Medicare Reimbursement for CPT 23020

CPT 23020 is a surgical procedure code reported to Medicare and other payers; this page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both at the national level and adjusted for your locality. Amounts are shown for non-facility (e.g., office) and facility (e.g., hospital) settings, since practice expense can differ by place of service.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$650.65	$650.65
ALASKA* (AK)	$792.80	$792.80
ALABAMA (AL)	$587.72	$587.72
ARKANSAS (AR)	$579.96	$579.96
ARIZONA (AZ)	$632.72	$632.72
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$758.52	$758.52
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$770.33	$770.33
OXNARD-THOUSAND OAKS-VENTURA (CA)	$686.44	$686.44
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$693.31	$693.31
NAPA (CA)	$728.12	$728.12
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$760.69	$760.69
VALLEJO (CA)	$724.99	$724.99
BAKERSFIELD (CA)	$658.56	$658.56
CHICO (CA)	$653.30	$653.30
FRESNO (CA)	$653.30	$653.30
HANFORD-CORCORAN (CA)	$653.30	$653.30
MADERA (CA)	$653.30	$653.30
MERCED (CA)	$653.30	$653.30
MODESTO (CA)	$653.30	$653.30
REDDING (CA)	$653.30	$653.30
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$673.82	$673.82
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$677.98	$677.98
SALINAS (CA)	$675.32	$675.32
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$779.19	$779.19
SANTA CRUZ-WATSONVILLE (CA)	$688.06	$688.06
SANTA ROSA-PETALUMA (CA)	$694.47	$694.47
STOCKTON (CA)	$653.30	$653.30
VISALIA (CA)	$653.30	$653.30
YUBA CITY (CA)	$653.30	$653.30
EL CENTRO (CA)	$653.61	$653.61
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$685.83	$685.83
SAN LUIS OBISPO-PASO ROBLES (CA)	$665.42	$665.42
SANTA MARIA-SANTA BARBARA (CA)	$676.38	$676.38
REST OF CALIFORNIA (CA)	$653.30	$653.30
COLORADO (CO)	$658.38	$658.38
CONNECTICUT (CT)	$691.85	$691.85
DC + MD/VA SUBURBS (DC)	$724.50	$724.50
DELAWARE (DE)	$642.35	$642.35
FORT LAUDERDALE (FL)	$705.86	$705.86
MIAMI (FL)	$759.75	$759.75
REST OF FLORIDA (FL)	$670.34	$670.34
ATLANTA (GA)	$668.90	$668.90
REST OF GEORGIA (GA)	$632.45	$632.45
HAWAII, GUAM (HI)	$662.41	$662.41
IOWA (IA)	$588.22	$588.22
IDAHO (ID)	$594.48	$594.48
EAST ST. LOUIS (IL)	$692.79	$692.79
SUBURBAN CHICAGO (IL)	$709.65	$709.65
CHICAGO (IL)	$736.81	$736.81
REST OF ILLINOIS (IL)	$662.04	$662.04
INDIANA (IN)	$597.28	$597.28
KANSAS (KS)	$591.94	$591.94
KENTUCKY (KY)	$613.94	$613.94
NEW ORLEANS (LA)	$642.69	$642.69
REST OF LOUISIANA (LA)	$615.55	$615.55
METROPOLITAN BOSTON (MA)	$710.82	$710.82
REST OF MASSACHUSETTS (MA)	$657.52	$657.52
BALTIMORE/SURR. CNTYS (MD)	$691.23	$691.23
REST OF MARYLAND (MD)	$651.85	$651.85
SOUTHERN MAINE (ME)	$624.57	$624.57
REST OF MAINE (ME)	$603.98	$603.98
DETROIT (MI)	$684.55	$684.55
REST OF MICHIGAN (MI)	$634.35	$634.35
MINNESOTA (MN)	$613.91	$613.91
METROPOLITAN ST. LOUIS (MO)	$637.25	$637.25
METROPOLITAN KANSAS CITY (MO)	$631.99	$631.99
REST OF MISSOURI (MO)	$610.09	$610.09
MISSISSIPPI (MS)	$594.81	$594.81
MONTANA** (MT)	$650.52	$650.52
NORTH CAROLINA (NC)	$608.73	$608.73
NORTH DAKOTA** (ND)	$612.75	$612.75
NEBRASKA (NE)	$589.26	$589.26
NEW HAMPSHIRE (NH)	$654.23	$654.23
NORTHERN NJ (NJ)	$719.30	$719.30
REST OF NEW JERSEY (NJ)	$694.97	$694.97
NEW MEXICO (NM)	$640.07	$640.07
NEVADA** (NV)	$640.28	$640.28
MANHATTAN (NY)	$753.22	$753.22
NYC SUBURBS/LONG ISLAND (NY)	$778.12	$778.12
POUGHKPSIE/N NYC SUBURBS (NY)	$704.55	$704.55
QUEENS (NY)	$749.67	$749.67
REST OF NEW YORK (NY)	$617.61	$617.61
OHIO (OH)	$626.63	$626.63
OKLAHOMA (OK)	$606.26	$606.26
PORTLAND (OR)	$670.49	$670.49
REST OF OREGON (OR)	$630.57	$630.57
METROPOLITAN PHILADELPHIA (PA)	$680.01	$680.01
REST OF PENNSYLVANIA (PA)	$624.02	$624.02
PUERTO RICO (PR)	$652.79	$652.79
RHODE ISLAND (RI)	$658.86	$658.86
SOUTH CAROLINA (SC)	$619.66	$619.66
SOUTH DAKOTA** (SD)	$608.29	$608.29
TENNESSEE (TN)	$595.46	$595.46
BRAZORIA (TX)	$636.52	$636.52
DALLAS (TX)	$643.21	$643.21
GALVESTON (TX)	$640.14	$640.14
HOUSTON (TX)	$675.10	$675.10
BEAUMONT (TX)	$620.75	$620.75
FORT WORTH (TX)	$641.22	$641.22
AUSTIN (TX)	$660.34	$660.34
REST OF TEXAS (TX)	$630.08	$630.08
UTAH (UT)	$627.23	$627.23
VIRGINIA (VA)	$627.10	$627.10
VIRGIN ISLANDS (VI)	$652.79	$652.79
VERMONT (VT)	$616.32	$616.32
SEATTLE (KING CNTY) (WA)	$718.21	$718.21
REST OF WASHINGTON (WA)	$654.31	$654.31
WISCONSIN (WI)	$594.66	$594.66
WEST VIRGINIA (WV)	$641.22	$641.22
WYOMING** (WY)	$634.06	$634.06

