Medicare Reimbursement for CPT 19081

CPT 19081 is a physician procedure code reported to Medicare for payment purposes; this page shows the Medicare Physician Fee Schedule (PFS) allowed amount for 2026, both nationally and adjustable 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)	$478.30	$138.28
ALASKA* (AK)	$550.02	$187.90
ALABAMA (AL)	$428.30	$130.78
ARKANSAS (AR)	$421.96	$129.88
ARIZONA (AZ)	$465.48	$136.00
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$629.12	$149.69
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$641.90	$151.59
OXNARD-THOUSAND OAKS-VENTURA (CA)	$542.31	$140.40
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$544.54	$142.29
NAPA (CA)	$593.59	$145.44
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$629.51	$150.08
VALLEJO (CA)	$593.02	$144.87
BAKERSFIELD (CA)	$510.27	$137.61
CHICO (CA)	$509.20	$136.54
FRESNO (CA)	$509.20	$136.54
HANFORD-CORCORAN (CA)	$509.20	$136.54
MADERA (CA)	$509.20	$136.54
MERCED (CA)	$509.20	$136.54
MODESTO (CA)	$509.20	$136.54
REDDING (CA)	$509.20	$136.54
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$513.01	$140.35
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$535.32	$139.87
SALINAS (CA)	$533.34	$139.26
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$643.52	$153.21
SANTA CRUZ-WATSONVILLE (CA)	$552.40	$139.27
SANTA ROSA-PETALUMA (CA)	$558.03	$140.49
STOCKTON (CA)	$509.20	$136.54
VISALIA (CA)	$509.20	$136.54
YUBA CITY (CA)	$509.20	$136.54
EL CENTRO (CA)	$509.26	$136.60
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$546.60	$139.94
SAN LUIS OBISPO-PASO ROBLES (CA)	$524.65	$137.37
SANTA MARIA-SANTA BARBARA (CA)	$535.54	$139.07
REST OF CALIFORNIA (CA)	$509.20	$136.54
COLORADO (CO)	$500.03	$138.25
CONNECTICUT (CT)	$510.57	$144.37
DC + MD/VA SUBURBS (DC)	$549.38	$148.84
DELAWARE (DE)	$473.34	$137.40
FORT LAUDERDALE (FL)	$492.42	$147.98
MIAMI (FL)	$510.91	$156.95
REST OF FLORIDA (FL)	$468.37	$143.31
ATLANTA (GA)	$486.72	$141.26
REST OF GEORGIA (GA)	$441.73	$138.43
HAWAII, GUAM (HI)	$522.62	$136.01
IOWA (IA)	$440.70	$129.58
IDAHO (ID)	$443.39	$130.57
EAST ST. LOUIS (IL)	$461.40	$148.58
SUBURBAN CHICAGO (IL)	$497.78	$148.58
CHICAGO (IL)	$495.99	$154.27
REST OF ILLINOIS (IL)	$453.62	$143.18
INDIANA (IN)	$446.06	$130.86
KANSAS (KS)	$438.00	$130.62
KENTUCKY (KY)	$437.41	$135.14
NEW ORLEANS (LA)	$458.69	$138.73
REST OF LOUISIANA (LA)	$436.48	$135.56
METROPOLITAN BOSTON (MA)	$551.13	$145.15
REST OF MASSACHUSETTS (MA)	$496.69	$138.65
BALTIMORE/SURR. CNTYS (MD)	$509.02	$144.18
REST OF MARYLAND (MD)	$482.73	$138.63
SOUTHERN MAINE (ME)	$470.75	$133.79
REST OF MAINE (ME)	$445.13	$132.31
DETROIT (MI)	$473.74	$145.62
REST OF MICHIGAN (MI)	$448.54	$138.10
MINNESOTA (MN)	$480.49	$130.61
METROPOLITAN ST. LOUIS (MO)	$461.07	$137.37
METROPOLITAN KANSAS CITY (MO)	$456.11	$136.83
REST OF MISSOURI (MO)	$428.40	$135.30
MISSISSIPPI (MS)	$425.29	$132.54
MONTANA** (MT)	$478.28	$138.26
NORTH CAROLINA (NC)	$450.00	$132.76
NORTH DAKOTA** (ND)	$471.36	$131.34
NEBRASKA (NE)	$443.36	$129.52
NEW HAMPSHIRE (NH)	$491.57	$137.61
NORTHERN NJ (NJ)	$543.35	$148.93
