Medicare Reimbursement for CPT 19100

CPT 19100 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 nationally and adjusted by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$163.33	$61.79
ALASKA* (AK)	$186.81	$78.67
ALABAMA (AL)	$144.99	$56.15
ARKANSAS (AR)	$142.69	$55.47
ARIZONA (AZ)	$158.42	$60.03
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$207.38	$64.21
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$211.30	$64.88
OXNARD-THOUSAND OAKS-VENTURA (CA)	$181.08	$61.06
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$182.14	$62.02
NAPA (CA)	$196.59	$62.76
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$207.72	$64.55
VALLEJO (CA)	$196.10	$62.27
BAKERSFIELD (CA)	$170.94	$59.65
CHICO (CA)	$170.13	$58.84
FRESNO (CA)	$170.13	$58.84
HANFORD-CORCORAN (CA)	$170.13	$58.84
MADERA (CA)	$170.13	$58.84
MERCED (CA)	$170.13	$58.84
MODESTO (CA)	$170.13	$58.84
REDDING (CA)	$170.13	$58.84
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$173.34	$62.06
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$178.41	$60.32
SALINAS (CA)	$177.76	$60.07
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$212.69	$66.27
SANTA CRUZ-WATSONVILLE (CA)	$183.61	$60.24
SANTA ROSA-PETALUMA (CA)	$185.44	$60.75
STOCKTON (CA)	$170.13	$58.84
VISALIA (CA)	$170.13	$58.84
YUBA CITY (CA)	$170.13	$58.84
EL CENTRO (CA)	$170.18	$58.89
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$181.91	$60.47
SAN LUIS OBISPO-PASO ROBLES (CA)	$174.94	$59.29
SANTA MARIA-SANTA BARBARA (CA)	$178.41	$60.02
REST OF CALIFORNIA (CA)	$170.13	$58.84
COLORADO (CO)	$168.79	$60.76
CONNECTICUT (CT)	$174.88	$65.52
DC + MD/VA SUBURBS (DC)	$186.62	$67.00
DELAWARE (DE)	$161.18	$60.86
FORT LAUDERDALE (FL)	$172.88	$70.02
MIAMI (FL)	$183.24	$77.54
REST OF FLORIDA (FL)	$163.45	$66.38
ATLANTA (GA)	$167.26	$64.10
REST OF GEORGIA (GA)	$153.17	$62.60
HAWAII, GUAM (HI)	$174.44	$58.99
IOWA (IA)	$147.78	$54.87
IDAHO (ID)	$149.10	$55.68
EAST ST. LOUIS (IL)	$164.54	$71.12
SUBURBAN CHICAGO (IL)	$174.38	$70.10
CHICAGO (IL)	$177.16	$75.11
REST OF ILLINOIS (IL)	$159.24	$66.53
INDIANA (IN)	$150.01	$55.89
KANSAS (KS)	$147.62	$55.83
KENTUCKY (KY)	$150.06	$59.79
NEW ORLEANS (LA)	$158.09	$62.54
REST OF LOUISIANA (LA)	$150.04	$60.18
METROPOLITAN BOSTON (MA)	$185.63	$64.40
REST OF MASSACHUSETTS (MA)	$167.89	$60.97
BALTIMORE/SURR. CNTYS (MD)	$174.54	$65.59
REST OF MARYLAND (MD)	$164.27	$61.51
SOUTHERN MAINE (ME)	$158.63	$58.00
REST OF MAINE (ME)	$150.59	$57.18
DETROIT (MI)	$166.29	$68.30
REST OF MICHIGAN (MI)	$154.89	$62.18
MINNESOTA (MN)	$159.52	$55.04
METROPOLITAN ST. LOUIS (MO)	$157.98	$61.31
METROPOLITAN KANSAS CITY (MO)	$156.27	$60.93
REST OF MISSOURI (MO)	$147.63	$60.10
MISSISSIPPI (MS)	$145.16	$57.74
MONTANA** (MT)	$163.31	$61.77
NORTH CAROLINA (NC)	$152.22	$57.48
NORTH DAKOTA** (ND)	$157.38	$55.84
NEBRASKA (NE)	$148.48	$54.76
NEW HAMPSHIRE (NH)	$166.67	$60.96
NORTHERN NJ (NJ)	$184.52	$66.74
REST OF NEW JERSEY (NJ)	$176.25	$65.37
NEW MEXICO (NM)	$156.06	$62.95
NEVADA** (NV)	$161.77	$60.13
MANHATTAN (NY)	$189.98	$71.99
NYC SUBURBS/LONG ISLAND (NY)	$195.72	$74.99
POUGHKPSIE/N NYC SUBURBS (NY)	$177.93	$66.74
QUEENS (NY)	$190.77	$70.76
REST OF NEW YORK (NY)	$154.76	$58.30
OHIO (OH)	$153.68	$60.97
OKLAHOMA (OK)	$149.12	$58.45
PORTLAND (OR)	$173.85	$61.04
REST OF OREGON (OR)	$159.91	$58.77
METROPOLITAN PHILADELPHIA (PA)	$170.60	$64.90
REST OF PENNSYLVANIA (PA)	$153.60	$60.39
PUERTO RICO (PR)	$164.41	$61.76
RHODE ISLAND (RI)	$166.73	$61.84
SOUTH CAROLINA (SC)	$153.32	$59.50
SOUTH DAKOTA** (SD)	$156.68	$55.14
TENNESSEE (TN)	$148.51	$56.21
BRAZORIA (TX)	$160.45	$59.83
DALLAS (TX)	$161.83	$60.70
GALVESTON (TX)	$161.16	$60.33
HOUSTON (TX)	$166.65	$65.82
BEAUMONT (TX)	$152.55	$60.15
FORT WORTH (TX)	$160.84	$60.73
AUSTIN (TX)	$168.76	$61.33
REST OF TEXAS (TX)	$156.65	$60.29
UTAH (UT)	$155.59	$60.15
VIRGINIA (VA)	$158.48	$58.67
VIRGIN ISLANDS (VI)	$164.41	$61.76
VERMONT (VT)	$157.26	$56.74
SEATTLE (KING CNTY) (WA)	$188.97	$64.38
REST OF WASHINGTON (WA)	$167.40	$60.48
WISCONSIN (WI)	$151.70	$54.42
WEST VIRGINIA (WV)	$152.99	$64.75
WYOMING** (WY)	$160.73	$59.19

