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CPT code 20526: Injection, carpal tunnel treatment2026 Medicare rate & RVUs in Puerto Rico

Report this service when medication is injected into the carpal tunnel to treat symptoms associated with median nerve compression at the wrist.

CMS RVU26DEffective Oct 1, 2026One payment locality81.5K Medicare services in 2024

In Puerto Rico, Medicare pays $88.66 for 20526 in the office and $49.49 when it’s performed in a hospital or facility.

$88.66Office (non-facility)
$49.49Hospital or facility
+0.5%vs the national office rate ($88.18)

Check a contract rate as a % of Medicare · 20526 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 20526 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 20526 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 20526 covers

A clinician injects medication, commonly a corticosteroid, into the carpal tunnel to treat symptoms such as pain, tingling, or numbness associated with median nerve compression. The service is typically performed by a physician or other qualified practitioner in an office or outpatient facility. The injection targets the carpal tunnel; it is not an injection into a tendon sheath or a surgical release of the tunnel.

Report the code for the treated wrist and document the indication, side, and injection performed. For treatment of both wrists, modifier 50 is paid at 150% under the CMS bilateral rule. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. The 0-day global period includes same-day preoperative and postoperative care. CMS does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 20526

Across 109 of 109 payment localities, the office rate for 20526 runs from $78.12 in Arkansas to $111.81 in San Benito County, CA. Puerto Rico pays $88.66. The RVUs are the same everywhere; the geographic indexes change the dollars.

20526 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$88.66
  2. Los Angeles, CA · California$97.00+$8.34
  3. Washington, DC area · District of Columbia$99.69+$11.03
  4. Miami, FL · Florida$98.98+$10.32
  5. Chicago, IL · Illinois$96.01+$7.35
  6. Manhattan, NY · New York$101.86+$13.20
  7. Alaska · Alaska$104.36+$15.70

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

20526 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$79.24$45.34
ArkansasArkansas$78.12$44.84
ArizonaArizona$85.76$48.21
Bakersfield, CACalifornia$91.51$49.05
Chico, CACalifornia$91.04$48.57
El Centro, CACalifornia$91.06$48.60
Fresno, CACalifornia$91.04$48.57
Hanford, CACalifornia$91.04$48.57

20526 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$78.12

$104.36

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
20526 office rate range by state
State / territoryOffice rate rangeLocalities
AK$104.361
AL$79.241
AR$78.121
AZ$85.761
CA$91.04–$111.8129
CO$90.621
CT$93.971
DC$99.691
DE$87.141
FL$88.76–$98.983
GA$83.68–$90.242
GU$92.881
HI$92.881
IA$80.351
ID$81.041
IL$86.87–$96.014
IN$81.481
KS$80.391
KY$81.951
LA$81.99–$85.902
MA$90.26–$98.862
MD$88.64–$99.693
ME$81.89–$85.622
MI$84.41–$90.262
MN$85.681
MO$80.89–$85.703
MS$79.501
MT$88.171
NC$82.661
ND$84.811
NE$80.661
NH$89.591
NJ$94.72–$98.782
NM$85.021
NV$87.281
NY$83.90–$104.805
OH$83.721
OK$81.371
OR$86.28–$92.962
PA$83.62–$91.952
PR$88.661
RI$89.861
SC$83.391
SD$84.411
TN$80.841
TX$83.12–$90.608
UT$84.491
VA$85.63–$99.692
VI$88.661
VT$84.861
WA$89.96–$100.432
WI$82.071
WV$83.841
WY$86.701

See 20526 in every payment locality

How the 20526 rate is calculated

Each of 20526’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 20526

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.92

0.92 RVUs× 1.000 GPCI

Practice expense1.55

1.55 RVUs× 1.000 GPCI

Malpractice0.17

0.17 RVUs× 1.000 GPCI

Adjusted RVUs

2.6400

Conversion factor

$33.4009

Medicare rate

$88.18

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,757

Code
20526
Physician work
0.92
Practice expense
1.55
Malpractice
0.17

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 20526 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.92× 1.0000.9200
Practice expense1.55× 1.0111.5670
Malpractice0.17× 0.9850.1675
Total RVUs2.6545
Conversion factor× 33.4009

Office rate, Puerto Rico$88.66

Office: (0.92 × 1 + 1.55 × 1.011 + 0.17 × 0.985) × $33.4009 = $88.66

Facility: (0.92 × 1 + 0.39 × 1.011 + 0.17 × 0.985) × $33.4009 = $49.49

Open 20526 in the RVU calculator

Payment rules and modifiers for 20526

The CMS indicators that decide how 20526 is paid alongside other services.

