Medicare Reimbursement for CPT 20975

CPT 20975 is a physician procedure code billed under Medicare Part B; the exact clinical service is defined by the AMA's CPT descriptor and is not reproduced here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code nationally and by locality, with non-facility and facility rates where they differ.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$168.67	$168.67
ALASKA* (AK)	$203.67	$203.67
ALABAMA (AL)	$150.45	$150.45
ARKANSAS (AR)	$148.24	$148.24
ARIZONA (AZ)	$163.24	$163.24
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$186.43	$186.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$188.88	$188.88
OXNARD-THOUSAND OAKS-VENTURA (CA)	$172.30	$172.30
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$174.49	$174.49
NAPA (CA)	$180.39	$180.39
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$187.28	$187.28
VALLEJO (CA)	$179.16	$179.16
BAKERSFIELD (CA)	$166.14	$166.14
CHICO (CA)	$164.14	$164.14
FRESNO (CA)	$164.14	$164.14
HANFORD-CORCORAN (CA)	$164.14	$164.14
MADERA (CA)	$164.14	$164.14
MERCED (CA)	$164.14	$164.14
MODESTO (CA)	$164.14	$164.14
REDDING (CA)	$164.14	$164.14
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$172.16	$172.16
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$169.69	$169.69
SALINAS (CA)	$169.03	$169.03
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$192.37	$192.37
SANTA CRUZ-WATSONVILLE (CA)	$171.47	$171.47
SANTA ROSA-PETALUMA (CA)	$173.00	$173.00
STOCKTON (CA)	$164.14	$164.14
VISALIA (CA)	$164.14	$164.14
YUBA CITY (CA)	$164.14	$164.14
EL CENTRO (CA)	$164.26	$164.26
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$171.27	$171.27
SAN LUIS OBISPO-PASO ROBLES (CA)	$166.66	$166.66
SANTA MARIA-SANTA BARBARA (CA)	$169.18	$169.18
REST OF CALIFORNIA (CA)	$164.14	$164.14
COLORADO (CO)	$167.97	$167.97
CONNECTICUT (CT)	$180.16	$180.16
DC + MD/VA SUBURBS (DC)	$186.55	$186.55
DELAWARE (DE)	$165.86	$165.86
FORT LAUDERDALE (FL)	$189.68	$189.68
MIAMI (FL)	$209.39	$209.39
REST OF FLORIDA (FL)	$178.69	$178.69
ATLANTA (GA)	$174.90	$174.90
REST OF GEORGIA (GA)	$167.14	$167.14
HAWAII, GUAM (HI)	$166.18	$166.18
IOWA (IA)	$148.57	$148.57
IDAHO (ID)	$150.77	$150.77
EAST ST. LOUIS (IL)	$189.37	$189.37
SUBURBAN CHICAGO (IL)	$190.19	$190.19
CHICAGO (IL)	$202.00	$202.00
REST OF ILLINOIS (IL)	$177.66	$177.66
INDIANA (IN)	$151.51	$151.51
KANSAS (KS)	$150.61	$150.61
KENTUCKY (KY)	$160.02	$160.02
NEW ORLEANS (LA)	$168.61	$168.61
REST OF LOUISIANA (LA)	$160.86	$160.86
METROPOLITAN BOSTON (MA)	$180.80	$180.80
REST OF MASSACHUSETTS (MA)	$168.06	$168.06
BALTIMORE/SURR. CNTYS (MD)	$180.26	$180.26
REST OF MARYLAND (MD)	$168.17	$168.17
SOUTHERN MAINE (ME)	$158.90	$158.90
REST OF MAINE (ME)	$154.50	$154.50
DETROIT (MI)	$183.80	$183.80
REST OF MICHIGAN (MI)	$166.79	$166.79
MINNESOTA (MN)	$152.74	$152.74
METROPOLITAN ST. LOUIS (MO)	$165.90	$165.90
METROPOLITAN KANSAS CITY (MO)	$164.51	$164.51
REST OF MISSOURI (MO)	$159.91	$159.91
MISSISSIPPI (MS)	$153.97	$153.97
MONTANA** (MT)	$168.62	$168.62
NORTH CAROLINA (NC)	$155.69	$155.69
NORTH DAKOTA** (ND)	$153.79	$153.79
NEBRASKA (NE)	$148.57	$148.57
NEW HAMPSHIRE (NH)	$167.95	$167.95
NORTHERN NJ (NJ)	$185.13	$185.13
REST OF NEW JERSEY (NJ)	$179.91	$179.91
NEW MEXICO (NM)	$168.83	$168.83
NEVADA** (NV)	$164.55	$164.55
MANHATTAN (NY)	$198.31	$198.31
NYC SUBURBS/LONG ISLAND (NY)	$206.68	$206.68
POUGHKPSIE/N NYC SUBURBS (NY)	$183.34	$183.34
QUEENS (NY)	$195.88	$195.88
REST OF NEW YORK (NY)	$158.30	$158.30
OHIO (OH)	$163.76	$163.76
OKLAHOMA (OK)	$156.80	$156.80
PORTLAND (OR)	$170.14	$170.14
REST OF OREGON (OR)	$161.00	$161.00
METROPOLITAN PHILADELPHIA (PA)	$177.45	$177.45
REST OF PENNSYLVANIA (PA)	$162.48	$162.48
PUERTO RICO (PR)	$168.95	$168.95
RHODE ISLAND (RI)	$169.52	$169.52
SOUTH CAROLINA (SC)	$160.45	$160.45
SOUTH DAKOTA** (SD)	$152.04	$152.04
TENNESSEE (TN)	$151.73	$151.73
BRAZORIA (TX)	$163.31	$163.31
DALLAS (TX)	$165.65	$165.65
GALVESTON (TX)	$164.63	$164.63
HOUSTON (TX)	$178.36	$178.36
BEAUMONT (TX)	$161.61	$161.61
FORT WORTH (TX)	$165.38	$165.38
AUSTIN (TX)	$169.40	$169.40
REST OF TEXAS (TX)	$163.25	$163.25
UTAH (UT)	$162.59	$162.59
VIRGINIA (VA)	$160.31	$160.31
VIRGIN ISLANDS (VI)	$168.95	$168.95
VERMONT (VT)	$155.71	$155.71
SEATTLE (KING CNTY) (WA)	$181.68	$181.68
REST OF WASHINGTON (WA)	$166.91	$166.91
WISCONSIN (WI)	$148.87	$148.87
WEST VIRGINIA (WV)	$171.77	$171.77
WYOMING** (WY)	$162.16	$162.16

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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 service locality. The geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can use different practice-expense RVUs, which is why two rates may be shown. For CPT 20975, the practice-expense RVU is the same in both settings, so the non-facility and facility amounts are identical. Final payment also reflects the patient's deductible and coinsurance status and any applicable claim adjustments.

RVUs — work 2.54, practice expense 1.76 (non-facility) / 1.76 (facility), malpractice 0.75 — × 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 Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, modifiers, place of service, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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

Because the practice-expense RVU used in the formula is identical for both settings for this code, the two calculated amounts come out equal.

Does this amount reflect what Medicare will actually pay?

No — it's an estimate based on the national conversion factor and RVUs. Actual payment depends on the specific locality GPCIs, applicable modifiers, and other claim-specific adjustments.

Why do amounts change year to year?

The conversion factor and RVUs are updated annually by CMS through rulemaking, often reflecting budget-neutrality adjustments and policy changes.

Can modifiers change this amount?

Yes, modifiers (such as those indicating bilateral procedures or reduced services) can increase or decrease the final allowed amount relative to the base PFS rate shown here.

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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.