Medicare Reimbursement for CPT 19125

CPT 19125 is a physician procedure code billed under the Medicare Physician Fee Schedule (PFS). This page shows the PFS allowed amount at the national level and estimates how it may vary by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$634.95	$452.58
ALASKA* (AK)	$742.11	$547.89
ALABAMA (AL)	$565.46	$405.89
ARKANSAS (AR)	$556.83	$400.17
ARIZONA (AZ)	$615.68	$438.96
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$771.41	$514.27
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$784.66	$521.68
OXNARD-THOUSAND OAKS-VENTURA (CA)	$685.61	$470.05
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$691.10	$475.36
NAPA (CA)	$735.88	$495.52
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$773.32	$516.18
VALLEJO (CA)	$733.13	$492.77
BAKERSFIELD (CA)	$651.81	$451.93
CHICO (CA)	$647.28	$447.40
FRESNO (CA)	$647.28	$447.40
HANFORD-CORCORAN (CA)	$647.28	$447.40
MADERA (CA)	$647.28	$447.40
MERCED (CA)	$647.28	$447.40
MODESTO (CA)	$647.28	$447.40
REDDING (CA)	$647.28	$447.40
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$665.28	$465.41
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$675.61	$463.51
SALINAS (CA)	$673.07	$461.71
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$792.46	$529.48
SANTA CRUZ-WATSONVILLE (CA)	$691.12	$469.54
SANTA ROSA-PETALUMA (CA)	$697.77	$473.82
STOCKTON (CA)	$647.28	$447.40
VISALIA (CA)	$647.28	$447.40
YUBA CITY (CA)	$647.28	$447.40
EL CENTRO (CA)	$647.56	$447.68
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$686.55	$468.44
SAN LUIS OBISPO-PASO ROBLES (CA)	$662.80	$455.09
SANTA MARIA-SANTA BARBARA (CA)	$674.95	$462.31
REST OF CALIFORNIA (CA)	$647.28	$447.40
COLORADO (CO)	$648.38	$454.34
CONNECTICUT (CT)	$678.89	$482.48
DC + MD/VA SUBURBS (DC)	$717.32	$502.49
DELAWARE (DE)	$626.04	$445.86
FORT LAUDERDALE (FL)	$684.98	$500.24
MIAMI (FL)	$735.55	$545.71
REST OF FLORIDA (FL)	$647.29	$472.94
ATLANTA (GA)	$652.66	$467.37
REST OF GEORGIA (GA)	$606.73	$444.06
HAWAII, GUAM (HI)	$660.79	$453.44
IOWA (IA)	$570.42	$403.56
IDAHO (ID)	$576.49	$408.71
EAST ST. LOUIS (IL)	$662.97	$495.19
SUBURBAN CHICAGO (IL)	$689.54	$502.25
CHICAGO (IL)	$710.95	$527.67
REST OF ILLINOIS (IL)	$635.13	$468.63
INDIANA (IN)	$579.75	$410.70
KANSAS (KS)	$572.46	$407.60
KENTUCKY (KY)	$590.10	$427.98
NEW ORLEANS (LA)	$621.28	$449.67
REST OF LOUISIANA (LA)	$591.07	$429.68
METROPOLITAN BOSTON (MA)	$707.75	$490.01
REST OF MASSACHUSETTS (MA)	$646.18	$454.15
BALTIMORE/SURR. CNTYS (MD)	$678.09	$482.41
REST OF MARYLAND (MD)	$636.86	$452.30
SOUTHERN MAINE (ME)	$611.00	$430.27
REST OF MAINE (ME)	$584.86	$417.08
DETROIT (MI)	$660.81	$484.82
REST OF MICHIGAN (MI)	$610.78	$444.27
MINNESOTA (MN)	$605.92	$418.26
METROPOLITAN ST. LOUIS (MO)	$617.73	$444.12
METROPOLITAN KANSAS CITY (MO)	$611.64	$440.39
REST OF MISSOURI (MO)	$583.67	$426.46
MISSISSIPPI (MS)	$570.12	$413.10
MONTANA** (MT)	$634.84	$452.47
NORTH CAROLINA (NC)	$590.50	$420.35
NORTH DAKOTA** (ND)	$601.62	$419.25
NEBRASKA (NE)	$572.25	$403.92
NEW HAMPSHIRE (NH)	$642.74	$452.89
NORTHERN NJ (NJ)	$710.26	$498.71
REST OF NEW JERSEY (NJ)	$682.32	$483.18
NEW MEXICO (NM)	$616.26	$449.03
NEVADA** (NV)	$625.94	$443.39
MANHATTAN (NY)	$740.26	$528.35
NYC SUBURBS/LONG ISLAND (NY)	$765.22	$548.38
POUGHKPSIE/N NYC SUBURBS (NY)	$690.84	$491.14
QUEENS (NY)	$739.40	$523.84
REST OF NEW YORK (NY)	$600.23	$426.98
OHIO (OH)	$603.99	$437.48
OKLAHOMA (OK)	$583.80	$420.95
PORTLAND (OR)	$664.15	$461.54
REST OF OREGON (OR)	$616.84	$435.20
METROPOLITAN PHILADELPHIA (PA)	$664.50	$474.66
REST OF PENNSYLVANIA (PA)	$602.26	$434.84
PUERTO RICO (PR)	$638.08	$453.71
RHODE ISLAND (RI)	$644.94	$456.56
SOUTH CAROLINA (SC)	$599.09	$430.58
SOUTH DAKOTA** (SD)	$597.69	$415.32
TENNESSEE (TN)	$576.11	$410.34
BRAZORIA (TX)	$621.10	$440.37
DALLAS (TX)	$627.50	$445.86
GALVESTON (TX)	$624.51	$443.42
HOUSTON (TX)	$655.26	$474.17
BEAUMONT (TX)	$598.47	$432.52
FORT WORTH (TX)	$624.62	$444.80
AUSTIN (TX)	$649.93	$456.99
REST OF TEXAS (TX)	$611.09	$438.03
UTAH (UT)	$607.56	$436.14
VIRGINIA (VA)	$612.32	$433.05
VIRGIN ISLANDS (VI)	$638.08	$453.71
VERMONT (VT)	$603.62	$423.08
SEATTLE (KING CNTY) (WA)	$717.53	$493.77
REST OF WASHINGTON (WA)	$643.51	$451.47
WISCONSIN (WI)	$580.96	$406.25
WEST VIRGINIA (WV)	$611.84	$453.36
WYOMING** (WY)	$620.36	$437.99