REST OF NEW JERSEY (NJ)	$516.79	$145.48
NEW MEXICO (NM)	$450.82	$139.02
NEVADA** (NV)	$476.71	$136.35
MANHATTAN (NY)	$550.24	$155.13
NYC SUBURBS/LONG ISLAND (NY)	$563.11	$158.82
POUGHKPSIE/N NYC SUBURBS (NY)	$519.72	$147.40
QUEENS (NY)	$555.74	$153.83
REST OF NEW YORK (NY)	$456.86	$133.84
OHIO (OH)	$447.13	$136.69
OKLAHOMA (OK)	$437.24	$133.60
PORTLAND (OR)	$516.92	$139.15
REST OF OREGON (OR)	$473.39	$134.73
METROPOLITAN PHILADELPHIA (PA)	$497.22	$143.26
REST OF PENNSYLVANIA (PA)	$448.19	$136.05
PUERTO RICO (PR)	$482.08	$138.32
RHODE ISLAND (RI)	$490.94	$139.69
SOUTH CAROLINA (SC)	$449.23	$135.05
SOUTH DAKOTA** (SD)	$470.54	$130.52
TENNESSEE (TN)	$440.18	$131.10
BRAZORIA (TX)	$473.35	$136.39
DALLAS (TX)	$476.17	$137.51
GALVESTON (TX)	$474.63	$136.99
HOUSTON (TX)	$481.04	$143.40
BEAUMONT (TX)	$445.13	$135.71
FORT WORTH (TX)	$472.73	$137.47
AUSTIN (TX)	$498.03	$138.29
REST OF TEXAS (TX)	$458.84	$136.16
UTAH (UT)	$455.54	$135.92
VIRGINIA (VA)	$468.75	$134.51
VIRGIN ISLANDS (VI)	$482.08	$138.32
VERMONT (VT)	$468.93	$132.31
SEATTLE (KING CNTY) (WA)	$563.10	$145.90
REST OF WASHINGTON (WA)	$495.95	$137.91
WISCONSIN (WI)	$455.12	$129.38
WEST VIRGINIA (WV)	$436.26	$140.78
WYOMING** (WY)	$475.26	$135.24

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. 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 amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality where the service is furnished. The geographically adjusted RVUs are summed and then multiplied by the annual conversion factor to produce the allowed amount. Non-facility and facility rates differ mainly in the practice-expense RVU, reflecting whether the physician's practice or the facility bears the overhead costs. National figures use a standard GPCI of 1.00, while locality-specific amounts will vary above or below that national rate.

RVUs — work 3.21, practice expense 10.76 (non-facility) / 0.58 (facility), malpractice 0.35 — × 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 annual deductible; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claims-based adjustments like sequestration, and annual budget-neutrality changes to RVUs or the conversion factor.
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 facility rate uses a lower practice-expense RVU because the hospital or facility, rather than the physician's office, absorbs most of the overhead and equipment costs for the service.

Does this amount apply everywhere in the country?

No. The national amount assumes standard GPCIs; actual payment in a specific locality will be higher or lower depending on that area's wage, rent, and malpractice cost indices.

Will modifiers change this amount?

Yes. Modifiers such as bilateral, multiple procedure, or assistant-at-surgery modifiers can increase or reduce the base PFS allowed amount.

How often does this amount change?

The conversion factor and RVUs are updated annually by CMS, and budget-neutrality adjustments can shift fees even when RVUs for a code stay the same.

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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.