Medicare Reimbursement for CPT 19110

CPT 19110 is a physician procedure code reported under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and 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)	$534.41	$355.72
ALASKA* (AK)	$612.66	$422.35
ALABAMA (AL)	$474.03	$317.67
ARKANSAS (AR)	$466.47	$312.97
ARIZONA (AZ)	$518.07	$344.91
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$670.79	$418.83
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$683.17	$425.49
OXNARD-THOUSAND OAKS-VENTURA (CA)	$588.31	$377.09
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$592.09	$380.69
NAPA (CA)	$636.91	$401.39
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$672.07	$420.11
VALLEJO (CA)	$635.06	$399.54
BAKERSFIELD (CA)	$556.20	$360.35
CHICO (CA)	$553.16	$357.31
FRESNO (CA)	$553.16	$357.31
HANFORD-CORCORAN (CA)	$553.16	$357.31
MADERA (CA)	$553.16	$357.31
MERCED (CA)	$553.16	$357.31
MODESTO (CA)	$553.16	$357.31
REDDING (CA)	$553.16	$357.31
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$565.27	$369.42
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$579.49	$371.67
SALINAS (CA)	$577.36	$370.25
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$688.41	$430.74
SANTA CRUZ-WATSONVILLE (CA)	$595.63	$378.51
SANTA ROSA-PETALUMA (CA)	$601.51	$382.07
STOCKTON (CA)	$553.16	$357.31
VISALIA (CA)	$553.16	$357.31
YUBA CITY (CA)	$553.16	$357.31
EL CENTRO (CA)	$553.35	$357.50
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$590.47	$376.75
SAN LUIS OBISPO-PASO ROBLES (CA)	$568.29	$364.76
SANTA MARIA-SANTA BARBARA (CA)	$579.39	$371.03
REST OF CALIFORNIA (CA)	$553.16	$357.31
COLORADO (CO)	$550.42	$360.28
CONNECTICUT (CT)	$572.34	$379.89
DC + MD/VA SUBURBS (DC)	$609.15	$398.65
DELAWARE (DE)	$527.10	$350.55
FORT LAUDERDALE (FL)	$569.49	$388.47
MIAMI (FL)	$606.56	$420.54
REST OF FLORIDA (FL)	$537.91	$367.08
ATLANTA (GA)	$548.07	$366.51
REST OF GEORGIA (GA)	$503.64	$344.24
HAWAII, GUAM (HI)	$566.75	$363.58
IOWA (IA)	$481.73	$318.23
IDAHO (ID)	$486.36	$321.96
EAST ST. LOUIS (IL)	$544.52	$380.12
SUBURBAN CHICAGO (IL)	$574.07	$390.55
CHICAGO (IL)	$586.06	$406.48
REST OF ILLINOIS (IL)	$525.04	$361.89
INDIANA (IN)	$489.32	$323.67
KANSAS (KS)	$481.90	$320.36
KENTUCKY (KY)	$492.13	$333.27
NEW ORLEANS (LA)	$518.78	$350.62
REST OF LOUISIANA (LA)	$492.34	$334.20
METROPOLITAN BOSTON (MA)	$604.49	$391.13
REST OF MASSACHUSETTS (MA)	$547.72	$359.56
BALTIMORE/SURR. CNTYS (MD)	$571.37	$379.63
REST OF MARYLAND (MD)	$536.99	$356.15
SOUTHERN MAINE (ME)	$517.32	$340.23
REST OF MAINE (ME)	$491.98	$327.58
DETROIT (MI)	$547.98	$375.54
REST OF MICHIGAN (MI)	$508.66	$345.51
MINNESOTA (MN)	$518.05	$334.18
METROPOLITAN ST. LOUIS (MO)	$517.59	$347.47
METROPOLITAN KANSAS CITY (MO)	$512.07	$344.28
REST OF MISSOURI (MO)	$484.85	$330.82
MISSISSIPPI (MS)	$475.63	$321.77
MONTANA** (MT)	$534.34	$355.64
NORTH CAROLINA (NC)	$497.20	$330.48
NORTH DAKOTA** (ND)	$512.00	$333.30
NEBRASKA (NE)	$483.83	$318.90
NEW HAMPSHIRE (NH)	$544.13	$358.11
NORTHERN NJ (NJ)	$602.42	$395.13
REST OF NEW JERSEY (NJ)	$576.25	$381.11
NEW MEXICO (NM)	$512.78	$348.92
NEVADA** (NV)	$528.46	$349.59
MANHATTAN (NY)	$622.82	$415.18
NYC SUBURBS/LONG ISLAND (NY)	$642.55	$430.08
POUGHKPSIE/N NYC SUBURBS (NY)	$582.29	$386.62
QUEENS (NY)	$624.43	$413.21
REST OF NEW YORK (NY)	$505.60	$335.84
OHIO (OH)	$504.09	$340.94
OKLAHOMA (OK)	$488.33	$328.75
PORTLAND (OR)	$566.14	$367.61
REST OF OREGON (OR)	$521.80	$343.82
METROPOLITAN PHILADELPHIA (PA)	$558.74	$372.71
REST OF PENNSYLVANIA (PA)	$503.47	$339.43
PUERTO RICO (PR)	$537.72	$357.06
RHODE ISLAND (RI)	$544.70	$360.11
SOUTH CAROLINA (SC)	$502.00	$336.88
SOUTH DAKOTA** (SD)	$509.35	$330.66
TENNESSEE (TN)	$484.90	$322.47
BRAZORIA (TX)	$524.10	$347.01
DALLAS (TX)	$528.95	$350.97
GALVESTON (TX)	$526.62	$349.17
HOUSTON (TX)	$547.30	$369.85
BEAUMONT (TX)	$500.05	$337.44
FORT WORTH (TX)	$525.92	$349.73
AUSTIN (TX)	$550.82	$361.76
REST OF TEXAS (TX)	$512.80	$343.22
UTAH (UT)	$509.44	$341.47
VIRGINIA (VA)	$517.33	$341.68
VIRGIN ISLANDS (VI)	$537.72	$357.06
VERMONT (VT)	$512.25	$335.34
SEATTLE (KING CNTY) (WA)	$614.65	$395.39
REST OF WASHINGTON (WA)	$545.93	$357.77
WISCONSIN (WI)	$493.51	$322.32
WEST VIRGINIA (WV)	$504.56	$349.28
WYOMING** (WY)	$524.60	$345.91

