Medicare Reimbursement for CPT 24200

This page covers CPT code 24200, a procedure code defined by the American Medical Association. It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility (office) and facility (hospital/ASC) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$243.16	$143.29
ALASKA* (AK)	$278.36	$171.99
ALABAMA (AL)	$216.40	$129.01
ARKANSAS (AR)	$213.03	$127.24
ARIZONA (AZ)	$236.08	$139.31
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$312.49	$171.68
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$318.55	$174.54
OXNARD-THOUSAND OAKS-VENTURA (CA)	$271.64	$153.59
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$273.07	$154.92
NAPA (CA)	$295.75	$164.13
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$312.90	$172.09
VALLEJO (CA)	$295.16	$163.54
BAKERSFIELD (CA)	$256.12	$146.66
CHICO (CA)	$255.12	$145.67
FRESNO (CA)	$255.12	$145.67
HANFORD-CORCORAN (CA)	$255.12	$145.67
MADERA (CA)	$255.12	$145.67
MERCED (CA)	$255.12	$145.67
MODESTO (CA)	$255.12	$145.67
REDDING (CA)	$255.12	$145.67
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$258.99	$149.54
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$267.79	$151.64
SALINAS (CA)	$266.81	$151.06
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$320.22	$176.21
SANTA CRUZ-WATSONVILLE (CA)	$275.87	$154.53
SANTA ROSA-PETALUMA (CA)	$278.64	$156.00
STOCKTON (CA)	$255.12	$145.67
VISALIA (CA)	$255.12	$145.67
YUBA CITY (CA)	$255.12	$145.67
EL CENTRO (CA)	$255.18	$145.73
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$273.20	$153.75
SAN LUIS OBISPO-PASO ROBLES (CA)	$262.54	$148.78
SANTA MARIA-SANTA BARBARA (CA)	$267.84	$151.39
REST OF CALIFORNIA (CA)	$255.12	$145.67
COLORADO (CO)	$252.26	$146.00
CONNECTICUT (CT)	$260.13	$152.57
DC + MD/VA SUBURBS (DC)	$278.37	$160.72
DELAWARE (DE)	$240.17	$141.50
FORT LAUDERDALE (FL)	$255.11	$153.95
MIAMI (FL)	$268.61	$164.65
REST OF FLORIDA (FL)	$241.62	$146.15
ATLANTA (GA)	$248.51	$147.04
REST OF GEORGIA (GA)	$226.85	$137.77
HAWAII, GUAM (HI)	$261.71	$148.16
IOWA (IA)	$221.26	$129.88
IDAHO (ID)	$223.03	$131.15
EAST ST. LOUIS (IL)	$241.56	$149.68
SUBURBAN CHICAGO (IL)	$257.51	$154.94
CHICAGO (IL)	$260.00	$159.64
REST OF ILLINOIS (IL)	$234.93	$143.75
INDIANA (IN)	$224.40	$131.82
KANSAS (KS)	$220.65	$130.37
KENTUCKY (KY)	$223.01	$134.22
NEW ORLEANS (LA)	$234.63	$140.65
REST OF LOUISIANA (LA)	$222.83	$134.45
METROPOLITAN BOSTON (MA)	$277.68	$158.44
REST OF MASSACHUSETTS (MA)	$250.79	$145.63
BALTIMORE/SURR. CNTYS (MD)	$259.53	$152.37
REST OF MARYLAND (MD)	$244.83	$143.76
SOUTHERN MAINE (ME)	$237.17	$138.20
REST OF MAINE (ME)	$224.83	$132.95
DETROIT (MI)	$245.38	$149.00
REST OF MICHIGAN (MI)	$229.72	$138.54
MINNESOTA (MN)	$239.69	$136.93
METROPOLITAN ST. LOUIS (MO)	$234.91	$139.83
METROPOLITAN KANSAS CITY (MO)	$232.37	$138.59
REST OF MISSOURI (MO)	$219.06	$132.97
MISSISSIPPI (MS)	$216.06	$130.08
MONTANA** (MT)	$243.13	$143.27
NORTH CAROLINA (NC)	$227.27	$134.09
NORTH DAKOTA** (ND)	$236.02	$136.15
NEBRASKA (NE)	$222.41	$130.23
NEW HAMPSHIRE (NH)	$248.72	$144.76
NORTHERN NJ (NJ)	$275.26	$159.41
REST OF NEW JERSEY (NJ)	$262.53	$153.48
NEW MEXICO (NM)	$231.27	$139.69
NEVADA** (NV)	$241.32	$141.35
MANHATTAN (NY)	$281.89	$165.84
NYC SUBURBS/LONG ISLAND (NY)	$289.80	$171.06
POUGHKPSIE/N NYC SUBURBS (NY)	$264.70	$155.35
QUEENS (NY)	$283.60	$165.56
REST OF NEW YORK (NY)	$230.97	$136.09
OHIO (OH)	$228.26	$137.08
OKLAHOMA (OK)	$222.04	$132.85
PORTLAND (OR)	$260.15	$149.20
REST OF OREGON (OR)	$238.90	$139.43
METROPOLITAN PHILADELPHIA (PA)	$253.60	$149.64
REST OF PENNSYLVANIA (PA)	$228.36	$136.69
PUERTO RICO (PR)	$244.87	$143.91
RHODE ISLAND (RI)	$248.66	$145.50
SOUTH CAROLINA (SC)	$228.26	$135.98
SOUTH DAKOTA** (SD)	$235.17	$135.31
TENNESSEE (TN)	$221.91	$131.13
BRAZORIA (TX)	$239.43	$140.46
DALLAS (TX)	$241.29	$141.82
GALVESTON (TX)	$240.35	$141.18
HOUSTON (TX)	$246.94	$147.77
BEAUMONT (TX)	$226.79	$135.91
FORT WORTH (TX)	$239.72	$141.25
AUSTIN (TX)	$251.90	$146.24
REST OF TEXAS (TX)	$233.20	$138.43
UTAH (UT)	$231.59	$137.71
VIRGINIA (VA)	$236.69	$138.52
VIRGIN ISLANDS (VI)	$244.87	$143.91
VERMONT (VT)	$235.50	$136.63
SEATTLE (KING CNTY) (WA)	$283.02	$160.48
REST OF WASHINGTON (WA)	$250.18	$145.02
WISCONSIN (WI)	$227.60	$131.92
WEST VIRGINIA (WV)	$225.76	$138.98
WYOMING** (WY)	$240.03	$140.16

