Medicare Reimbursement for CPT 20970
This page covers CPT code 20970, a physician procedure code billed under the Medicare Physician Fee Schedule (PFS). It shows the estimated Medicare-allowed amount at the national level and adjusted for your locality, broken out by non-facility (office) and facility (hospital/ASC) settings. Because CPT descriptors are licensed by the AMA, this page refers to the code generically rather than reprinting its official description.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $2540.81 | $2540.81 |
| ALASKA* (AK) | $3178.23 | $3178.23 |
| ALABAMA (AL) | $2308.92 | $2308.92 |
| ARKANSAS (AR) | $2280.65 | $2280.65 |
| ARIZONA (AZ) | $2472.03 | $2472.03 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $2819.87 | $2819.87 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $2857.89 | $2857.89 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $2606.37 | $2606.37 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $2638.73 | $2638.73 |
| NAPA (CA) | $2727.47 | $2727.47 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $2830.40 | $2830.40 |
| VALLEJO (CA) | $2712.28 | $2712.28 |
| BAKERSFIELD (CA) | $2521.97 | $2521.97 |
| CHICO (CA) | $2496.44 | $2496.44 |
| FRESNO (CA) | $2496.44 | $2496.44 |
| HANFORD-CORCORAN (CA) | $2496.44 | $2496.44 |
| MADERA (CA) | $2496.44 | $2496.44 |
| MERCED (CA) | $2496.44 | $2496.44 |
| MODESTO (CA) | $2496.44 | $2496.44 |
| REDDING (CA) | $2496.44 | $2496.44 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $2596.15 | $2596.15 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $2576.22 | $2576.22 |
| SALINAS (CA) | $2565.84 | $2565.84 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $2900.98 | $2900.98 |
| SANTA CRUZ-WATSONVILLE (CA) | $2594.94 | $2594.94 |
| SANTA ROSA-PETALUMA (CA) | $2618.13 | $2618.13 |
| STOCKTON (CA) | $2496.44 | $2496.44 |
| VISALIA (CA) | $2496.44 | $2496.44 |
| YUBA CITY (CA) | $2496.44 | $2496.44 |
| EL CENTRO (CA) | $2497.99 | $2497.99 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $2595.07 | $2595.07 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $2529.94 | $2529.94 |
| SANTA MARIA-SANTA BARBARA (CA) | $2566.94 | $2566.94 |
| REST OF CALIFORNIA (CA) | $2496.44 | $2496.44 |
| COLORADO (CO) | $2540.20 | $2540.20 |
| CONNECTICUT (CT) | $2694.91 | $2694.91 |
| DC + MD/VA SUBURBS (DC) | $2792.88 | $2792.88 |
| DELAWARE (DE) | $2507.41 | $2507.41 |
| FORT LAUDERDALE (FL) | $2801.38 | $2801.38 |
| MIAMI (FL) | $3046.67 | $3046.67 |
| REST OF FLORIDA (FL) | $2662.44 | $2662.44 |
| ATLANTA (GA) | $2619.93 | $2619.93 |
| REST OF GEORGIA (GA) | $2516.20 | $2516.20 |
| HAWAII, GUAM (HI) | $2517.02 | $2517.02 |
| IOWA (IA) | $2287.69 | $2287.69 |
| IDAHO (ID) | $2315.14 | $2315.14 |
| EAST ST. LOUIS (IL) | $2792.79 | $2792.79 |
| SUBURBAN CHICAGO (IL) | $2811.29 | $2811.29 |
| CHICAGO (IL) | $2956.26 | $2956.26 |
| REST OF ILLINOIS (IL) | $2647.55 | $2647.55 |
| INDIANA (IN) | $2324.63 | $2324.63 |
| KANSAS (KS) | $2312.29 | $2312.29 |
| KENTUCKY (KY) | $2428.00 | $2428.00 |
| NEW ORLEANS (LA) | $2537.01 | $2537.01 |
| REST OF LOUISIANA (LA) | $2438.21 | $2438.21 |
| METROPOLITAN BOSTON (MA) | $2717.35 | $2717.35 |
| REST OF MASSACHUSETTS (MA) | $2542.40 | $2542.40 |
| BALTIMORE/SURR. CNTYS (MD) | $2694.36 | $2694.36 |
| REST OF MARYLAND (MD) | $2539.26 | $2539.26 |
| SOUTHERN MAINE (ME) | $2419.42 | $2419.42 |
| REST OF MAINE (ME) | $2361.33 | $2361.33 |
| DETROIT (MI) | $2726.18 | $2726.18 |
| REST OF MICHIGAN (MI) | $2513.03 | $2513.03 |
| MINNESOTA (MN) | $2345.18 | $2345.18 |
| METROPOLITAN ST. LOUIS (MO) | $2504.04 | $2504.04 |
| METROPOLITAN KANSAS CITY (MO) | $2486.16 | $2486.16 |
| REST OF MISSOURI (MO) | $2425.26 | $2425.26 |
| MISSISSIPPI (MS) | $2351.64 | $2351.64 |
| MONTANA** (MT) | $2540.19 | $2540.19 |
| NORTH CAROLINA (NC) | $2376.72 | $2376.72 |
| NORTH DAKOTA** (ND) | $2356.69 | $2356.69 |
| NEBRASKA (NE) | $2288.04 | $2288.04 |
| NEW HAMPSHIRE (NH) | $2534.00 | $2534.00 |
| NORTHERN NJ (NJ) | $2777.98 | $2777.98 |
