Medicare Reimbursement for CPT 20985

CPT 20985 is a procedure code defined by the American Medical Association (AMA); the official descriptor is not reproduced here due to licensing restrictions. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$123.92	$123.92
ALASKA* (AK)	$158.84	$158.84
ALABAMA (AL)	$113.45	$113.45
ARKANSAS (AR)	$112.19	$112.19
ARIZONA (AZ)	$120.72	$120.72
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$132.60	$132.60
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$134.18	$134.18
OXNARD-THOUSAND OAKS-VENTURA (CA)	$124.58	$124.58
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$126.35	$126.35
NAPA (CA)	$129.01	$129.01
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$133.17	$133.17
VALLEJO (CA)	$128.20	$128.20
BAKERSFIELD (CA)	$121.40	$121.40
CHICO (CA)	$120.02	$120.02
FRESNO (CA)	$120.02	$120.02
HANFORD-CORCORAN (CA)	$120.02	$120.02
MADERA (CA)	$120.02	$120.02
MERCED (CA)	$120.02	$120.02
MODESTO (CA)	$120.02	$120.02
REDDING (CA)	$120.02	$120.02
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$125.40	$125.40
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$123.29	$123.29
SALINAS (CA)	$122.78	$122.78
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$136.50	$136.50
SANTA CRUZ-WATSONVILLE (CA)	$123.41	$123.41
SANTA ROSA-PETALUMA (CA)	$124.48	$124.48
STOCKTON (CA)	$120.02	$120.02
VISALIA (CA)	$120.02	$120.02
YUBA CITY (CA)	$120.02	$120.02
EL CENTRO (CA)	$120.11	$120.11
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$123.75	$123.75
SAN LUIS OBISPO-PASO ROBLES (CA)	$121.13	$121.13
SANTA MARIA-SANTA BARBARA (CA)	$122.72	$122.72
REST OF CALIFORNIA (CA)	$120.02	$120.02
COLORADO (CO)	$122.88	$122.88
CONNECTICUT (CT)	$131.03	$131.03
DC + MD/VA SUBURBS (DC)	$134.78	$134.78
DELAWARE (DE)	$122.33	$122.33
FORT LAUDERDALE (FL)	$137.75	$137.75
MIAMI (FL)	$150.51	$150.51
REST OF FLORIDA (FL)	$131.19	$131.19
ATLANTA (GA)	$127.93	$127.93
REST OF GEORGIA (GA)	$124.35	$124.35
HAWAII, GUAM (HI)	$120.41	$120.41
IOWA (IA)	$111.66	$111.66
IDAHO (ID)	$113.06	$113.06
EAST ST. LOUIS (IL)	$138.79	$138.79
SUBURBAN CHICAGO (IL)	$138.07	$138.07
CHICAGO (IL)	$146.24	$146.24
REST OF ILLINOIS (IL)	$131.08	$131.08
INDIANA (IN)	$113.46	$113.46
KANSAS (KS)	$113.16	$113.16
KENTUCKY (KY)	$119.64	$119.64
NEW ORLEANS (LA)	$124.67	$124.67
REST OF LOUISIANA (LA)	$120.26	$120.26
METROPOLITAN BOSTON (MA)	$130.41	$130.41
REST OF MASSACHUSETTS (MA)	$123.19	$123.19
BALTIMORE/SURR. CNTYS (MD)	$131.06	$131.06
REST OF MARYLAND (MD)	$123.67	$123.67
SOUTHERN MAINE (ME)	$117.52	$117.52
REST OF MAINE (ME)	$115.55	$115.55
DETROIT (MI)	$134.47	$134.47
REST OF MICHIGAN (MI)	$123.83	$123.83
MINNESOTA (MN)	$112.91	$112.91
METROPOLITAN ST. LOUIS (MO)	$122.72	$122.72
METROPOLITAN KANSAS CITY (MO)	$121.96	$121.96
REST OF MISSOURI (MO)	$119.93	$119.93
MISSISSIPPI (MS)	$115.98	$115.98
MONTANA** (MT)	$123.88	$123.88
NORTH CAROLINA (NC)	$116.17	$116.17
NORTH DAKOTA** (ND)	$114.00	$114.00
NEBRASKA (NE)	$111.55	$111.55
NEW HAMPSHIRE (NH)	$122.88	$122.88
NORTHERN NJ (NJ)	$134.30	$134.30
REST OF NEW JERSEY (NJ)	$131.16	$131.16
NEW MEXICO (NM)	$125.14	$125.14
NEVADA** (NV)	$121.15	$121.15
MANHATTAN (NY)	$143.09	$143.09
NYC SUBURBS/LONG ISLAND (NY)	$148.31	$148.31
POUGHKPSIE/N NYC SUBURBS (NY)	$133.54	$133.54
QUEENS (NY)	$141.20	$141.20
REST OF NEW YORK (NY)	$117.67	$117.67
OHIO (OH)	$121.81	$121.81
OKLAHOMA (OK)	$117.44	$117.44
PORTLAND (OR)	$123.80	$123.80
REST OF OREGON (OR)	$118.85	$118.85
METROPOLITAN PHILADELPHIA (PA)	$129.66	$129.66
REST OF PENNSYLVANIA (PA)	$120.89	$120.89
PUERTO RICO (PR)	$123.95	$123.95
RHODE ISLAND (RI)	$124.51	$124.51
SOUTH CAROLINA (SC)	$119.46	$119.46
SOUTH DAKOTA** (SD)	$112.83	$112.83
TENNESSEE (TN)	$113.84	$113.84
BRAZORIA (TX)	$120.66	$120.66
DALLAS (TX)	$122.18	$122.18
GALVESTON (TX)	$121.52	$121.52
HOUSTON (TX)	$130.67	$130.67
BEAUMONT (TX)	$120.42	$120.42
FORT WORTH (TX)	$122.14	$122.14
AUSTIN (TX)	$123.67	$123.67
REST OF TEXAS (TX)	$120.99	$120.99
UTAH (UT)	$120.67	$120.67
VIRGINIA (VA)	$118.57	$118.57
VIRGIN ISLANDS (VI)	$123.95	$123.95
VERMONT (VT)	$115.41	$115.41
SEATTLE (KING CNTY) (WA)	$130.77	$130.77
REST OF WASHINGTON (WA)	$122.35	$122.35
WISCONSIN (WI)	$111.28	$111.28
WEST VIRGINIA (WV)	$127.75	$127.75
WYOMING** (WY)	$119.58	$119.58

