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CPT 20500 Medicare rate in Q1 2013

Historical · Q1 2013
$107.17

National (GPCI 1.000)

$84.93–$131.55 across payment localities

Participating physician · Before sequestration

CMS evidence · Q1 2013 release

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The national PFS baseline was $107.17 for CPT 20500 in the Office (non-facility) setting and $86.08 in a facility under the Q1 2013 Physician Fee Schedule, effective January 2013. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Why are the facility and non-facility amounts different?

Only the practice-expense RVU changes with the setting. For 20500 it's 1.75 RVUs in the Office (non-facility) setting versus 1.13 in a facility—the whole $21.09 gap between $107.17 and $86.08. In the Office (non-facility) setting the practice bears the overhead, so the allowed amount is higher; in a hospital or ASC the facility bills its own fee, so the professional amount is lower. See facility vs non-facility.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).

Contract rate as % of Medicare Copy link

Applies to your locality's allowed amount, not the $107.17 national baseline. How to find your contract's percentage.

Need rates from another insurer? Join the waitlist →

Allowed amount, Medicare's share, and patient share Copy link

A physician's $107.17 Office (non-facility) allowed amount: Medicare pays $84.03 after sequestration and the patient owes $21.43, once the Part B deductible is met.

Adjust for your locality →
20500: allowed amount and each party's share by who bills it, Office (non-facility), national baseline
Billed by Allowed amount Participating claim If not participating
What Medicare pays Patient coinsurance Non-participating amount Limiting charge
Physician (MD/DO) 100% Calculator $107.17 $84.03 $85.74 − $1.71 $21.43 $101.81 $117.08

National Q1 2013, GPCI 1.000. Rows are provider types with at least 1% of 20500’s Medicare services in CMS’s CY2024 Physician & Other Practitioners data; each % applies before the 80/20 split and sequestration.

Is $107.17 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($85.74) and the patient owes 20% coinsurance ($21.43). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 20500?

$101.81 in the Office (non-facility) setting—95% of the $107.17 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 20500?

$117.08 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $107.17 amount above. The non-participating amount is 95% of the fee schedule rate ($101.81), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

CMS RVU13AJanuary 1 – March 31, 2013revision 2 See file rows

Which billing rules and modifiers apply? Copy link

CMS indicators that apply to 20500: GLOB DAYS 010 (10-day follow-up) · MULT PROC 2 (standard reduction applies).

Global surgery period

10-day follow-up

GLOB DAYS

010

The fee covers pre-operative work on the day of the procedure plus related follow-up care for the next 10 days. Related visits inside that window are not billed separately.

Multiple procedures

Standard reduction applies

MULT PROC

2

When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.

-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.

Not payable with 20500: -26/TC · -50 · -80/81/82 · -AS · -62 · -66.

Why would a Medicare claim for 20500 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

CMS RVU13AJanuary 1 – March 31, 2013revision 2 See file rows

Can you bill it with another code? Copy link

This code

20500

See every current NCCI pair for 20500 →

Payment review for 20500 Copy link

Checking a paid 20500 line?

Check an actual payment Model this code in a contract
What to check (5)

Four published payment rules can change what 20500 allows on a claim: the office/facility differential, the 10-day global package, the standard multiple-procedure reduction and the assistant-at-surgery prohibition. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

  • Check the place-of-service code before attributing the gap to the payer: office and facility pricing differ by $21.09 nationally at GPCI 1.000, before any locality adjustment.
  • Check the dates before appealing a denial: related follow-up care in the 10 days after the procedure is already paid in this fee, so a post-operative visit denied in that window was denied correctly.
  • Rank the claim’s procedure lines before calling this one short-paid: billed with a higher-valued procedure on the same date, its allowed amount is $53.59 instead of $107.17 (national, GPCI 1.000). That is the rule, not a payer error.
  • Expect an assistant-at-surgery denial here rather than appealing it—a -80 or -AS line on this procedure is never separately payable.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

How location and RVUs set the amount Copy link

Office (non-facility): 3.15 RVUs × $34.0230 = $107.17 national PFS baseline. Local GPCIs move it from $84.93 in Puerto Rico, PR to $131.55 in Alaska, AK.

