Medicare Reimbursement for CPT 23920

CPT 23920 is a physician procedure code reported on Medicare claims; this page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjustable by locality, with non-facility and facility rate comparisons.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1034.43	$1034.43
ALASKA* (AK)	$1273.83	$1273.83
ALABAMA (AL)	$936.49	$936.49
ARKANSAS (AR)	$924.47	$924.47
ARIZONA (AZ)	$1006.06	$1006.06
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1181.55	$1181.55
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1198.94	$1198.94
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1078.58	$1078.58
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1090.45	$1090.45
NAPA (CA)	$1137.73	$1137.73
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1185.37	$1185.37
VALLEJO (CA)	$1132.23	$1132.23
BAKERSFIELD (CA)	$1038.39	$1038.39
CHICO (CA)	$1029.14	$1029.14
FRESNO (CA)	$1029.14	$1029.14
HANFORD-CORCORAN (CA)	$1029.14	$1029.14
MADERA (CA)	$1029.14	$1029.14
MERCED (CA)	$1029.14	$1029.14
MODESTO (CA)	$1029.14	$1029.14
REDDING (CA)	$1029.14	$1029.14
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1065.24	$1065.24
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1065.56	$1065.56
SALINAS (CA)	$1061.35	$1061.35
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1214.53	$1214.53
SANTA CRUZ-WATSONVILLE (CA)	$1078.12	$1078.12
SANTA ROSA-PETALUMA (CA)	$1087.99	$1087.99
STOCKTON (CA)	$1029.14	$1029.14
VISALIA (CA)	$1029.14	$1029.14
YUBA CITY (CA)	$1029.14	$1029.14
EL CENTRO (CA)	$1029.70	$1029.70
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1076.06	$1076.06
SAN LUIS OBISPO-PASO ROBLES (CA)	$1046.07	$1046.07
SANTA MARIA-SANTA BARBARA (CA)	$1062.52	$1062.52
REST OF CALIFORNIA (CA)	$1029.14	$1029.14
COLORADO (CO)	$1041.39	$1041.39
CONNECTICUT (CT)	$1098.88	$1098.88
DC + MD/VA SUBURBS (DC)	$1145.74	$1145.74
DELAWARE (DE)	$1021.01	$1021.01
FORT LAUDERDALE (FL)	$1130.22	$1130.22
MIAMI (FL)	$1222.17	$1222.17
REST OF FLORIDA (FL)	$1073.55	$1073.55
ATLANTA (GA)	$1064.87	$1064.87
REST OF GEORGIA (GA)	$1013.44	$1013.44
HAWAII, GUAM (HI)	$1041.13	$1041.13
IOWA (IA)	$933.28	$933.28
IDAHO (ID)	$943.78	$943.78
EAST ST. LOUIS (IL)	$1116.72	$1116.72
SUBURBAN CHICAGO (IL)	$1135.40	$1135.40
CHICAGO (IL)	$1185.43	$1185.43
REST OF ILLINOIS (IL)	$1063.35	$1063.35
INDIANA (IN)	$947.99	$947.99
KANSAS (KS)	$940.96	$940.96
KENTUCKY (KY)	$981.18	$981.18
NEW ORLEANS (LA)	$1026.45	$1026.45
REST OF LOUISIANA (LA)	$984.43	$984.43
METROPOLITAN BOSTON (MA)	$1120.14	$1120.14
REST OF MASSACHUSETTS (MA)	$1040.97	$1040.97
BALTIMORE/SURR. CNTYS (MD)	$1098.23	$1098.23
REST OF MARYLAND (MD)	$1035.23	$1035.23
SOUTHERN MAINE (ME)	$989.47	$989.47
REST OF MAINE (ME)	$960.50	$960.50
DETROIT (MI)	$1097.63	$1097.63
REST OF MICHIGAN (MI)	$1014.64	$1014.64
MINNESOTA (MN)	$966.84	$966.84
METROPOLITAN ST. LOUIS (MO)	$1015.75	$1015.75
METROPOLITAN KANSAS CITY (MO)	$1007.82	$1007.82
REST OF MISSOURI (MO)	$977.16	$977.16
MISSISSIPPI (MS)	$950.40	$950.40
MONTANA** (MT)	$1034.20	$1034.20
NORTH CAROLINA (NC)	$967.53	$967.53
NORTH DAKOTA** (ND)	$967.76	$967.76
NEBRASKA (NE)	$934.30	$934.30
NEW HAMPSHIRE (NH)	$1036.54	$1036.54
NORTHERN NJ (NJ)	$1138.35	$1138.35
REST OF NEW JERSEY (NJ)	$1102.68	$1102.68
NEW MEXICO (NM)	$1024.30	$1024.30
NEVADA** (NV)	$1016.08	$1016.08
MANHATTAN (NY)	$1197.80	$1197.80
NYC SUBURBS/LONG ISLAND (NY)	$1238.85	$1238.85
POUGHKPSIE/N NYC SUBURBS (NY)	$1119.18	$1119.18
QUEENS (NY)	$1189.52	$1189.52
REST OF NEW YORK (NY)	$981.40	$981.40
OHIO (OH)	$1001.06	$1001.06
OKLAHOMA (OK)	$967.26	$967.26
PORTLAND (OR)	$1057.86	$1057.86
REST OF OREGON (OR)	$999.52	$999.52
METROPOLITAN PHILADELPHIA (PA)	$1081.74	$1081.74
REST OF PENNSYLVANIA (PA)	$995.96	$995.96
PUERTO RICO (PR)	$1037.07	$1037.07
RHODE ISLAND (RI)	$1045.34	$1045.34
SOUTH CAROLINA (SC)	$987.66	$987.66
SOUTH DAKOTA** (SD)	$959.91	$959.91
TENNESSEE (TN)	$946.63	$946.63
BRAZORIA (TX)	$1010.42	$1010.42
DALLAS (TX)	$1021.67	$1021.67
GALVESTON (TX)	$1016.59	$1016.59
HOUSTON (TX)	$1078.09	$1078.09
BEAUMONT (TX)	$991.02	$991.02
FORT WORTH (TX)	$1019.19	$1019.19
AUSTIN (TX)	$1045.53	$1045.53
REST OF TEXAS (TX)	$1003.46	$1003.46
UTAH (UT)	$999.35	$999.35
VIRGINIA (VA)	$994.74	$994.74
VIRGIN ISLANDS (VI)	$1037.07	$1037.07
VERMONT (VT)	$975.05	$975.05
SEATTLE (KING CNTY) (WA)	$1129.70	$1129.70
REST OF WASHINGTON (WA)	$1035.34	$1035.34
WISCONSIN (WI)	$940.23	$940.23
WEST VIRGINIA (WV)	$1031.21	$1031.21
WYOMING** (WY)	$1005.25	$1005.25

