Medicare Reimbursement for CPT Code 19085

This page covers a specific CPT procedure code (the official AMA descriptor is not reproduced here due to licensing). It shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for 2026, 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)	$718.79	$151.31
ALASKA* (AK)	$811.08	$206.71
ALABAMA (AL)	$640.15	$143.60
ARKANSAS (AR)	$630.14	$142.67
ARIZONA (AZ)	$698.86	$148.97
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$964.62	$164.48
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$984.91	$166.60
OXNARD-THOUSAND OAKS-VENTURA (CA)	$824.81	$154.05
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$827.42	$156.09
NAPA (CA)	$907.66	$159.72
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$965.02	$164.87
VALLEJO (CA)	$907.08	$159.14
BAKERSFIELD (CA)	$772.97	$151.01
CHICO (CA)	$771.88	$149.92
FRESNO (CA)	$771.88	$149.92
HANFORD-CORCORAN (CA)	$771.88	$149.92
MADERA (CA)	$771.88	$149.92
MERCED (CA)	$771.88	$149.92
MODESTO (CA)	$771.88	$149.92
REDDING (CA)	$771.88	$149.92
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$775.70	$153.74
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$813.56	$153.58
SALINAS (CA)	$810.61	$152.90
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$986.53	$168.23
SANTA CRUZ-WATSONVILLE (CA)	$842.39	$152.90
SANTA ROSA-PETALUMA (CA)	$851.10	$154.24
STOCKTON (CA)	$771.88	$149.92
VISALIA (CA)	$771.88	$149.92
YUBA CITY (CA)	$771.88	$149.92
EL CENTRO (CA)	$771.94	$149.98
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$832.34	$153.63
SAN LUIS OBISPO-PASO ROBLES (CA)	$797.18	$150.82
SANTA MARIA-SANTA BARBARA (CA)	$814.38	$152.69
REST OF CALIFORNIA (CA)	$771.88	$149.92
COLORADO (CO)	$755.32	$151.52
CONNECTICUT (CT)	$768.93	$157.75
DC + MD/VA SUBURBS (DC)	$831.27	$162.78
DELAWARE (DE)	$711.14	$150.47
FORT LAUDERDALE (FL)	$735.88	$161.03
MIAMI (FL)	$760.79	$170.04
REST OF FLORIDA (FL)	$698.77	$156.26
ATLANTA (GA)	$730.91	$154.35
REST OF GEORGIA (GA)	$657.47	$151.28
HAWAII, GUAM (HI)	$794.49	$149.27
IOWA (IA)	$661.71	$142.47
IDAHO (ID)	$665.54	$143.46
EAST ST. LOUIS (IL)	$683.56	$161.48
SUBURBAN CHICAGO (IL)	$744.53	$161.73
CHICAGO (IL)	$737.70	$167.38
REST OF ILLINOIS (IL)	$674.17	$156.06
INDIANA (IN)	$669.82	$143.76
KANSAS (KS)	$656.49	$143.49
KENTUCKY (KY)	$652.47	$147.98
NEW ORLEANS (LA)	$685.65	$151.65
REST OF LOUISIANA (LA)	$650.62	$148.40
METROPOLITAN BOSTON (MA)	$836.54	$158.96
REST OF MASSACHUSETTS (MA)	$749.50	$151.95
BALTIMORE/SURR. CNTYS (MD)	$766.42	$157.51
REST OF MARYLAND (MD)	$726.08	$151.79
SOUTHERN MAINE (ME)	$709.18	$146.80
REST OF MAINE (ME)	$667.29	$145.20
DETROIT (MI)	$706.21	$158.59
REST OF MICHIGAN (MI)	$669.09	$150.98
MINNESOTA (MN)	$727.62	$143.69
METROPOLITAN ST. LOUIS (MO)	$690.56	$150.32
METROPOLITAN KANSAS CITY (MO)	$682.62	$149.75
REST OF MISSOURI (MO)	$637.27	$148.10
MISSISSIPPI (MS)	$633.93	$145.33
MONTANA** (MT)	$718.76	$151.28
NORTH CAROLINA (NC)	$675.14	$145.68
NORTH DAKOTA** (ND)	$711.84	$144.36
NEBRASKA (NE)	$666.20	$142.41
NEW HAMPSHIRE (NH)	$741.46	$150.71
NORTHERN NJ (NJ)	$821.22	$162.94
REST OF NEW JERSEY (NJ)	$778.81	$159.12
NEW MEXICO (NM)	$672.29	$151.91
NEVADA** (NV)	$717.42	$149.37
MANHATTAN (NY)	$828.57	$169.15
NYC SUBURBS/LONG ISLAND (NY)	$847.63	$172.89
POUGHKPSIE/N NYC SUBURBS (NY)	$782.49	$161.10
QUEENS (NY)	$838.65	$167.89
REST OF NEW YORK (NY)	$685.89	$146.78
OHIO (OH)	$667.68	$149.57
OKLAHOMA (OK)	$653.21	$146.45
PORTLAND (OR)	$783.02	$152.55
REST OF OREGON (OR)	$712.96	$147.75
METROPOLITAN PHILADELPHIA (PA)	$747.31	$156.56
REST OF PENNSYLVANIA (PA)	$669.89	$148.94
PUERTO RICO (PR)	$725.09	$151.36
RHODE ISLAND (RI)	$739.20	$152.99
SOUTH CAROLINA (SC)	$672.31	$147.95
SOUTH DAKOTA** (SD)	$711.02	$143.54
TENNESSEE (TN)	$659.82	$143.98
BRAZORIA (TX)	$711.87	$149.49
DALLAS (TX)	$715.84	$150.63
GALVESTON (TX)	$713.61	$150.10
HOUSTON (TX)	$720.01	$156.50
BEAUMONT (TX)	$664.99	$148.58
FORT WORTH (TX)	$710.11	$150.57
AUSTIN (TX)	$751.83	$151.43
REST OF TEXAS (TX)	$687.64	$149.10
UTAH (UT)	$682.28	$148.85
VIRGINIA (VA)	$705.35	$147.51
VIRGIN ISLANDS (VI)	$725.09	$151.36
VERMONT (VT)	$707.13	$145.32
SEATTLE (KING CNTY) (WA)	$856.17	$159.87
REST OF WASHINGTON (WA)	$748.73	$151.17
WISCONSIN (WI)	$685.98	$142.33
WEST VIRGINIA (WV)	$646.73	$153.59
WYOMING** (WY)	$715.75	$148.27