Office (non-facility)

Office (non-facility): each RVU times its GPCI, summed, times the conversion factor
Component RVU × GPCI =
Work 1.28 1.000 1.28
Practice expense 1.75 1.000 1.75
Malpractice 0.12 1.000 0.12
Total RVUs 3.15
× Conversion factor $34.0230
= National PFS baseline $107.17

Facility

Facility: each RVU times its GPCI, summed, times the conversion factor
Component RVU × GPCI =
Work 1.28 1.000 1.28
Practice expense 1.13 1.000 1.13
Malpractice 0.12 1.000 0.12
Total RVUs 2.53
× Conversion factor $34.0230
= National PFS baseline $86.08

Rates by locality Copy link

Maine: no locality amount on file for this code ME Wisconsin: no locality amount on file for this code WI Vermont: no locality amount on file for this code VT New Hampshire: no locality amount on file for this code NH Montana: $107.59 MT North Dakota: $105.20 ND Minnesota: no locality amount on file for this code MN Michigan: $102.87–$112.82 across 2 localities MI New York: $101.75–$123.73 across 5 localities NY Massachusetts: no locality amount on file for this code MA Rhode Island: no locality amount on file for this code RI Washington: $107.32–$116.35 across 2 localities WA Idaho: $99.24 ID Wyoming: $108.12 WY South Dakota: $104.85 SD Iowa: $98.22 IA Illinois: no locality amount on file for this code IL Indiana: $101.01 IN Ohio: $103.81 OH Pennsylvania: $102.49–$113.84 across 2 localities PA New Jersey: $115.77–$120.35 across 2 localities NJ Connecticut: $115.73 CT Oregon: $103.38–$108.48 across 2 localities OR Nevada: no locality amount on file for this code NV Utah: $102.59 UT Colorado: $106.89 CO Nebraska: $98.69 NE Missouri: $98.39–$105.33 across 3 localities MO Kentucky: $98.48 KY West Virginia: $97.87 WV Virginia: $104.70 VA Maryland: $109.68–$114.96 across 2 localities MD Delaware: $108.98 DE California: no locality amount on file for this code CA Arizona: $105.92 AZ New Mexico: $102.16 NM Kansas: $100.69 KS Oklahoma: $97.51 OK Arkansas: $96.89 AR Tennessee: no locality amount on file for this code TN North Carolina: $101.58 NC South Carolina: $99.79 SC District of Columbia: $121.63 DC Texas: $100.67–$107.90 across 8 localities TX Louisiana: $98.80–$105.42 across 2 localities LA Mississippi: $98.22 MS Alabama: no locality amount on file for this code AL Georgia: no locality amount on file for this code GA Florida: $107.52–$117.80 across 3 localities FL Alaska: $131.55 AK Hawaii: no locality amount on file for this code HI
$85–$93 $93–$100 $100–$108 $108–$116 $116–$124 $124–$132 No amount on file