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 4 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 the Geographic Practice Cost Index (GPCI) for the specific locality to reflect local cost differences, then 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 (e.g., physician office) and facility (e.g., hospital outpatient) settings because overhead costs differ, which is why the two amounts shown are not the same. The conversion factor and RVU values are updated annually by CMS and can shift due to budget-neutrality adjustments.

RVUs — work 1.24, practice expense 3.35 (non-facility) / 0.31 (facility), malpractice 0.3 — × 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 Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can vary based on locality, applicable modifiers, sequestration, and annual CMS budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why is the facility amount lower than the non-facility amount for CPT 19100?

The facility rate uses a lower practice expense RVU because Medicare assumes the facility (e.g., hospital) is absorbing certain overhead and equipment costs separately, rather than the physician's practice.

Does this amount reflect what my specific Medicare Administrative Contractor (MAC) will pay?

Not exactly. The amount shown is calculated using locality GPCIs, but final MAC payment can differ slightly due to claim-specific modifiers, contractor pricing rules, or timing of fee schedule updates.

Will the amount change next year?

Yes. CMS updates RVUs and the conversion factor annually, and the resulting fee schedule amount for CPT 19100 can increase or decrease as a result.

What does the beneficiary owe for this code?

After the Part B deductible is met, the beneficiary is generally responsible for 20% of the Medicare-allowed amount, unless secondary insurance or other coverage applies.

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.