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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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility settings can have different practice-expense RVUs, since facility settings (like hospitals) typically have lower overhead attributed to the billing physician.

RVUs — work 2.44, practice expense 0.77 (non-facility) / 0.77 (facility), malpractice 0.5 — × 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 responsible for the rest.
Modifiers, place-of-service codes, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Actual payment depends on the specific Medicare Administrative Contractor (MAC) and locality-specific GPCI values in effect at the time of service.
Always verify current rates and coverage policy with your MAC before billing or appealing a denial.

Frequently asked

Why does the amount differ between non-facility and facility settings?

The practice-expense RVU component differs because overhead costs (equipment, staff, supplies) attributed to the billing provider are typically lower when the service is performed in a facility, such as a hospital, that absorbs some of those costs itself.

Why might my locality's payment differ from the national amount?

Each locality has its own GPCI values for work, practice expense, and malpractice, reflecting regional differences in wages and costs. These GPCIs adjust the RVUs before the conversion factor is applied, so localities with higher relative costs will show higher allowed amounts.

Does this amount reflect what I'll actually be paid?

No. This figure is the Medicare-allowed amount before claim-specific adjustments like modifiers, multiple-procedure reductions, sequestration, or secondary payer coordination, all of which can change the final reimbursement.

Why do fee schedule amounts change from year to year?

RVUs, GPCIs, and the conversion factor are reviewed and updated annually (and sometimes mid-year) by CMS, often due to legislative changes, budget-neutrality requirements, and periodic revaluation of codes.

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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.