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. 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 pricing for this code starts with three Relative Value Units (RVUs): physician work, practice expense, and malpractice. Each RVU component is adjusted for a locality's cost-of-living differences using Geographic Practice Cost Indices (GPCIs), then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed amount. Non-facility and facility amounts differ mainly because the practice-expense RVU is higher in non-facility settings (reflecting the overhead a physician's own office absorbs) and lower in facility settings (where the facility bears more of the cost). This same formula is reapplied each year as RVUs, GPCIs, and the conversion factor are updated.

RVUs — work 6.52, practice expense 10.81 (non-facility) / 5.35 (facility), malpractice 1.68 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All figures are estimates derived from the published PFS formula, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient's deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Actual payment can differ due to locality-specific GPCIs, applicable modifiers, multiple-procedure or bilateral adjustments, sequestration, and annual budget-neutrality adjustments.
Facility vs. non-facility amounts assume the place of service is correctly reported; incorrect site-of-service coding can change the allowed amount.
Always confirm final payment policy and amounts with your Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount for this code?

In facility settings, the hospital or facility — not the physician's practice — bears most of the overhead costs, so the practice-expense RVU used in the calculation is lower, resulting in a lower PFS allowed amount for the professional service.

Does this amount reflect what Medicare will actually pay?

No. It reflects the PFS allowed amount before the standard 80/20 cost-sharing split, deductible status, modifiers, and any local adjustments are applied, so actual reimbursement can differ.

Why do PFS amounts for this code change each year?

The conversion factor, RVUs, and GPCIs are all updated annually (and sometimes mid-year) based on CMS rulemaking, utilization data, and budget-neutrality requirements, which shifts the calculated allowed amount.

Can I use the national amount instead of a locality-specific one for billing?

The national figure is useful for general reference, but actual Medicare payments are based on the GPCI-adjusted locality amount where the service was furnished, so you should use locality-specific figures for billing and reconciliation.

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.