Medicare Reimbursement for CPT 19105

CPT 19105 is a procedure code defined by the American Medical Association; because CPT descriptors are licensed content, a plain-language description is not included here. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, nationally and adjustable by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2535.80	$193.73
ALASKA* (AK)	$2736.10	$241.80
ALABAMA (AL)	$2223.74	$174.43
ARKANSAS (AR)	$2183.94	$172.10
ARIZONA (AZ)	$2457.22	$187.75
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$3505.35	$203.03
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$3582.49	$205.23
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2960.50	$192.17
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2965.78	$195.11
NAPA (CA)	$3285.00	$198.15
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$3506.47	$204.15
VALLEJO (CA)	$3283.40	$196.55
BAKERSFIELD (CA)	$2754.03	$187.12
CHICO (CA)	$2751.40	$184.49
FRESNO (CA)	$2751.40	$184.49
HANFORD-CORCORAN (CA)	$2751.40	$184.49
MADERA (CA)	$2751.40	$184.49
MERCED (CA)	$2751.40	$184.49
MODESTO (CA)	$2751.40	$184.49
REDDING (CA)	$2751.40	$184.49
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2761.90	$194.99
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2913.34	$189.51
SALINAS (CA)	$2903.20	$188.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$3587.04	$209.78
SANTA CRUZ-WATSONVILLE (CA)	$3035.44	$189.82
SANTA ROSA-PETALUMA (CA)	$3067.50	$191.44
STOCKTON (CA)	$2751.40	$184.49
VISALIA (CA)	$2751.40	$184.49
YUBA CITY (CA)	$2751.40	$184.49
EL CENTRO (CA)	$2751.57	$184.66
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2991.44	$190.33
SAN LUIS OBISPO-PASO ROBLES (CA)	$2853.86	$186.25
SANTA MARIA-SANTA BARBARA (CA)	$2919.52	$188.67
REST OF CALIFORNIA (CA)	$2751.40	$184.49
COLORADO (CO)	$2682.57	$190.61
CONNECTICUT (CT)	$2728.55	$206.14
DC + MD/VA SUBURBS (DC)	$2970.13	$211.17
DELAWARE (DE)	$2504.50	$190.53
FORT LAUDERDALE (FL)	$2593.22	$220.70
MIAMI (FL)	$2683.54	$245.44
REST OF FLORIDA (FL)	$2447.42	$208.40
ATLANTA (GA)	$2580.86	$201.32
REST OF GEORGIA (GA)	$2284.74	$195.61
HAWAII, GUAM (HI)	$2848.46	$185.53
IOWA (IA)	$2313.52	$170.52
IDAHO (ID)	$2327.92	$173.22
EAST ST. LOUIS (IL)	$2378.36	$223.66
SUBURBAN CHICAGO (IL)	$2626.24	$220.94
CHICAGO (IL)	$2590.94	$237.16
REST OF ILLINOIS (IL)	$2346.92	$208.61
INDIANA (IN)	$2345.03	$173.93
KANSAS (KS)	$2290.81	$173.58
KENTUCKY (KY)	$2268.52	$186.42
NEW ORLEANS (LA)	$2399.66	$195.77
REST OF LOUISIANA (LA)	$2260.40	$187.66
METROPOLITAN BOSTON (MA)	$2999.39	$202.96
REST OF MASSACHUSETTS (MA)	$2657.36	$191.16
BALTIMORE/SURR. CNTYS (MD)	$2719.42	$206.38
REST OF MARYLAND (MD)	$2562.91	$192.73
SOUTHERN MAINE (ME)	$2502.27	$181.28
REST OF MAINE (ME)	$2332.80	$178.09
DETROIT (MI)	$2474.85	$214.75
REST OF MICHIGAN (MI)	$2332.71	$194.40
MINNESOTA (MN)	$2581.85	$171.86
METROPOLITAN ST. LOUIS (MO)	$2421.49	$191.83
METROPOLITAN KANSAS CITY (MO)	$2389.69	$190.49
REST OF MISSOURI (MO)	$2206.12	$187.25
MISSISSIPPI (MS)	$2196.04	$179.52
MONTANA** (MT)	$2535.73	$193.66
NORTH CAROLINA (NC)	$2364.33	$179.18
NORTH DAKOTA** (ND)	$2516.35	$174.28
NEBRASKA (NE)	$2331.96	$170.23
NEW HAMPSHIRE (NH)	$2629.40	$191.30
