST OF WASHINGTON (WA)	$2426.38	$2426.38
WISCONSIN (WI)	$2202.95	$2202.95
WEST VIRGINIA (WV)	$2430.41	$2430.41
WYOMING** (WY)	$2357.47	$2357.47

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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 fee schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Index (GPCI) for the specific locality where the service is furnished. The geographically adjusted RVUs are summed and multiplied by the annual conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can differ because practice-expense RVUs account for whether the physician or the facility bears the overhead costs; for this code, the practice-expense RVU is the same in both settings, so the national estimates shown here are equal. Final payment also reflects any applicable modifiers and the Medicare Economic Index-driven updates each year.

RVUs — work 38.23, practice expense 26.32 (non-facility) / 26.32 (facility), malpractice 8.15 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on the national conversion factor and standard RVUs — 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 rest.
Actual payment varies by locality GPCI, applicable modifiers, place of service, sequestration, and yearly budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The practice-expense RVU used in this code's formula is identical for both settings, so the calculated allowed amount comes out the same nationally. Locality-specific amounts can still differ due to GPCI adjustments.

Does this amount reflect what Medicare will actually pay?

No — it's an estimate of the allowed amount. Medicare generally reimburses 80% of the allowed amount after the deductible, and the final payment can be affected by modifiers, sequestration, and locality adjustments.

Can I use this figure to bill a patient directly?

No. Billing and collection practices should follow your payer contracts and Medicare rules; this page is for reference and estimation purposes only.

Why isn't the CPT code description shown?

CPT codes and their descriptors are copyrighted by the American Medical Association (AMA) and cannot be reproduced here without a license.

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.