20500 Office (non-facility) by metro, highest first

Anchorage, AK $131.55 Locality 02102-01 Long Island, NY $123.73 Locality 13202-02 Queens, NY $123.49 Locality 13292-04 Washington, DC $121.63 Locality 12202-01 New York City, NY $120.62 Locality 13202-01 Northern New Jersey, NJ $120.35 Locality 12402-01
Show 34 more metros
Miami, FL $117.80 Locality 09102-04 Seattle, WA $116.35 Locality 02402-02 Hartford, CT $115.73 Locality 13102-00 Baltimore, MD $114.96 Locality 12302-01 Fort Lauderdale, FL $114.22 Locality 09102-03 Philadelphia, PA $113.84 Locality 12502-01 Detroit, MI $112.82 Locality 08202-01 Portland, OR $108.48 Locality 02302-01 Dallas, TX $107.90 Locality 04412-11 Tampa, FL $107.52 Locality 09102-99 Houston, TX $107.37 Locality 04412-18 Denver, CO $106.89 Locality 04112-01 Austin, TX $106.69 Locality 04412-31 Phoenix, AZ $105.92 Locality 03102-00 New Orleans, LA $105.42 Locality 07202-01 Kansas City, MO $105.33 Locality 05302-02 St. Louis, MO $105.29 Locality 05302-01 Fort Worth, TX $105.21 Locality 04412-28 Richmond, VA $104.70 Locality 11302-00 Columbus, OH $103.81 Locality 15202-00 Salt Lake City, UT $102.59 Locality 03502-09 Pittsburgh, PA $102.49 Locality 12502-99 Albuquerque, NM $102.16 Locality 04212-05 Buffalo, NY $101.75 Locality 13282-99 Charlotte, NC $101.58 Locality 11502-00 San Antonio, TX $101.15 Locality 04412-99 Indianapolis, IN $101.01 Locality 08102-00 Wichita, KS $100.69 Locality 05202-00 Charleston, SC $99.79 Locality 11202-01 Boise, ID $99.24 Locality 02202-00 Omaha, NE $98.69 Locality 05402-00 Louisville, KY $98.48 Locality 15102-00 Des Moines, IA $98.22 Locality 05102-00 Oklahoma City, OK $97.51 Locality 04312-00
Maine: no locality amount on file for this code ME Wisconsin: no locality amount on file for this code WI Vermont: no locality amount on file for this code VT New Hampshire: no locality amount on file for this code NH Montana: $86.50 MT North Dakota: $84.11 ND Minnesota: no locality amount on file for this code MN Michigan: $83.40–$91.24 across 2 localities MI New York: $81.94–$98.28 across 5 localities NY Massachusetts: no locality amount on file for this code MA Rhode Island: no locality amount on file for this code RI Washington: $85.97–$92.22 across 2 localities WA Idaho: $80.38 ID Wyoming: $87.03 WY South Dakota: $83.76 SD Iowa: $79.51 IA Illinois: no locality amount on file for this code IL Indiana: $81.54 IN Ohio: $84.25 OH Pennsylvania: $83.24–$91.50 across 2 localities PA New Jersey: $92.02–$95.33 across 2 localities NJ Connecticut: $92.31 CT Oregon: $83.09–$86.46 across 2 localities OR Nevada: no locality amount on file for this code NV Utah: $83.27 UT Colorado: $85.71 CO Nebraska: $79.62 NE Missouri: $80.44–$85.22 across 3 localities MO Kentucky: $80.11 KY West Virginia: $80.40 WV Virginia: $84.10 VA Maryland: $87.85–$91.82 across 2 localities MD Delaware: $86.95 DE California: no locality amount on file for this code CA Arizona: $85.29 AZ New Mexico: $82.84 NM Kansas: $81.83 KS Oklahoma: $79.46 OK Arkansas: $78.64 AR Tennessee: no locality amount on file for this code TN North Carolina: $82.03 NC South Carolina: $80.62 SC District of Columbia: $96.36 DC Texas: $81.77–$86.45 across 8 localities TX Louisiana: $80.30–$84.83 across 2 localities LA Mississippi: $79.95 MS Alabama: no locality amount on file for this code AL Georgia: no locality amount on file for this code GA Florida: $87.11–$95.56 across 3 localities FL Alaska: $109.04 AK Hawaii: no locality amount on file for this code HI
$71–$77 $77–$83 $83–$90 $90–$96 $96–$103 $103–$109 No amount on file

20500 Facility by metro, highest first

Anchorage, AK $109.04 Locality 02102-01 Queens, NY $98.28 Locality 13292-04 Long Island, NY $98.16 Locality 13202-02 Washington, DC $96.36 Locality 12202-01 New York City, NY $96.11 Locality 13202-01 Miami, FL $95.56 Locality 09102-04
Show 34 more metros
Northern New Jersey, NJ $95.33 Locality 12402-01 Hartford, CT $92.31 Locality 13102-00 Seattle, WA $92.22 Locality 02402-02 Fort Lauderdale, FL $92.05 Locality 09102-03 Baltimore, MD $91.82 Locality 12302-01 Philadelphia, PA $91.50 Locality 12502-01 Detroit, MI $91.24 Locality 08202-01 Tampa, FL $87.11 Locality 09102-99 Portland, OR $86.46 Locality 02302-01 Dallas, TX $86.45 Locality 04412-11 Houston, TX $86.23 Locality 04412-18 Denver, CO $85.71 Locality 04112-01 Austin, TX $85.41 Locality 04412-31 Phoenix, AZ $85.29 Locality 03102-00 Kansas City, MO $85.22 Locality 05302-02 St. Louis, MO $84.96 Locality 05302-01 New Orleans, LA $84.83 Locality 07202-01 Fort Worth, TX $84.56 Locality 04412-28 Columbus, OH $84.25 Locality 15202-00 Richmond, VA $84.10 Locality 11302-00 Salt Lake City, UT $83.27 Locality 03502-09 Pittsburgh, PA $83.24 Locality 12502-99 Albuquerque, NM $82.84 Locality 04212-05 Charlotte, NC $82.03 Locality 11502-00 Buffalo, NY $81.94 Locality 13282-99 San Antonio, TX $81.92 Locality 04412-99 Wichita, KS $81.83 Locality 05202-00 Indianapolis, IN $81.54 Locality 08102-00 Charleston, SC $80.62 Locality 11202-01 Boise, ID $80.38 Locality 02202-00 Louisville, KY $80.11 Locality 15102-00 Omaha, NE $79.62 Locality 05402-00 Des Moines, IA $79.51 Locality 05102-00 Oklahoma City, OK $79.46 Locality 04312-00

