Medicare Reimbursement for CPT 19112

This page covers CPT code 19112, a physician procedure code billed under the Medicare Physician Fee Schedule (PFS). It shows the estimated Medicare allowed amount nationally and how it can vary by locality, as well as the difference between non-facility (e.g., office) and facility (e.g., hospital) payment amounts.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$505.69	$331.00
ALASKA* (AK)	$575.12	$389.08
ALABAMA (AL)	$447.54	$294.69
ARKANSAS (AR)	$440.25	$290.20
ARIZONA (AZ)	$490.04	$320.77
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$640.76	$394.45
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$652.81	$400.91
OXNARD-THOUSAND OAKS-VENTURA (CA)	$559.78	$353.30
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$563.13	$356.47
NAPA (CA)	$607.57	$377.34
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$641.91	$395.60
VALLEJO (CA)	$605.92	$375.68
BAKERSFIELD (CA)	$528.27	$336.81
CHICO (CA)	$525.55	$334.10
FRESNO (CA)	$525.55	$334.10
HANFORD-CORCORAN (CA)	$525.55	$334.10
MADERA (CA)	$525.55	$334.10
MERCED (CA)	$525.55	$334.10
MODESTO (CA)	$525.55	$334.10
REDDING (CA)	$525.55	$334.10
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$536.37	$344.92
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$551.23	$348.07
SALINAS (CA)	$549.22	$346.75
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$657.50	$405.60
SANTA CRUZ-WATSONVILLE (CA)	$567.47	$355.22
SANTA ROSA-PETALUMA (CA)	$573.11	$358.59
STOCKTON (CA)	$525.55	$334.10
VISALIA (CA)	$525.55	$334.10
YUBA CITY (CA)	$525.55	$334.10
EL CENTRO (CA)	$525.72	$334.27
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$562.17	$353.25
SAN LUIS OBISPO-PASO ROBLES (CA)	$540.52	$341.55
SANTA MARIA-SANTA BARBARA (CA)	$551.28	$347.60
REST OF CALIFORNIA (CA)	$525.55	$334.10
COLORADO (CO)	$522.06	$336.20
CONNECTICUT (CT)	$542.05	$353.91
DC + MD/VA SUBURBS (DC)	$578.14	$372.36
DELAWARE (DE)	$498.73	$326.14
FORT LAUDERDALE (FL)	$537.47	$360.51
MIAMI (FL)	$571.54	$389.69
REST OF FLORIDA (FL)	$507.34	$340.34
ATLANTA (GA)	$518.41	$340.93
REST OF GEORGIA (GA)	$474.58	$318.76
HAWAII, GUAM (HI)	$539.17	$340.55
IOWA (IA)	$455.76	$295.93
IDAHO (ID)	$460.07	$299.36
EAST ST. LOUIS (IL)	$512.05	$351.34
SUBURBAN CHICAGO (IL)	$542.00	$362.59
CHICAGO (IL)	$551.98	$376.42
REST OF ILLINOIS (IL)	$494.40	$334.91
INDIANA (IN)	$462.94	$301.01
KANSAS (KS)	$455.55	$297.63
KENTUCKY (KY)	$464.19	$308.89
NEW ORLEANS (LA)	$489.74	$325.36
REST OF LOUISIANA (LA)	$464.25	$309.65
METROPOLITAN BOSTON (MA)	$574.58	$366.00
REST OF MASSACHUSETTS (MA)	$519.27	$335.32
BALTIMORE/SURR. CNTYS (MD)	$541.07	$353.64
REST OF MARYLAND (MD)	$508.34	$331.56
SOUTHERN MAINE (ME)	$490.11	$316.99
REST OF MAINE (ME)	$465.09	$304.38
DETROIT (MI)	$516.65	$348.08
REST OF MICHIGAN (MI)	$479.76	$320.27
MINNESOTA (MN)	$492.03	$312.28
METROPOLITAN ST. LOUIS (MO)	$489.05	$322.75
METROPOLITAN KANSAS CITY (MO)	$483.68	$319.65
REST OF MISSOURI (MO)	$456.78	$306.20
MISSISSIPPI (MS)	$448.51	$298.10
MONTANA** (MT)	$505.62	$330.94
NORTH CAROLINA (NC)	$470.19	$307.21
NORTH DAKOTA** (ND)	$485.65	$310.96
NEBRASKA (NE)	$457.91	$296.67
NEW HAMPSHIRE (NH)	$515.74	$333.89
NORTHERN NJ (NJ)	$571.48	$368.84
REST OF NEW JERSEY (NJ)	$545.94	$355.18
NEW MEXICO (NM)	$483.58	$323.40
NEVADA** (NV)	$500.40	$325.54
MANHATTAN (NY)	$589.77	$386.79
NYC SUBURBS/LONG ISLAND (NY)	$608.31	$400.61
POUGHKPSIE/N NYC SUBURBS (NY)	$551.41	$360.13
QUEENS (NY)	$591.87	$385.39
REST OF NEW YORK (NY)	$478.27	$312.32
OHIO (OH)	$475.68	$316.19
OKLAHOMA (OK)	$460.93	$304.93
PORTLAND (OR)	$537.67	$343.59
REST OF OREGON (OR)	$494.28	$320.29
METROPOLITAN PHILADELPHIA (PA)	$528.70	$346.85
REST OF PENNSYLVANIA (PA)	$475.30	$314.93
PUERTO RICO (PR)	$509.01	$332.40
RHODE ISLAND (RI)	$515.89	$335.43
SOUTH CAROLINA (SC)	$474.18	$312.77
SOUTH DAKOTA** (SD)	$483.29	$308.60
TENNESSEE (TN)	$458.40	$299.61
BRAZORIA (TX)	$496.13	$323.01
DALLAS (TX)	$500.62	$326.63
GALVESTON (TX)	$498.44	$324.98
HOUSTON (TX)	$516.93	$343.47
BEAUMONT (TX)	$471.97	$313.01
FORT WORTH (TX)	$497.58	$325.34
AUSTIN (TX)	$522.28	$337.46
REST OF TEXAS (TX)	$484.67	$318.89
UTAH (UT)	$481.37	$317.16
VIRGINIA (VA)	$489.85	$318.14
VIRGIN ISLANDS (VI)	$509.01	$332.40
VERMONT (VT)	$485.54	$312.60
SEATTLE (KING CNTY) (WA)	$584.72	$370.38
REST OF WASHINGTON (WA)	$517.68	$333.74
WISCONSIN (WI)	$467.73	$300.38
WEST VIRGINIA (WV)	$474.64	$322.83
WYOMING** (WY)	$496.92	$322.23