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: 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 amounts are built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) 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 and facility settings because overhead costs (equipment, staff, supplies) are counted differently depending on where the service is performed, which is why the two settings show different allowed amounts.

RVUs — work 4.33, practice expense 10.54 (non-facility) / 5.19 (facility), malpractice 1.13 — × 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 deductible is met; the patient or secondary insurer is responsible for the remainder.
Modifiers, multiple-procedure rules, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Amounts vary by locality based on GPCI values; always confirm the exact rate with your Medicare Administrative Contractor (MAC).

Frequently asked

Why does the facility amount differ from the non-facility amount for CPT 19110?

The two settings use different practice-expense RVUs because overhead costs are allocated differently when a service is performed in a facility (e.g., hospital) versus a non-facility setting like a physician's office.

Is this the amount my practice will actually be paid?

No. This is a calculated estimate using national RVUs, GPCIs, and the conversion factor. Actual payment depends on your specific locality, any applicable modifiers, the patient's deductible status, and other claim-specific factors.

Does this amount already reflect the Medicare deductible and coinsurance?

No. The figures shown are the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount once the deductible has been met, with the remaining 20% owed by the patient or secondary payer.

Why might my MAC's rate differ from the number shown here?

Local GPCI values, annual rule updates, sequestration, and budget-neutrality adjustments can all cause the actual MAC-published rate to differ slightly from a generically calculated estimate.

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.