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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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to the code. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is performed, reflecting local cost-of-living and practice-cost differences. The locality-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility rates can differ because the practice-expense RVU often changes depending on whether the service is performed in a physician office versus a hospital or ambulatory surgical center; for this code, that distinction may not produce a different result if the practice-expense RVU is the same in both settings.

RVUs — work 9.13, practice expense 8.44 (non-facility) / 8.44 (facility), malpractice 1.91 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment — actual reimbursement depends on claim-specific factors.
Medicare typically pays 80% of the approved amount after the patient's Part B deductible is met; the patient or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral surgery rules, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
GPCI values and the conversion factor are updated annually and may be revised mid-year by CMS rulemaking.
Always confirm current, locality-specific amounts with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the amount for CPT 23020 differ by locality?

Medicare applies Geographic Practice Cost Indices (GPCIs) to the work, practice-expense, and malpractice RVUs to reflect regional differences in wages, rents, and other practice costs, so the same code can price differently from one locality to another.

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

When the practice-expense RVU assigned to a code is identical for both the non-facility and facility settings, the calculated PFS amount will also be the same, since the work and malpractice RVUs don't vary by place of service.

Does this page show what Medicare will actually pay?

No — it shows the estimated Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible, and the actual claim payment can be affected by modifiers, other adjustments, and MAC-specific processing.

Where can I verify the exact rate for my location?

Your Medicare Administrative Contractor (MAC) publishes the finalized, locality-specific fee schedule, which should be used as the authoritative source for billing and 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.