Medicare Reimbursement for CPT 20973

CPT 20973 is a physician procedure code reimbursed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2670.40	$2670.40
ALASKA* (AK)	$3344.36	$3344.36
ALABAMA (AL)	$2427.27	$2427.27
ARKANSAS (AR)	$2397.65	$2397.65
ARIZONA (AZ)	$2598.13	$2598.13
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2955.95	$2955.95
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2995.47	$2995.47
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2735.24	$2735.24
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2769.56	$2769.56
NAPA (CA)	$2860.27	$2860.27
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2967.15	$2967.15
VALLEJO (CA)	$2844.13	$2844.13
BAKERSFIELD (CA)	$2647.84	$2647.84
CHICO (CA)	$2620.72	$2620.72
FRESNO (CA)	$2620.72	$2620.72
HANFORD-CORCORAN (CA)	$2620.72	$2620.72
MADERA (CA)	$2620.72	$2620.72
MERCED (CA)	$2620.72	$2620.72
MODESTO (CA)	$2620.72	$2620.72
REDDING (CA)	$2620.72	$2620.72
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2726.66	$2726.66
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2703.68	$2703.68
SALINAS (CA)	$2692.77	$2692.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$3041.25	$3041.25
SANTA CRUZ-WATSONVILLE (CA)	$2722.27	$2722.27
SANTA ROSA-PETALUMA (CA)	$2746.54	$2746.54
STOCKTON (CA)	$2620.72	$2620.72
VISALIA (CA)	$2620.72	$2620.72
YUBA CITY (CA)	$2620.72	$2620.72
EL CENTRO (CA)	$2622.36	$2622.36
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2722.87	$2722.87
SAN LUIS OBISPO-PASO ROBLES (CA)	$2655.19	$2655.19
SANTA MARIA-SANTA BARBARA (CA)	$2693.77	$2693.77
REST OF CALIFORNIA (CA)	$2620.72	$2620.72
COLORADO (CO)	$2668.06	$2668.06
CONNECTICUT (CT)	$2832.08	$2832.08
DC + MD/VA SUBURBS (DC)	$2933.44	$2933.44
DELAWARE (DE)	$2635.22	$2635.22
FORT LAUDERDALE (FL)	$2946.92	$2946.92
MIAMI (FL)	$3206.82	$3206.82
REST OF FLORIDA (FL)	$2800.79	$2800.79
ATLANTA (GA)	$2754.04	$2754.04
REST OF GEORGIA (GA)	$2647.06	$2647.06
HAWAII, GUAM (HI)	$2641.57	$2641.57
IOWA (IA)	$2403.68	$2403.68
IDAHO (ID)	$2432.71	$2432.71
EAST ST. LOUIS (IL)	$2940.22	$2940.22
SUBURBAN CHICAGO (IL)	$2957.07	$2957.07
CHICAGO (IL)	$3111.67	$3111.67
REST OF ILLINOIS (IL)	$2786.08	$2786.08
INDIANA (IN)	$2442.61	$2442.61
KANSAS (KS)	$2430.10	$2430.10
KENTUCKY (KY)	$2553.43	$2553.43
NEW ORLEANS (LA)	$2667.90	$2667.90
REST OF LOUISIANA (LA)	$2564.38	$2564.38
METROPOLITAN BOSTON (MA)	$2852.81	$2852.81
REST OF MASSACHUSETTS (MA)	$2670.66	$2670.66
BALTIMORE/SURR. CNTYS (MD)	$2831.60	$2831.60
REST OF MARYLAND (MD)	$2668.41	$2668.41
SOUTHERN MAINE (ME)	$2541.66	$2541.66
REST OF MAINE (ME)	$2481.78	$2481.78
DETROIT (MI)	$2868.27	$2868.27
REST OF MICHIGAN (MI)	$2643.14	$2643.14
MINNESOTA (MN)	$2461.80	$2461.80
METROPOLITAN ST. LOUIS (MO)	$2632.58	$2632.58
METROPOLITAN KANSAS CITY (MO)	$2613.93	$2613.93
REST OF MISSOURI (MO)	$2551.22	$2551.22
MISSISSIPPI (MS)	$2473.02	$2473.02
MONTANA** (MT)	$2669.74	$2669.74
NORTH CAROLINA (NC)	$2497.80	$2497.80
NORTH DAKOTA** (ND)	$2474.78	$2474.78
NEBRASKA (NE)	$2403.83	$2403.83
NEW HAMPSHIRE (NH)	$2662.10	$2662.10
NORTHERN NJ (NJ)	$2918.04	$2918.04
REST OF NEW JERSEY (NJ)	$2837.67	$2837.67
NEW MEXICO (NM)	$2670.06	$2670.06
NEVADA** (NV)	$2616.20	$2616.20
