Medicare Reimbursement for CPT 20972

This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for CPT code 20972, a procedure code maintained by the AMA. Amounts are shown nationally and can vary by locality, and may differ between non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2531.79	$2531.79
ALASKA* (AK)	$3167.95	$3167.95
ALABAMA (AL)	$2300.94	$2300.94
ARKANSAS (AR)	$2272.80	$2272.80
ARIZONA (AZ)	$2463.29	$2463.29
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2808.54	$2808.54
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2846.36	$2846.36
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2596.44	$2596.44
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2628.74	$2628.74
NAPA (CA)	$2716.72	$2716.72
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2819.06	$2819.06
VALLEJO (CA)	$2701.57	$2701.57
BAKERSFIELD (CA)	$2512.60	$2512.60
CHICO (CA)	$2487.12	$2487.12
FRESNO (CA)	$2487.12	$2487.12
HANFORD-CORCORAN (CA)	$2487.12	$2487.12
MADERA (CA)	$2487.12	$2487.12
MERCED (CA)	$2487.12	$2487.12
MODESTO (CA)	$2487.12	$2487.12
REDDING (CA)	$2487.12	$2487.12
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2586.61	$2586.61
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2566.44	$2566.44
SALINAS (CA)	$2556.10	$2556.10
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2889.35	$2889.35
SANTA CRUZ-WATSONVILLE (CA)	$2584.89	$2584.89
SANTA ROSA-PETALUMA (CA)	$2607.99	$2607.99
STOCKTON (CA)	$2487.12	$2487.12
VISALIA (CA)	$2487.12	$2487.12
YUBA CITY (CA)	$2487.12	$2487.12
EL CENTRO (CA)	$2488.66	$2488.66
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2585.11	$2585.11
SAN LUIS OBISPO-PASO ROBLES (CA)	$2520.35	$2520.35
SANTA MARIA-SANTA BARBARA (CA)	$2557.17	$2557.17
REST OF CALIFORNIA (CA)	$2487.12	$2487.12
COLORADO (CO)	$2530.91	$2530.91
CONNECTICUT (CT)	$2685.24	$2685.24
DC + MD/VA SUBURBS (DC)	$2782.59	$2782.59
DELAWARE (DE)	$2498.52	$2498.52
FORT LAUDERDALE (FL)	$2791.74	$2791.74
MIAMI (FL)	$3036.38	$3036.38
REST OF FLORIDA (FL)	$2653.35	$2653.35
ATLANTA (GA)	$2610.67	$2610.67
REST OF GEORGIA (GA)	$2507.70	$2507.70
HAWAII, GUAM (HI)	$2507.46	$2507.46
IOWA (IA)	$2279.59	$2279.59
IDAHO (ID)	$2306.96	$2306.96
EAST ST. LOUIS (IL)	$2783.58	$2783.58
SUBURBAN CHICAGO (IL)	$2801.58	$2801.58
CHICAGO (IL)	$2946.33	$2946.33
REST OF ILLINOIS (IL)	$2638.68	$2638.68
INDIANA (IN)	$2316.39	$2316.39
KANSAS (KS)	$2304.18	$2304.18
KENTUCKY (KY)	$2419.71	$2419.71
NEW ORLEANS (LA)	$2528.25	$2528.25
REST OF LOUISIANA (LA)	$2429.91	$2429.91
METROPOLITAN BOSTON (MA)	$2707.14	$2707.14
REST OF MASSACHUSETTS (MA)	$2533.16	$2533.16
BALTIMORE/SURR. CNTYS (MD)	$2684.71	$2684.71
REST OF MARYLAND (MD)	$2530.20	$2530.20
SOUTHERN MAINE (ME)	$2410.70	$2410.70
REST OF MAINE (ME)	$2353.04	$2353.04
DETROIT (MI)	$2716.91	$2716.91
REST OF MICHIGAN (MI)	$2504.44	$2504.44
MINNESOTA (MN)	$2336.46	$2336.46
METROPOLITAN ST. LOUIS (MO)	$2495.31	$2495.31
METROPOLITAN KANSAS CITY (MO)	$2477.53	$2477.53
REST OF MISSOURI (MO)	$2417.09	$2417.09
MISSISSIPPI (MS)	$2343.63	$2343.63
MONTANA** (MT)	$2531.17	$2531.17
NORTH CAROLINA (NC)	$2368.35	$2368.35
NORTH DAKOTA** (ND)	$2348.07	$2348.07
NEBRASKA (NE)	$2279.90	$2279.90
NEW HAMPSHIRE (NH)	$2524.82	$2524.82
NORTHERN NJ (NJ)	$2767.81	$2767.81
REST OF NEW JERSEY (NJ)	$2690.88	$2690.88
NEW MEXICO (NM)	$2529.81	$2529.81
NEVADA** (NV)	$2480.91	$2480.91
MANHATTAN (NY)	$2931.02	$2931.02
NYC SUBURBS/LONG ISLAND (NY)	$3035.70	$3035.70
POUGHKPSIE/N NYC SUBURBS (NY)	$2735.40	$2735.40
QUEENS (NY)	$2901.94	$2901.94
REST OF NEW YORK (NY)	$2401.28	$2401.28
OHIO (OH)	$2467.02	$2467.02
OKLAHOMA (OK)	$2380.12	$2380.12
PORTLAND (OR)	$2561.59	$2561.59
REST OF OREGON (OR)	$2436.84	$2436.84
METROPOLITAN PHILADELPHIA (PA)	$2649.26	$2649.26
REST OF PENNSYLVANIA (PA)	$2451.40	$2451.40
PUERTO RICO (PR)	$2535.65	$2535.65
RHODE ISLAND (RI)	$2551.43	$2551.43
SOUTH CAROLINA (SC)	$2426.65	$2426.65
SOUTH DAKOTA** (SD)	$2326.42	$2326.42
TENNESSEE (TN)	$2318.25	$2318.25
BRAZORIA (TX)	$2468.38	$2468.38
DALLAS (TX)	$2497.82	$2497.82
GALVESTON (TX)	$2484.78	$2484.78
HOUSTON (TX)	$2654.27	$2654.27
BEAUMONT (TX)	$2440.27	$2440.27
FORT WORTH (TX)	$2494.12	$2494.12
AUSTIN (TX)	$2544.26	$2544.26
REST OF TEXAS (TX)	$2462.37	$2462.37
UTAH (UT)	$2453.87	$2453.87
VIRGINIA (VA)	$2427.72	$2427.72
VIRGIN ISLANDS (VI)	$2535.65	$2535.65
VERMONT (VT)	$2371.27	$2371.27
SEATTLE (KING CNTY) (WA)	$2723.12	$2723.12
REST OF WASHINGTON (WA)	$2517.68	$2517.68
WISCONSIN (WI)	$2285.30	$2285.30
WEST VIRGINIA (WV)	$2563.84	$2563.84
WYOMING** (WY)	$2451.37	$2451.37