| REST OF NEW JERSEY (NJ) | $2700.61 | $2700.61 |
| NEW MEXICO (NM) | $2538.46 | $2538.46 |
| NEVADA** (NV) | $2489.82 | $2489.82 |
| MANHATTAN (NY) | $2941.55 | $2941.55 |
| NYC SUBURBS/LONG ISLAND (NY) | $3046.58 | $3046.58 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $2745.23 | $2745.23 |
| QUEENS (NY) | $2912.49 | $2912.49 |
| REST OF NEW YORK (NY) | $2409.80 | $2409.80 |
| OHIO (OH) | $2475.52 | $2475.52 |
| OKLAHOMA (OK) | $2388.34 | $2388.34 |
| PORTLAND (OR) | $2571.15 | $2571.15 |
| REST OF OREGON (OR) | $2445.63 | $2445.63 |
| METROPOLITAN PHILADELPHIA (PA) | $2658.70 | $2658.70 |
| REST OF PENNSYLVANIA (PA) | $2459.89 | $2459.89 |
| PUERTO RICO (PR) | $2544.73 | $2544.73 |
| RHODE ISLAND (RI) | $2560.62 | $2560.62 |
| SOUTH CAROLINA (SC) | $2435.12 | $2435.12 |
| SOUTH DAKOTA** (SD) | $2334.99 | $2334.99 |
| TENNESSEE (TN) | $2326.41 | $2326.41 |
| BRAZORIA (TX) | $2477.22 | $2477.22 |
| DALLAS (TX) | $2506.74 | $2506.74 |
| GALVESTON (TX) | $2493.66 | $2493.66 |
| HOUSTON (TX) | $2663.51 | $2663.51 |
| BEAUMONT (TX) | $2448.70 | $2448.70 |
| FORT WORTH (TX) | $2502.98 | $2502.98 |
| AUSTIN (TX) | $2553.55 | $2553.55 |
| REST OF TEXAS (TX) | $2471.02 | $2471.02 |
| UTAH (UT) | $2462.46 | $2462.46 |
| VIRGINIA (VA) | $2436.44 | $2436.44 |
| VIRGIN ISLANDS (VI) | $2544.73 | $2544.73 |
| VERMONT (VT) | $2379.90 | $2379.90 |
| SEATTLE (KING CNTY) (WA) | $2733.49 | $2733.49 |
| REST OF WASHINGTON (WA) | $2526.88 | $2526.88 |
| WISCONSIN (WI) | $2293.60 | $2293.60 |
| WEST VIRGINIA (WV) | $2572.36 | $2572.36 |
| WYOMING** (WY) | $2460.22 | $2460.22 |
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: 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 for a code is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the billing locality, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility and facility rates can differ because the practice-expense RVU reflects whether the physician's office bears the overhead (non-facility) or whether a hospital/ASC supplies the facility resources (facility). The resulting figure is the Medicare-allowed amount before cost-sharing, not the amount the provider ultimately collects.
RVUs — work 43.47, practice expense 23.32 (non-facility) / 23.32 (facility), malpractice 9.28 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimate only, based on standard, unmodified national and locality-adjusted PFS inputs.
- Medicare typically pays 80% of the allowed amount after the patient meets the Part B deductible; the patient or secondary payer is responsible for the rest.
- Modifiers, multiple-procedure reductions, bilateral billing, sequestration, and annual budget-neutrality adjustments can change the actual payment.
- Locality-specific GPCIs and the current-year conversion factor may differ from what's assumed here; always confirm with your Medicare Administrative Contractor (MAC) or official CMS files before billing or appealing a denial.
Frequently asked
Why does the facility amount differ from the non-facility amount for this code?
The two amounts use different practice-expense RVUs, reflecting whether the billing physician's practice or the facility (hospital/ASC) absorbs the overhead costs of the procedure.
Does this amount reflect what the patient will owe?
No. The figure shown is the Medicare-allowed amount before cost-sharing. The patient typically owes 20% coinsurance after the deductible, unless secondary coverage applies.
Why might my MAC's actual payment differ from this estimate?
Actual payment can vary due to locality GPCI updates, applied modifiers, multiple-procedure payment reductions, sequestration, and mid-year or annual budget-neutrality adjustments to the conversion factor.
Can I use this figure to predict a claim denial or appeal outcome?
No. This page provides a pricing estimate only and does not address coverage, medical necessity, or documentation requirements that drive denials or appeals.
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.
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