CMS payment indicators · 20526

Injection, carpal tunnel treatment

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

20526 without 50 · national office

$88.18

Injection, carpal tunnel treatment

20526-50 · Bilateral: 150%

$132.27

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 20526

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 20526
CodeHow it relatesOffice range, Puerto Rico
Used instead
64721Carpal tunnel release, median nerve at carpal tunnelCarpal tunnel release is a surgical treatment option rather than an injection.$485.31
Often billed with
76942Ultrasound needle guidance, biopsy, aspiration, injection, or localizationMay accompany a separately documented ultrasound-guided needle placement service.$64.56
J3301Triamcinolone injection, per 10 mgMay identify triamcinolone administered during the injection when separately reportable.No office rate

How 20526 has changed in Puerto Rico

20526 · Office / nonfacility

$88.66

Effective 2026-10-01

The base rate is $7.57 higher than on 2025-10-01, moving from $81.09 to $88.66 (9.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $81.09changed to$88.66

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.94 changed to 0.92
    • Practice expense RVU 1.40 changed to 1.55
    • Malpractice RVU 0.16 changed to 0.17
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $82.77changed to$81.09

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.37 changed to 1.40
    • Malpractice RVU 0.17 changed to 0.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $81.42changed to$82.77

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $83.63changed to$81.42

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.34 changed to 1.37
    • Malpractice RVU 0.18 changed to 0.17
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $83.36changed to$83.63

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $84.72changed to$83.36

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.32 changed to 1.34
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $82.97changed to$84.72

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.27 changed to 1.32
    • Malpractice RVU 0.16 changed to 0.18

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $81.46changed to$82.97

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.15 changed to 1.27
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $79.51changed to$81.46

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.10 changed to 1.15
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $79.78changed to$79.51

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.11 changed to 1.10

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $71.21changed to$79.78

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.10 changed to 1.11
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $62.85changed to$71.21

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.09 changed to 1.10
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $63.33changed to$62.85

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.10 changed to 1.09

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $63.01changed to$63.33

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $61.71changed to$63.01

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.08 changed to 1.10
    • Malpractice RVU 0.13 changed to 0.16
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $60.16changed to$61.71

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.17 changed to 1.08
    • Malpractice RVU 0.14 changed to 0.13
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $60.16

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$88.66$49.49RVU26D
2026-07-01$88.66$49.49RVU26C
2026-04-01$88.66$49.49RVU26B
2026-01-01$88.66$49.49RVU26A
2025-10-01$81.09$55.36RVU25D
2025-07-01$81.09$55.36RVU25C
2025-04-01$81.09$55.36RVU25B
2025-01-01$81.09$55.36RVU25A
2024-10-01$82.77$56.62RVU24D
2024-07-01$82.77$56.62RVU24C
2024-04-01$82.77$56.62RVU24B
2024-03-09$82.77$56.62RVU24AR
2024-01-01$81.42$55.70RVU24A
2023-10-01$83.63$57.67RVU23D
2023-07-01$83.36$57.61RVU23C
2023-04-01$83.36$57.61RVU23B
2023-01-01$83.36$57.61RVU23A
2022-10-01$84.72$58.56RVU22D
2022-07-01$84.72$58.56RVU22C
2022-04-01$84.72$58.56RVU22B
2022-01-01$84.72$58.56RVU22A
2021-10-01$82.97$58.35RVU21D
2021-07-01$82.97$58.35RVU21C
2021-04-01$82.97$58.35RVU21B
2021-01-01$82.97$58.35RVU21A
2020-10-01$81.46$59.64RVU20D
2020-07-01$81.46$59.64RVU20C
2020-04-01$81.46$59.64RVU20B
2020-01-01$81.46$59.64RVU20A
2019-10-01$79.51$59.91RVU19D
2019-07-01$79.51$59.91RVU19C
2019-04-01$79.51$59.91RVU19B
2019-01-01$79.51$59.91RVU19A
2018-10-01$79.78$59.84RVU18D
2018-07-01$79.78$59.84RVU18C
2018-04-01$79.78$59.84RVU18B
2018-01-01$79.78$59.84RVU18AR1
2017-10-01$71.21$54.63RVU17D
2017-07-01$71.21$54.63RVU17C
2017-04-01$71.21$54.63RVU17B
2017-01-01$71.21$54.63RVU17A
2016-10-01$62.85$49.22RVU16D
2016-07-01$62.85$49.22RVU16C
2016-04-01$62.85$49.22RVU16B
2016-01-01$62.85$49.22RVU16A
2015-10-01$63.33$49.65RVU15D
2015-07-01$63.33$49.65RVU15C
2015-04-01$63.01$49.40RVU15B
2015-01-01$63.01$49.40RVU15A
2014-10-01$61.71$48.57RVU14D
2014-07-01$61.71$48.57RVU14C
2014-04-01$61.71$48.57RVU14B
2014-01-01$61.71$48.57RVU14A
2013-10-01$60.16$46.78RVU13D
2013-07-01$60.16$46.78RVU13C
2013-04-01$60.16$46.78RVU13B
2013-01-01$60.16$46.78RVU13AR

Price 20526 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

20526 billing questions

When should I choose this code instead of 20550?

Use 20526 when the medication is injected into the carpal tunnel. Code 20550 describes an injection into a tendon sheath or ligament, such as for a tendon-related condition.

Can I report this code for injections in both wrists?

Yes. Report the bilateral service with modifier 50; CMS pays it at 150% under the bilateral rule.

Is same-day follow-up care included?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

How does the multiple procedure reduction affect this service?

When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and the others at 50%.

Can an assistant or co-surgeon be reported?

CMS does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.

Can the medication be reported separately?

The procedure code describes the injection service. The administered drug may be separately reported with an applicable drug code when reporting requirements are met.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 20526PPRRVU2026_Oct_nonQPP.csv, line 1,757 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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