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 units 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 PFS payments are derived from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility settings often have different practice-expense RVUs because the resources required differ when a provider bills for a service performed in their own office versus a hospital or ambulatory surgical center.

RVUs — work 43.4, practice expense 23.14 (non-facility) / 23.14 (facility), malpractice 9.26 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient's annual deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs mean the actual allowed amount in a given area may differ from the national figure shown here.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the Medicare allowed amount for this code change by location?

The PFS formula applies locality-specific GPCIs to the work, practice expense, and malpractice RVUs before multiplying by the conversion factor, so costs of living and practice differences across regions change the final allowed amount.

Why are non-facility and facility amounts sometimes different?

The practice-expense RVU component differs depending on whether the service is furnished in a non-facility setting (like a physician's office, where the provider bears more overhead) or a facility setting (like a hospital, which bears some of those costs separately).

Is this the amount the patient or practice will actually receive?

No. This is an estimated PFS allowed amount. Actual payment depends on the patient's deductible status, applicable modifiers, sequestration, secondary coverage, and any annual payment adjustments finalized by CMS.

Where can I find the official descriptor for CPT 20972?

CPT code descriptors are copyrighted by the American Medical Association (AMA) and are not reproduced here; consult your CPT codebook or AMA-licensed coding resource for the official language.

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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.