Medicare Reimbursement for CPT 19000

CPT 19000 is a procedure code defined by the American Medical Association; its specific descriptor is not reproduced here due to licensing restrictions. This page shows the 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 and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$96.19	$36.41
ALASKA* (AK)	$112.47	$48.80
ALABAMA (AL)	$86.46	$34.14
ARKANSAS (AR)	$85.23	$33.87
ARIZONA (AZ)	$93.65	$35.71
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$123.39	$39.09
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$125.78	$39.57
OXNARD-THOUSAND OAKS-VENTURA (CA)	$107.43	$36.76
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$108.00	$37.27
NAPA (CA)	$116.82	$38.02
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$123.51	$39.21
VALLEJO (CA)	$116.64	$37.84
BAKERSFIELD (CA)	$101.53	$36.00
CHICO (CA)	$101.21	$35.68
FRESNO (CA)	$101.21	$35.68
HANFORD-CORCORAN (CA)	$101.21	$35.68
MADERA (CA)	$101.21	$35.68
MERCED (CA)	$101.21	$35.68
MODESTO (CA)	$101.21	$35.68
REDDING (CA)	$101.21	$35.68
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$102.40	$36.87
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$106.09	$36.56
SALINAS (CA)	$105.69	$36.40
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$126.29	$40.08
SANTA CRUZ-WATSONVILLE (CA)	$109.07	$36.43
SANTA ROSA-PETALUMA (CA)	$110.16	$36.74
STOCKTON (CA)	$101.21	$35.68
VISALIA (CA)	$101.21	$35.68
YUBA CITY (CA)	$101.21	$35.68
EL CENTRO (CA)	$101.23	$35.70
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$108.10	$36.59
SAN LUIS OBISPO-PASO ROBLES (CA)	$104.01	$35.91
SANTA MARIA-SANTA BARBARA (CA)	$106.07	$36.36
REST OF CALIFORNIA (CA)	$101.21	$35.68
COLORADO (CO)	$99.89	$36.27
CONNECTICUT (CT)	$102.53	$38.14
DC + MD/VA SUBURBS (DC)	$109.68	$39.25
DELAWARE (DE)	$95.18	$36.11
FORT LAUDERDALE (FL)	$100.01	$39.45
MIAMI (FL)	$104.48	$42.24
REST OF FLORIDA (FL)	$95.18	$38.02
ATLANTA (GA)	$98.06	$37.31
REST OF GEORGIA (GA)	$89.87	$36.54
HAWAII, GUAM (HI)	$103.57	$35.59
IOWA (IA)	$88.44	$33.74
IDAHO (ID)	$89.05	$34.04
EAST ST. LOUIS (IL)	$94.71	$39.70
SUBURBAN CHICAGO (IL)	$100.98	$39.58
CHICAGO (IL)	$101.47	$41.38
REST OF ILLINOIS (IL)	$92.60	$38.01
INDIANA (IN)	$89.55	$34.13
KANSAS (KS)	$88.12	$34.07
KENTUCKY (KY)	$88.65	$35.50
NEW ORLEANS (LA)	$92.85	$36.59
REST OF LOUISIANA (LA)	$88.55	$35.64
METROPOLITAN BOSTON (MA)	$109.55	$38.16
REST OF MASSACHUSETTS (MA)	$99.34	$36.38
BALTIMORE/SURR. CNTYS (MD)	$102.26	$38.11
REST OF MARYLAND (MD)	$96.95	$36.44
SOUTHERN MAINE (ME)	$94.25	$35.00
REST OF MAINE (ME)	$89.60	$34.59
DETROIT (MI)	$96.44	$38.74
REST OF MICHIGAN (MI)	$91.00	$36.42
MINNESOTA (MN)	$95.50	$33.98
METROPOLITAN ST. LOUIS (MO)	$93.08	$36.16
METROPOLITAN KANSAS CITY (MO)	$92.14	$36.00
REST OF MISSOURI (MO)	$87.11	$35.57
MISSISSIPPI (MS)	$86.18	$34.71
MONTANA** (MT)	$96.19	$36.40
NORTH CAROLINA (NC)	$90.50	$34.72
NORTH DAKOTA** (ND)	$94.01	$34.22
NEBRASKA (NE)	$88.89	$33.71
NEW HAMPSHIRE (NH)	$98.41	$36.17
NORTHERN NJ (NJ)	$108.59	$39.24
REST OF NEW JERSEY (NJ)	$103.64	$38.35
NEW MEXICO (NM)	$91.53	$36.70
NEVADA** (NV)	$95.65	$35.80
MANHATTAN (NY)	$110.65	$41.18
NYC SUBURBS/LONG ISLAND (NY)	$113.41	$42.32
POUGHKPSIE/N NYC SUBURBS (NY)	$104.39	$38.92
QUEENS (NY)	$111.43	$40.76
REST OF NEW YORK (NY)	$91.85	$35.05
OHIO (OH)	$90.56	$35.97
OKLAHOMA (OK)	$88.41	$35.02
PORTLAND (OR)	$102.92	$36.50
REST OF OREGON (OR)	$94.84	$35.29
METROPOLITAN PHILADELPHIA (PA)	$100.07	$37.83
REST OF PENNSYLVANIA (PA)	$90.65	$35.77
PUERTO RICO (PR)	$96.86	$36.41
RHODE ISLAND (RI)	$98.47	$36.71
SOUTH CAROLINA (SC)	$90.69	$35.45
SOUTH DAKOTA** (SD)	$93.75	$33.97
TENNESSEE (TN)	$88.57	$34.22
BRAZORIA (TX)	$95.02	$35.77
DALLAS (TX)	$95.66	$36.11
GALVESTON (TX)	$95.33	$35.96
HOUSTON (TX)	$97.34	$37.97
BEAUMONT (TX)	$90.07	$35.67
FORT WORTH (TX)	$95.06	$36.10
AUSTIN (TX)	$99.61	$36.35
REST OF TEXAS (TX)	$92.52	$35.78
UTAH (UT)	$91.91	$35.71
VIRGINIA (VA)	$94.01	$35.24
VIRGIN ISLANDS (VI)	$96.86	$36.41
VERMONT (VT)	$93.73	$34.54
SEATTLE (KING CNTY) (WA)	$111.68	$38.32
REST OF WASHINGTON (WA)	$99.12	$36.17
WISCONSIN (WI)	$90.92	$33.64
WEST VIRGINIA (WV)	$89.25	$37.29
WYOMING** (WY)	$95.24	$35.45