Look up another code or locality →

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) assigned to the code: physician work, practice expense, and malpractice. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting differences in local costs. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Non-facility settings (like an independent office) generally carry higher practice-expense RVUs than facility settings (like a hospital), since the physician bears more overhead costs in a non-facility setting — this is why the two amounts differ for the same code.

RVUs — work 3.71, practice expense 10.42 (non-facility) / 5.19 (facility), malpractice 1.01 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This figure is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary insurance is responsible for the remainder.
Actual payment can vary by locality GPCI values, applicable modifiers, claim-level adjustments, and annual sequestration or budget-neutrality changes.
Always verify the current, locality-specific amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility amount differ from the non-facility amount for the same code?

The practice-expense RVU component is lower in the facility setting because the facility, not the physician's office, absorbs most of the overhead costs (equipment, supplies, staff) for the service.

Why might the amount I was paid differ from the national figure shown here?

The national amount uses national GPCI/conversion factor inputs as a baseline. Actual payment is adjusted by the GPCIs specific to the provider's locality, plus any modifiers, place-of-service rules, or sequestration reductions applied to the claim.

Does this amount reflect what the patient will owe?

No. This reflects the Medicare-allowed amount before cost-sharing. After the deductible is met, Medicare generally pays 80%, and the patient or supplemental insurance is responsible for the remaining 20%.

Where can I confirm the exact rate for my locality?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules, and the official CMS Physician Fee Schedule Look-Up Tool can also be used to verify current, locality-adjusted amounts.

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.