NORTHERN NJ (NJ)	$2926.85	$210.05
REST OF NEW JERSEY (NJ)	$2763.00	$205.46
NEW MEXICO (NM)	$2344.60	$196.92
NEVADA** (NV)	$2532.71	$188.30
MANHATTAN (NY)	$2948.69	$227.20
NYC SUBURBS/LONG ISLAND (NY)	$3021.90	$237.17
POUGHKPSIE/N NYC SUBURBS (NY)	$2774.45	$209.88
QUEENS (NY)	$2991.63	$223.31
REST OF NEW YORK (NY)	$2406.93	$181.97
OHIO (OH)	$2328.75	$190.44
OKLAHOMA (OK)	$2273.54	$182.07
PORTLAND (OR)	$2793.83	$191.79
REST OF OREGON (OR)	$2516.54	$183.84
METROPOLITAN PHILADELPHIA (PA)	$2641.97	$203.88
REST OF PENNSYLVANIA (PA)	$2338.60	$188.58
PUERTO RICO (PR)	$2561.52	$193.68
RHODE ISLAND (RI)	$2613.18	$193.82
SOUTH CAROLINA (SC)	$2349.79	$185.72
SOUTH DAKOTA** (SD)	$2514.06	$171.99
TENNESSEE (TN)	$2303.80	$174.86
BRAZORIA (TX)	$2508.11	$187.12
DALLAS (TX)	$2522.70	$190.00
GALVESTON (TX)	$2514.45	$188.77
HOUSTON (TX)	$2532.39	$206.71
BEAUMONT (TX)	$2319.02	$187.73
FORT WORTH (TX)	$2499.30	$190.01
AUSTIN (TX)	$2670.51	$192.60
REST OF TEXAS (TX)	$2411.10	$188.47
UTAH (UT)	$2389.49	$187.94
VIRGINIA (VA)	$2485.66	$183.41
VIRGIN ISLANDS (VI)	$2561.52	$193.68
VERMONT (VT)	$2495.80	$177.15
SEATTLE (KING CNTY) (WA)	$3076.72	$203.00
REST OF WASHINGTON (WA)	$2655.83	$189.62
WISCONSIN (WI)	$2413.07	$169.36
WEST VIRGINIA (WV)	$2237.75	$202.49
WYOMING** (WY)	$2527.29	$185.21

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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'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. These locality-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, which is why the two allowed amounts differ. The resulting figure represents the full Medicare-allowed amount before patient cost-sharing is applied.

RVUs — work 3.6, practice expense 71.34 (non-facility) / 1.22 (facility), malpractice 0.98 — × 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 beneficiary or secondary insurer is responsible for the rest.
Modifiers, bilateral or multiple-procedure rules, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Amounts shown use national averages or locality GPCIs as available and may not reflect your specific Medicare Administrative Contractor (MAC) locality.
Always confirm final allowed amounts and coverage policy with your MAC before billing or appealing a claim.

Frequently asked

Why is the facility amount lower than the non-facility amount?

In facility settings, Medicare assumes the facility (not the physician's practice) bears most overhead costs, so the practice-expense RVU component is lower, reducing the total allowed amount.

Does this amount reflect what Medicare will actually pay?

No. It reflects the full fee schedule allowed amount. Medicare generally pays 80% of this amount after the deductible, with the remainder owed by the patient or secondary payer.

Why might my locality's amount differ from the national figure?

GPCIs adjust the work, practice expense, and malpractice RVUs to reflect regional cost differences, so the same code can have different allowed amounts in different localities.

Can modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the final payment relative to the base PFS amount 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.