Look up another code or locality →

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 — assigned to the code. 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 (e.g., office) and facility (e.g., hospital) settings use different practice-expense RVUs because overhead costs differ, which is why the two allowed amounts for this code are not the same. These figures reflect the Medicare-approved amount before patient cost-sharing is applied.

RVUs — work 3.55, practice expense 17.62 (non-facility) / 0.63 (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; actual claims processing may differ.
Medicare typically pays 80% of the approved amount after the patient meets the Part B deductible; the patient or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final payment.
Locality-adjusted amounts vary by where the service is furnished; confirm the correct locality for your billing address.
Always verify current rates and coverage rules with your local Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

Facility rates use a lower practice-expense RVU because Medicare assumes the facility (e.g., hospital) — not the billing physician — incurs most of the overhead costs like equipment, supplies, and staff.

Does this amount represent what Medicare actually pays?

No. The PFS amount is the approved rate before patient cost-sharing. Medicare generally pays 80% of this amount once the deductible is met, with the remaining 20% owed by the patient or a secondary payer.

Will this amount be the same in every state?

No. The national figure is a baseline; actual payment is adjusted using GPCIs specific to the locality where the service was rendered, so the same code can pay differently across regions.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple-procedure reductions can increase or decrease the final reimbursement from the base PFS rate shown here.

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.