Medicare Reimbursement for CPT 19101
CPT 19101 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed payment amount nationally and the inputs used to calculate it, broken out by non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $350.38 | $216.44 |
| ALASKA* (AK) | $405.35 | $262.71 |
| ALABAMA (AL) | $311.58 | $194.38 |
| ARKANSAS (AR) | $306.73 | $191.68 |
| ARIZONA (AZ) | $339.79 | $210.01 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $434.90 | $246.04 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $442.74 | $249.60 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $383.19 | $224.88 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $385.86 | $227.41 |
| NAPA (CA) | $413.59 | $237.06 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $435.79 | $246.94 |
| VALLEJO (CA) | $412.30 | $235.77 |
| BAKERSFIELD (CA) | $363.06 | $216.26 |
| CHICO (CA) | $360.92 | $214.13 |
| FRESNO (CA) | $360.92 | $214.13 |
| HANFORD-CORCORAN (CA) | $360.92 | $214.13 |
| MADERA (CA) | $360.92 | $214.13 |
| MERCED (CA) | $360.92 | $214.13 |
| MODESTO (CA) | $360.92 | $214.13 |
| REDDING (CA) | $360.92 | $214.13 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $369.39 | $222.60 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $377.58 | $221.81 |
| SALINAS (CA) | $376.18 | $220.95 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $446.40 | $253.27 |
| SANTA CRUZ-WATSONVILLE (CA) | $387.38 | $224.64 |
| SANTA ROSA-PETALUMA (CA) | $391.17 | $226.69 |
| STOCKTON (CA) | $360.92 | $214.13 |
| VISALIA (CA) | $360.92 | $214.13 |
| YUBA CITY (CA) | $360.92 | $214.13 |
| EL CENTRO (CA) | $361.06 | $214.26 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $384.33 | $224.14 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $370.33 | $217.78 |
| SANTA MARIA-SANTA BARBARA (CA) | $377.39 | $221.22 |
| REST OF CALIFORNIA (CA) | $360.92 | $214.13 |
| COLORADO (CO) | $359.86 | $217.35 |
| CONNECTICUT (CT) | $374.87 | $230.62 |
| DC + MD/VA SUBURBS (DC) | $397.98 | $240.20 |
| DELAWARE (DE) | $345.61 | $213.28 |
| FORT LAUDERDALE (FL) | $374.54 | $238.86 |
| MIAMI (FL) | $399.69 | $260.26 |
| REST OF FLORIDA (FL) | $354.02 | $225.98 |
| ATLANTA (GA) | $359.50 | $223.41 |
| REST OF GEORGIA (GA) | $331.81 | $212.34 |
| HAWAII, GUAM (HI) | $369.24 | $216.95 |
| IOWA (IA) | $315.87 | $193.32 |
| IDAHO (ID) | $318.97 | $195.74 |
| EAST ST. LOUIS (IL) | $359.63 | $236.41 |
| SUBURBAN CHICAGO (IL) | $377.39 | $239.84 |
| CHICAGO (IL) | $386.38 | $251.77 |
| REST OF ILLINOIS (IL) | $346.20 | $223.91 |
| INDIANA (IN) | $320.84 | $196.68 |
| KANSAS (KS) | $316.29 | $195.21 |
| KENTUCKY (KY) | $323.85 | $204.78 |
| NEW ORLEANS (LA) | $341.06 | $215.02 |
| REST OF LOUISIANA (LA) | $324.11 | $205.57 |
| METROPOLITAN BOSTON (MA) | $394.23 | $234.31 |
| REST OF MASSACHUSETTS (MA) | $358.30 | $217.26 |
| BALTIMORE/SURR. CNTYS (MD) | $374.28 | $230.57 |
| REST OF MARYLAND (MD) | $351.89 | $216.34 |
| SOUTHERN MAINE (ME) | $338.67 | $205.94 |
| REST OF MAINE (ME) | $322.90 | $199.68 |
| DETROIT (MI) | $360.82 | $231.57 |
| REST OF MICHIGAN (MI) | $334.75 | $212.46 |
| MINNESOTA (MN) | $338.14 | $200.32 |
| METROPOLITAN ST. LOUIS (MO) | $339.93 | $212.42 |
| METROPOLITAN KANSAS CITY (MO) | $336.42 | $210.66 |
| REST OF MISSOURI (MO) | $319.50 | $204.04 |
| MISSISSIPPI (MS) | $313.08 | $197.76 |
| MONTANA** (MT) | $350.32 | $216.39 |
| NORTH CAROLINA (NC) | $326.19 | $201.23 |
| NORTH DAKOTA** (ND) | $334.70 | $200.76 |
| NEBRASKA (NE) | $317.12 | $193.49 |
| NEW HAMPSHIRE (NH) | $356.05 | $216.62 |
| NORTHERN NJ (NJ) | $393.80 | $238.43 |
| REST OF NEW JERSEY (NJ) | $377.27 | $231.01 |
| NEW MEXICO (NM) | $337.52 | $214.70 |
| NEVADA** (NV) | $346.19 | $212.12 |
