Medicare Reimbursement for CPT 19020

CPT 19020 is a procedure code priced under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and by locality, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings. Because CPT descriptors are licensed by the AMA, this page refers to the code generically rather than reproducing its official description.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$514.37	$316.31
ALASKA* (AK)	$586.21	$375.27
ALABAMA (AL)	$456.16	$282.85
ARKANSAS (AR)	$448.84	$278.70
ARIZONA (AZ)	$498.82	$306.89
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$655.75	$376.48
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$668.25	$382.64
OXNARD-THOUSAND OAKS-VENTURA (CA)	$571.63	$337.51
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$574.86	$340.55
NAPA (CA)	$621.29	$360.23
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$656.80	$377.52
VALLEJO (CA)	$619.78	$358.73
BAKERSFIELD (CA)	$539.20	$322.11
CHICO (CA)	$536.70	$319.62
FRESNO (CA)	$536.70	$319.62
HANFORD-CORCORAN (CA)	$536.70	$319.62
MADERA (CA)	$536.70	$319.62
MERCED (CA)	$536.70	$319.62
MODESTO (CA)	$536.70	$319.62
REDDING (CA)	$536.70	$319.62
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$546.57	$329.49
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$563.13	$332.78
SALINAS (CA)	$561.07	$331.51
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$672.52	$386.91
SANTA CRUZ-WATSONVILLE (CA)	$579.93	$339.28
SANTA ROSA-PETALUMA (CA)	$585.72	$342.49
STOCKTON (CA)	$536.70	$319.62
VISALIA (CA)	$536.70	$319.62
YUBA CITY (CA)	$536.70	$319.62
EL CENTRO (CA)	$536.86	$319.78
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$574.41	$337.52
SAN LUIS OBISPO-PASO ROBLES (CA)	$552.14	$326.54
SANTA MARIA-SANTA BARBARA (CA)	$563.21	$332.26
REST OF CALIFORNIA (CA)	$536.70	$319.62
COLORADO (CO)	$532.12	$321.38
CONNECTICUT (CT)	$550.97	$337.65
DC + MD/VA SUBURBS (DC)	$588.49	$355.16
DELAWARE (DE)	$507.58	$311.89
FORT LAUDERDALE (FL)	$543.87	$343.23
MIAMI (FL)	$576.08	$369.89
REST OF FLORIDA (FL)	$514.03	$324.68
ATLANTA (GA)	$526.67	$325.43
REST OF GEORGIA (GA)	$481.50	$304.82
HAWAII, GUAM (HI)	$550.63	$325.43
IOWA (IA)	$465.32	$284.09
IDAHO (ID)	$469.45	$287.23
EAST ST. LOUIS (IL)	$516.81	$334.59
SUBURBAN CHICAGO (IL)	$548.66	$345.25
CHICAGO (IL)	$556.84	$357.78
REST OF ILLINOIS (IL)	$500.44	$319.60
INDIANA (IN)	$472.37	$288.76
KANSAS (KS)	$464.66	$285.61
KENTUCKY (KY)	$471.91	$295.82
NEW ORLEANS (LA)	$497.37	$310.99
REST OF LOUISIANA (LA)	$471.79	$296.50
METROPOLITAN BOSTON (MA)	$585.76	$349.27
REST OF MASSACHUSETTS (MA)	$529.16	$320.59
BALTIMORE/SURR. CNTYS (MD)	$549.86	$337.34
REST OF MARYLAND (MD)	$517.41	$316.96
SOUTHERN MAINE (ME)	$499.80	$303.52
REST OF MAINE (ME)	$474.03	$291.81
DETROIT (MI)	$522.89	$331.75
REST OF MICHIGAN (MI)	$487.10	$306.26
MINNESOTA (MN)	$503.15	$299.34
METROPOLITAN ST. LOUIS (MO)	$497.20	$308.64
METROPOLITAN KANSAS CITY (MO)	$491.76	$305.78
REST OF MISSOURI (MO)	$464.02	$293.29
MISSISSIPPI (MS)	$456.44	$285.91
MONTANA** (MT)	$514.31	$316.25
NORTH CAROLINA (NC)	$479.22	$294.43
NORTH DAKOTA** (ND)	$496.12	$298.05
NEBRASKA (NE)	$467.61	$284.80
NEW HAMPSHIRE (NH)	$525.25	$319.07
NORTHERN NJ (NJ)	$581.76	$352.00
REST OF NEW JERSEY (NJ)	$555.37	$339.08
NEW MEXICO (NM)	$490.75	$309.12
NEVADA** (NV)	$509.60	$311.34
MANHATTAN (NY)	$598.52	$368.37
NYC SUBURBS/LONG ISLAND (NY)	$616.54	$381.04
POUGHKPSIE/N NYC SUBURBS (NY)	$560.54	$343.66
QUEENS (NY)	$601.28	$367.16
REST OF NEW YORK (NY)	$487.29	$299.13
OHIO (OH)	$483.38	$302.55
OKLAHOMA (OK)	$469.10	$292.23
PORTLAND (OR)	$548.36	$328.30
REST OF OREGON (OR)	$503.81	$306.54
METROPOLITAN PHILADELPHIA (PA)	$537.27	$331.08
REST OF PENNSYLVANIA (PA)	$483.24	$301.42
PUERTO RICO (PR)	$517.86	$317.62
RHODE ISLAND (RI)	$525.27	$320.67
SOUTH CAROLINA (SC)	$482.48	$299.46
SOUTH DAKOTA** (SD)	$493.97	$295.90
TENNESSEE (TN)	$467.47	$287.43
BRAZORIA (TX)	$505.38	$309.09
DALLAS (TX)	$509.70	$312.42
GALVESTON (TX)	$507.57	$310.89
HOUSTON (TX)	$524.41	$327.73
BEAUMONT (TX)	$479.88	$299.64
FORT WORTH (TX)	$506.50	$311.21
AUSTIN (TX)	$531.95	$322.39
REST OF TEXAS (TX)	$493.08	$305.12
UTAH (UT)	$489.70	$303.51
VIRGINIA (VA)	$499.24	$304.54
VIRGIN ISLANDS (VI)	$517.86	$317.62
VERMONT (VT)	$495.60	$299.52
SEATTLE (KING CNTY) (WA)	$596.49	$353.46
REST OF WASHINGTON (WA)	$527.68	$319.11
WISCONSIN (WI)	$478.03	$288.28
WEST VIRGINIA (WV)	$480.58	$308.46
WYOMING** (WY)	$506.38	$308.32

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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 pricing for this code is based on three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The geographically adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice-expense RVUs differ depending on whether the service is reported in a non-facility (e.g., physician office) or facility (e.g., hospital, ASC) setting, which is why the two allowed amounts differ. These figures update annually when CMS publishes new RVUs, GPCIs, and the conversion factor.

RVUs — work 3.73, practice expense 10.75 (non-facility) / 4.82 (facility), malpractice 0.92 — × 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 annual Part B deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary based on locality, applicable modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The practice-expense RVU component is lower in the facility setting because the facility (not the billing physician) incurs certain overhead costs, such as equipment and supplies.

Why might my locality's payment differ from the national amount shown here?

Medicare adjusts each RVU component using locality-specific GPCIs to reflect regional differences in labor and practice costs before applying the conversion factor.

Does this amount include the patient's share?

No. The allowed amount typically reflects the full approved payment; Medicare generally covers 80% after the deductible, with the patient or secondary payer responsible for the rest.

Will this amount change during the year?

It can. CMS applies annual updates to RVUs and the conversion factor, and mid-year corrections or legislative adjustments are possible.

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.