Medicare Reimbursement for CPT 19001
CPT 19001 is a physician procedure code reported under Medicare Part B. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both at the national level and adjusted by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $26.39 | $18.04 |
| ALASKA* (AK) | $33.20 | $24.31 |
| ALABAMA (AL) | $24.28 | $16.98 |
| ARKANSAS (AR) | $24.02 | $16.85 |
| ARIZONA (AZ) | $25.80 | $17.71 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $31.25 | $19.47 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $31.76 | $19.72 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $28.15 | $18.28 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $28.40 | $18.53 |
| NAPA (CA) | $29.93 | $18.93 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $31.30 | $19.53 |
| VALLEJO (CA) | $29.85 | $18.85 |
| BAKERSFIELD (CA) | $27.05 | $17.90 |
| CHICO (CA) | $26.90 | $17.75 |
| FRESNO (CA) | $26.90 | $17.75 |
| HANFORD-CORCORAN (CA) | $26.90 | $17.75 |
| MADERA (CA) | $26.90 | $17.75 |
| MERCED (CA) | $26.90 | $17.75 |
| MODESTO (CA) | $26.90 | $17.75 |
| REDDING (CA) | $26.90 | $17.75 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $27.45 | $18.29 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $27.90 | $18.19 |
| SALINAS (CA) | $27.79 | $18.11 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $31.99 | $19.95 |
| SANTA CRUZ-WATSONVILLE (CA) | $28.27 | $18.12 |
| SANTA ROSA-PETALUMA (CA) | $28.54 | $18.28 |
| STOCKTON (CA) | $26.90 | $17.75 |
| VISALIA (CA) | $26.90 | $17.75 |
| YUBA CITY (CA) | $26.90 | $17.75 |
| EL CENTRO (CA) | $26.91 | $17.76 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $28.19 | $18.21 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $27.38 | $17.87 |
| SANTA MARIA-SANTA BARBARA (CA) | $27.82 | $18.09 |
| REST OF CALIFORNIA (CA) | $26.90 | $17.75 |
| COLORADO (CO) | $26.89 | $18.01 |
| CONNECTICUT (CT) | $27.86 | $18.87 |
| DC + MD/VA SUBURBS (DC) | $29.28 | $19.44 |
| DELAWARE (DE) | $26.15 | $17.90 |
| FORT LAUDERDALE (FL) | $27.88 | $19.42 |
| MIAMI (FL) | $29.39 | $20.70 |
| REST OF FLORIDA (FL) | $26.74 | $18.76 |
| ATLANTA (GA) | $26.94 | $18.46 |
| REST OF GEORGIA (GA) | $25.52 | $18.07 |
| HAWAII, GUAM (HI) | $27.19 | $17.70 |
| IOWA (IA) | $24.44 | $16.80 |
| IDAHO (ID) | $24.62 | $16.94 |
| EAST ST. LOUIS (IL) | $27.20 | $19.52 |
| SUBURBAN CHICAGO (IL) | $28.07 | $19.49 |
| CHICAGO (IL) | $28.70 | $20.31 |
| REST OF ILLINOIS (IL) | $26.37 | $18.74 |
| INDIANA (IN) | $24.72 | $16.98 |
| KANSAS (KS) | $24.50 | $16.95 |
| KENTUCKY (KY) | $25.02 | $17.60 |
| NEW ORLEANS (LA) | $25.96 | $18.11 |
| REST OF LOUISIANA (LA) | $25.05 | $17.66 |
| METROPOLITAN BOSTON (MA) | $28.90 | $18.93 |
| REST OF MASSACHUSETTS (MA) | $26.85 | $18.06 |
| BALTIMORE/SURR. CNTYS (MD) | $27.81 | $18.85 |
| REST OF MARYLAND (MD) | $26.52 | $18.07 |
| SOUTHERN MAINE (ME) | $25.67 | $17.40 |
| REST OF MAINE (ME) | $24.87 | $17.19 |
| DETROIT (MI) | $27.15 | $19.09 |
| REST OF MICHIGAN (MI) | $25.64 | $18.02 |
| MINNESOTA (MN) | $25.53 | $16.94 |
| METROPOLITAN ST. LOUIS (MO) | $25.86 | $17.91 |
| METROPOLITAN KANSAS CITY (MO) | $25.68 | $17.84 |
| REST OF MISSOURI (MO) | $24.82 | $17.62 |
| MISSISSIPPI (MS) | $24.42 | $17.23 |
| MONTANA** (MT) | $26.38 | $18.03 |
| NORTH CAROLINA (NC) | $25.05 | $17.25 |
| NORTH DAKOTA** (ND) | $25.39 | $17.04 |
| NEBRASKA (NE) | $24.50 | $16.79 |
| NEW HAMPSHIRE (NH) | $26.63 | $17.94 |
| NORTHERN NJ (NJ) | $29.13 | $19.44 |