| MANHATTAN (NY) | $408.01 | $252.38 |
| NYC SUBURBS/LONG ISLAND (NY) | $421.07 | $261.82 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $381.43 | $234.77 |
| QUEENS (NY) | $408.59 | $250.27 |
| REST OF NEW YORK (NY) | $331.60 | $204.36 |
| OHIO (OH) | $331.55 | $209.27 |
| OKLAHOMA (OK) | $321.08 | $201.48 |
| PORTLAND (OR) | $369.59 | $220.78 |
| REST OF OREGON (OR) | $341.66 | $208.26 |
| METROPOLITAN PHILADELPHIA (PA) | $366.33 | $226.90 |
| REST OF PENNSYLVANIA (PA) | $330.98 | $208.03 |
| PUERTO RICO (PR) | $352.39 | $216.98 |
| RHODE ISLAND (RI) | $356.74 | $218.39 |
| SOUTH CAROLINA (SC) | $329.79 | $206.03 |
| SOUTH DAKOTA** (SD) | $332.85 | $198.92 |
| TENNESSEE (TN) | $318.25 | $196.50 |
| BRAZORIA (TX) | $343.44 | $210.71 |
| DALLAS (TX) | $346.70 | $213.30 |
| GALVESTON (TX) | $345.15 | $212.15 |
| HOUSTON (TX) | $359.61 | $226.61 |
| BEAUMONT (TX) | $328.81 | $206.93 |
| FORT WORTH (TX) | $344.86 | $212.79 |
| AUSTIN (TX) | $360.27 | $218.56 |
| REST OF TEXAS (TX) | $336.66 | $209.55 |
| UTAH (UT) | $334.56 | $208.66 |
| VIRGINIA (VA) | $338.90 | $207.24 |
| VIRGIN ISLANDS (VI) | $352.39 | $216.98 |
| VERMONT (VT) | $335.15 | $202.55 |
| SEATTLE (KING CNTY) (WA) | $400.47 | $236.13 |
| REST OF WASHINGTON (WA) | $357.03 | $216.00 |
| WISCONSIN (WI) | $322.93 | $194.62 |
| WEST VIRGINIA (WV) | $333.09 | $216.70 |
| WYOMING** (WY) | $343.51 | $209.58 |
Look up another code or locality →
Maximum units per day (MUE)
Medicare’s Medically Unlikely Edit caps this code at 3 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 PFS payments are built from three Relative Value Units (RVUs) — work, practice expense (PE), and malpractice (MP) — assigned to each code. These RVUs are each adjusted by locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences, then summed and multiplied by the annual national conversion factor to produce a dollar amount. The PE RVU differs between non-facility and facility settings because overhead costs (staff, supplies, equipment) are assumed to be higher when the procedure is performed in a physician office versus a hospital or facility setting where the facility itself absorbs some of those costs.
RVUs — work 3.15, practice expense 6.55 (non-facility) / 2.54 (facility), malpractice 0.79 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- This is an estimated allowed amount 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 varies by locality (GPCIs differ by region), applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
- Always confirm the exact allowed amount and coverage determination with your Medicare Administrative Contractor (MAC).
Frequently asked
Why is the facility amount lower than the non-facility amount?
The facility rate uses a lower practice expense RVU because the facility (not the physician's practice) bears many of the overhead costs, such as equipment and supplies, when the service is performed there.
Does this amount apply in every state?
No. The national amount shown is before locality adjustment. Actual payment is calculated using the GPCIs for the specific locality where the service was performed.
Will modifiers change this amount?
Yes. Modifiers such as those indicating bilateral procedures, reduced services, or multiple procedures can increase or decrease the final allowed amount from what is shown here.
Is this the amount Medicare will pay me?
This figure is the Medicare-allowed amount, not the payment. Medicare generally pays 80% of the allowed amount after the deductible, with the remainder owed by the patient or a secondary payer.
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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