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 2 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 payment is built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility rates apply when the service is performed in a setting like a physician's office, where the practice absorbs overhead costs; facility rates apply in settings like a hospital, where the facility bills separately for overhead, resulting in lower practice-expense RVUs and a lower total payment for the professional service.

RVUs — work 0.82, practice expense 1.95 (non-facility) / 0.16 (facility), malpractice 0.11 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on the national Medicare Physician Fee Schedule; actual payment may differ.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Rates vary by locality due to GPCI adjustments; always confirm the exact amount with your Medicare Administrative Contractor (MAC).
This figure reflects Medicare's PFS allowed amount and does not necessarily reflect contracted rates from commercial or Medicare Advantage payers.

Frequently asked

Why does the facility rate differ from the non-facility rate for CPT 19000?

The facility rate uses lower practice-expense RVUs because the facility (e.g., hospital) is separately reimbursed for overhead costs like supplies and staff time, whereas the non-facility rate assumes the billing practice covers those costs itself.

Does this amount reflect what Medicare will actually pay?

No — this is the Medicare allowed amount before the 80/20 split. Medicare generally pays 80% of this figure after the deductible, and the final paid amount can be affected by modifiers, sequestration, and locality adjustments.

Why do amounts vary by locality?

Medicare adjusts the work, practice expense, and malpractice RVUs using Geographic Practice Cost Indices (GPCIs) that reflect regional differences in costs, so the same code can have different allowed amounts in different areas.

Where can I find the official descriptor for CPT 19000?

CPT code descriptors are copyrighted by the American Medical Association. Refer to your AMA CPT codebook or licensed coding software for the official language.

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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.