| REST OF NEW JERSEY (NJ) | $28.11 | $18.99 |
| NEW MEXICO (NM) | $25.81 | $18.15 |
| NEVADA** (NV) | $26.12 | $17.76 |
| MANHATTAN (NY) | $30.03 | $20.32 |
| NYC SUBURBS/LONG ISLAND (NY) | $30.78 | $20.85 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $28.40 | $19.26 |
| QUEENS (NY) | $30.01 | $20.14 |
| REST OF NEW YORK (NY) | $25.34 | $17.41 |
| OHIO (OH) | $25.44 | $17.82 |
| OKLAHOMA (OK) | $24.83 | $17.38 |
| PORTLAND (OR) | $27.40 | $18.12 |
| REST OF OREGON (OR) | $25.85 | $17.53 |
| METROPOLITAN PHILADELPHIA (PA) | $27.41 | $18.71 |
| REST OF PENNSYLVANIA (PA) | $25.39 | $17.73 |
| PUERTO RICO (PR) | $26.48 | $18.04 |
| RHODE ISLAND (RI) | $26.83 | $18.20 |
| SOUTH CAROLINA (SC) | $25.30 | $17.58 |
| SOUTH DAKOTA** (SD) | $25.28 | $16.93 |
| TENNESSEE (TN) | $24.61 | $17.02 |
| BRAZORIA (TX) | $26.03 | $17.75 |
| DALLAS (TX) | $26.23 | $17.91 |
| GALVESTON (TX) | $26.13 | $17.84 |
| HOUSTON (TX) | $27.05 | $18.76 |
| BEAUMONT (TX) | $25.28 | $17.68 |
| FORT WORTH (TX) | $26.14 | $17.91 |
| AUSTIN (TX) | $26.86 | $18.03 |
| REST OF TEXAS (TX) | $25.66 | $17.74 |
| UTAH (UT) | $25.56 | $17.71 |
| VIRGINIA (VA) | $25.71 | $17.50 |
| VIRGIN ISLANDS (VI) | $26.48 | $18.04 |
| VERMONT (VT) | $25.45 | $17.18 |
| SEATTLE (KING CNTY) (WA) | $29.27 | $19.02 |
| REST OF WASHINGTON (WA) | $26.75 | $17.96 |
| WISCONSIN (WI) | $24.77 | $16.77 |
| WEST VIRGINIA (WV) | $25.66 | $18.41 |
| WYOMING** (WY) | $25.95 | $17.60 |
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Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 5 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 fee schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, since costs vary by region. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility (office) and facility (hospital/ASC) settings because overhead costs differ, which is why two separate amounts are shown.
RVUs — work 0.41, practice expense 0.33 (non-facility) / 0.08 (facility), malpractice 0.05 — × 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 Part B deductible; the patient or secondary payer is responsible for the remainder.
- Actual payment can vary by locality, applicable modifiers, claim-level adjustments, and annual sequestration or budget-neutrality changes.
- Always verify the current fee and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why is the facility amount different from the non-facility amount?
Facility amounts use lower practice-expense RVUs because Medicare assumes the facility (not the physician's office) bears certain overhead costs, such as equipment and staff, when the service is performed in a hospital or other facility setting.
Why does the fee change between localities?
Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs to reflect regional differences in wages, rent, and other costs, so the same code can have different allowed amounts in different areas.
Does this amount reflect what Medicare will actually pay?
No. It reflects the estimated Medicare-allowed amount before the standard 20% coinsurance, deductible status, modifiers, and any sequestration or budget-neutrality adjustments are applied.
Where can I find the official rate for my area?
Your Medicare Administrative Contractor (MAC) publishes the finalized, locality-specific Physician Fee Schedule amounts, which should be used for actual billing and reconciliation.
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.
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