Look up another code or locality →

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

The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the locality where the service is performed. These locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs (and therefore the total) can differ between non-facility settings, such as an office, and facility settings, such as a hospital, because overhead costs differ. For CPT 23920, the non-facility and facility practice-expense RVUs shown are the same, so the national allowed amounts for both settings are identical in this case. Actual payment also depends on claim-specific factors like modifiers and locality.

RVUs — work 15.82, practice expense 11.79 (non-facility) / 11.79 (facility), malpractice 3.36 — × 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 patient meets the annual Part B deductible; the patient or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality-specific GPCIs can shift the allowed amount up or down from the national figure shown here.
Always verify the current, locality-specific rate with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does CPT 23920 show the same amount for non-facility and facility settings?

Because the practice-expense RVU for this code is the same in both settings, the calculated national allowed amount is identical for non-facility and facility claims.

Will my local Medicare payment match the national amount shown here?

Not necessarily. The national figure uses a national GPCI baseline; your actual locality's GPCIs can raise or lower the final allowed amount.

Does this amount reflect what Medicare will actually pay my practice?

No. This is the PFS allowed amount before patient responsibility, deductible status, modifiers, and sequestration are applied, so actual reimbursement may differ.

What should I do if a claim for CPT 23920 is denied or paid differently than expected?

Review the remittance advice for applied modifiers, adjustments, or locality factors, and confirm current rates and policy details with your MAC.

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.