MANHATTAN (NY)	$3091.78	$3091.78
NYC SUBURBS/LONG ISLAND (NY)	$3202.67	$3202.67
POUGHKPSIE/N NYC SUBURBS (NY)	$2884.99	$2884.99
QUEENS (NY)	$3060.39	$3060.39
REST OF NEW YORK (NY)	$2532.51	$2532.51
OHIO (OH)	$2603.30	$2603.30
OKLAHOMA (OK)	$2511.19	$2511.19
PORTLAND (OR)	$2699.70	$2699.70
REST OF OREGON (OR)	$2569.38	$2569.38
METROPOLITAN PHILADELPHIA (PA)	$2794.54	$2794.54
REST OF PENNSYLVANIA (PA)	$2586.56	$2586.56
PUERTO RICO (PR)	$2674.28	$2674.28
RHODE ISLAND (RI)	$2690.54	$2690.54
SOUTH CAROLINA (SC)	$2560.08	$2560.08
SOUTH DAKOTA** (SD)	$2451.72	$2451.72
TENNESSEE (TN)	$2444.97	$2444.97
BRAZORIA (TX)	$2603.05	$2603.05
DALLAS (TX)	$2634.29	$2634.29
GALVESTON (TX)	$2620.46	$2620.46
HOUSTON (TX)	$2800.94	$2800.94
BEAUMONT (TX)	$2574.87	$2574.87
FORT WORTH (TX)	$2630.55	$2630.55
AUSTIN (TX)	$2682.43	$2682.43
REST OF TEXAS (TX)	$2597.57	$2597.57
UTAH (UT)	$2588.71	$2588.71
VIRGINIA (VA)	$2559.95	$2559.95
VIRGIN ISLANDS (VI)	$2674.28	$2674.28
VERMONT (VT)	$2499.70	$2499.70
SEATTLE (KING CNTY) (WA)	$2869.07	$2869.07
REST OF WASHINGTON (WA)	$2654.19	$2654.19
WISCONSIN (WI)	$2408.84	$2408.84
WEST VIRGINIA (WV)	$2707.33	$2707.33
WYOMING** (WY)	$2584.78	$2584.78

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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: Policy. 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 built 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 furnished, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs often differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings because overhead costs differ, which can change the final allowed amount even though work and malpractice RVUs stay the same. The conversion factor is set annually by CMS and can change due to legislative or budget-neutrality adjustments.

RVUs — work 46.09, practice expense 24 (non-facility) / 24 (facility), malpractice 9.86 — × 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 patient or secondary payer is generally responsible for the rest.
Actual payment can vary by locality, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality changes.
Always verify the current amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the allowed amount for CPT 20973 differ by locality?

Medicare adjusts the work, practice-expense, and malpractice RVUs using locality-specific GPCIs, which reflect regional differences in costs like wages and rent, so the final amount varies by location.

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

When the practice-expense RVU is identical for non-facility and facility settings, the calculated allowed amount will also be the same, since the other RVU components (work and malpractice) do not change by setting.

Does this amount reflect what Medicare will actually pay?

No. It reflects the Medicare-allowed amount before the standard 80/20 split, deductible status, modifiers, and any sequestration or claim-specific adjustments are applied.

Where can I find the official CPT descriptor for this code?

CPT code descriptors are copyrighted by the American Medical Association; consult your AMA CPT codebook or licensed coding software for the official description.

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.