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 3 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 the code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting local cost-of-living and practice-cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ between non-facility and facility settings because facility settings (like hospitals) assume lower practice overhead for the billing physician, since the facility itself bills separately for overhead costs.

RVUs — work 1.76, practice expense 5.16 (non-facility) / 2.17 (facility), malpractice 0.36 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary insurance is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts can vary by Medicare Administrative Contractor (MAC) and locality; always verify current rates with your MAC before billing or appealing a denial.

Frequently asked

Why is the facility amount different from the non-facility amount?

The facility amount uses lower practice-expense RVUs because the facility (not the billing physician) covers overhead costs like space, equipment, and staff when the service is performed in a hospital or ambulatory surgical center.

Why might the amount I was paid differ from the figure shown here?

Actual payments can be affected by your specific locality's GPCIs, applied modifiers, multiple-procedure payment reductions, sequestration, and mid-year or annual rate updates not reflected in a static reference figure.

Does this amount include the patient's share?

No. The figure represents the total Medicare-allowed amount. Medicare generally pays 80% after the deductible, with the remaining 20% being the patient's or secondary payer's responsibility.

Where can I find the official descriptor for CPT 24200?

CPT descriptors are copyrighted by the American Medical Association. Consult your CPT codebook, encoder software, or AMA resources for the official language, as it cannot be reproduced here.

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.