Q1 2013, each locality's GPCIs, before sequestration. Multi-locality states are shaded by their mean. Look up your exact locality →

CMS RVU13AJanuary 1 – March 31, 2013revision 2 See file rows

Source & method Copy link

  1. 01 PPRRVU13_V1226_UP0.csv · Q1 2013 (RVU13A) · row 4,952—status A, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q1 2013 release
    Effective
    January 1 – March 31, 2013
    Locator
    PPRRVU13_V1226_UP0.csv in rvu13ar.zip · row 4,952 of 15,619 · via CMS
    Fields read
    Status A (col 4) Work RVU 1.28 (col 6) Office (non-facility) PE RVU 1.75 (col 7) Facility PE RVU 1.13 (col 9) Malpractice RVU 0.12 (col 11)
    SHA-256 79b1988bb9cbab6a…
    Doesn’t establish
    A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
    Note
    Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
  2. 02 Conversion factor · same file · row 4,952 · column 25—$34.0230
    Source
    Conversion factor, read from the same file as the RVUs
  3. 03 Physician & Other Practitioners · CY2024—volume and who bills it limits
    Source
    CMS Physician & Other Practitioners dataset
    Effective
    Calendar-year snapshot, on a different cycle from the Q1 2013 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 20500 National PFS baseline: Office (non-facility) $107.17; Facility $86.08 (Q1 2013; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU13A, PPRRVU13_V1226_UP0.csv row 4,952. Localis. https://localishealth.com/cpt/20500/2013/A

Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON

How has it changed? Copy link

$128.59 Office (non-facility) and $83.50 Facility since Jan 1, 2026, after a +4.9% increase in the Office (non-facility) amount. +20.0% increase since Q1 2013; peak $128.59 in Q1 2026.

  1. Jan 1, 2026 – present

    Q1 2026

    Still in effect · 4 releases at this rate
    Office
    $128.59 (+$6.00, +4.9% increase)
    Facility
    $83.50 (−$5.13, -5.8% decrease)

    Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present

  2. Jan 1, 2025 – Dec 31, 2025

    Q1 2025

    4 releases at this rate
    Office
    $122.59 (−$1.57, -1.3% decrease)
    Facility
    $88.63 (−$0.91, -1.0% decrease)

    Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025

  3. Mar 9, 2024 – Dec 31, 2024

    Q1 2024

    4 releases at this rate
    Office
    $124.16 (+$2.02, +1.7% increase)
    Facility
    $89.54 (+$1.46, +1.7% increase)

    Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024

  4. Jan 1, 2024 – Mar 8, 2024 · Superseded revision

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    $122.14
    Facility
    $88.08

  5. Jan 1, 2023 – Dec 31, 2023

    Q1 2023

    4 releases at this rate
    Office
    $126.06 (+$1.82, +1.5% increase)
    Facility
    $90.14 (+$1.55, +1.7% increase)

    Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023

  6. Jan 1, 2022 – Dec 31, 2022

    Q1 2022

    4 releases at this rate
    Office
    $124.24 (+$2.46, +2.0% increase)
    Facility
    $88.59 (−$0.39, -0.4% decrease)

    Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022

National baseline (GPCI 1.000), before sequestration.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 20500 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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Usage and related codes Copy link

In CY2024, 20500 ranked #5,472 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
416
Allowed
$42,053
Beneficiaries
330

CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).