Medicare Reimbursement for CPT 19126

CPT 19126 is a physician procedure code reported to Medicare for payment purposes; the specific clinical descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted by locality, with non-facility and facility rates shown separately. All figures are estimates based on published Medicare rate-setting inputs.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$143.96	$143.96
ALASKA* (AK)	$182.34	$182.34
ALABAMA (AL)	$130.37	$130.37
ARKANSAS (AR)	$128.74	$128.74
ARIZONA (AZ)	$139.70	$139.70
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$148.87	$148.87
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$150.39	$150.39
OXNARD-THOUSAND OAKS-VENTURA (CA)	$141.82	$141.82
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$144.08	$144.08
NAPA (CA)	$145.63	$145.63
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$149.70	$149.70
VALLEJO (CA)	$144.43	$144.43
BAKERSFIELD (CA)	$138.55	$138.55
CHICO (CA)	$136.58	$136.58
FRESNO (CA)	$136.58	$136.58
HANFORD-CORCORAN (CA)	$136.58	$136.58
MADERA (CA)	$136.58	$136.58
MERCED (CA)	$136.58	$136.58
MODESTO (CA)	$136.58	$136.58
REDDING (CA)	$136.58	$136.58
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$144.40	$144.40
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$140.00	$140.00
SALINAS (CA)	$139.43	$139.43
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$153.78	$153.78
SANTA CRUZ-WATSONVILLE (CA)	$139.82	$139.82
SANTA ROSA-PETALUMA (CA)	$140.99	$140.99
STOCKTON (CA)	$136.58	$136.58
VISALIA (CA)	$136.58	$136.58
YUBA CITY (CA)	$136.58	$136.58
EL CENTRO (CA)	$136.70	$136.70
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$140.37	$140.37
SAN LUIS OBISPO-PASO ROBLES (CA)	$137.61	$137.61
SANTA MARIA-SANTA BARBARA (CA)	$139.31	$139.31
REST OF CALIFORNIA (CA)	$136.58	$136.58
COLORADO (CO)	$141.30	$141.30
CONNECTICUT (CT)	$152.84	$152.84
DC + MD/VA SUBURBS (DC)	$156.15	$156.15
DELAWARE (DE)	$141.68	$141.68
FORT LAUDERDALE (FL)	$163.97	$163.97
MIAMI (FL)	$182.22	$182.22
REST OF FLORIDA (FL)	$155.16	$155.16
ATLANTA (GA)	$149.53	$149.53
REST OF GEORGIA (GA)	$146.04	$146.04
HAWAII, GUAM (HI)	$136.99	$136.99
IOWA (IA)	$127.21	$127.21
IDAHO (ID)	$129.18	$129.18
EAST ST. LOUIS (IL)	$166.76	$166.76
SUBURBAN CHICAGO (IL)	$164.10	$164.10
CHICAGO (IL)	$176.32	$176.32
REST OF ILLINOIS (IL)	$155.59	$155.59
INDIANA (IN)	$129.67	$129.67
KANSAS (KS)	$129.56	$129.56
KENTUCKY (KY)	$139.22	$139.22
NEW ORLEANS (LA)	$145.86	$145.86
REST OF LOUISIANA (LA)	$140.17	$140.17
METROPOLITAN BOSTON (MA)	$149.86	$149.86
REST OF MASSACHUSETTS (MA)	$141.81	$141.81
BALTIMORE/SURR. CNTYS (MD)	$153.02	$153.02
REST OF MARYLAND (MD)	$143.20	$143.20
SOUTHERN MAINE (ME)	$134.74	$134.74
REST OF MAINE (ME)	$132.82	$132.82
DETROIT (MI)	$159.84	$159.84
REST OF MICHIGAN (MI)	$145.01	$145.01
MINNESOTA (MN)	$127.49	$127.49
METROPOLITAN ST. LOUIS (MO)	$142.85	$142.85
METROPOLITAN KANSAS CITY (MO)	$141.93	$141.93
REST OF MISSOURI (MO)	$140.01	$140.01
MISSISSIPPI (MS)	$134.25	$134.25
MONTANA** (MT)	$143.91	$143.91
NORTH CAROLINA (NC)	$133.54	$133.54
NORTH DAKOTA** (ND)	$129.47	$129.47
NEBRASKA (NE)	$126.94	$126.94
NEW HAMPSHIRE (NH)	$141.90	$141.90
NORTHERN NJ (NJ)	$155.48	$155.48
REST OF NEW JERSEY (NJ)	$152.36	$152.36
NEW MEXICO (NM)	$146.86	$146.86
NEVADA** (NV)	$139.91	$139.91
MANHATTAN (NY)	$168.26	$168.26
NYC SUBURBS/LONG ISLAND (NY)	$175.51	$175.51
POUGHKPSIE/N NYC SUBURBS (NY)	$155.66	$155.66
QUEENS (NY)	$165.23	$165.23
REST OF NEW YORK (NY)	$135.51	$135.51
OHIO (OH)	$142.06	$142.06
OKLAHOMA (OK)	$135.95	$135.95
PORTLAND (OR)	$141.91	$141.91
REST OF OREGON (OR)	$136.62	$136.62
METROPOLITAN PHILADELPHIA (PA)	$151.37	$151.37
REST OF PENNSYLVANIA (PA)	$140.64	$140.64
PUERTO RICO (PR)	$143.86	$143.86
RHODE ISLAND (RI)	$143.93	$143.93
SOUTH CAROLINA (SC)	$138.47	$138.47
SOUTH DAKOTA** (SD)	$127.77	$127.77
TENNESSEE (TN)	$130.48	$130.48
BRAZORIA (TX)	$139.14	$139.14
DALLAS (TX)	$141.26	$141.26
GALVESTON (TX)	$140.36	$140.36
HOUSTON (TX)	$153.72	$153.72
BEAUMONT (TX)	$140.06	$140.06
FORT WORTH (TX)	$141.34	$141.34
AUSTIN (TX)	$142.76	$142.76
REST OF TEXAS (TX)	$140.37	$140.37
UTAH (UT)	$140.03	$140.03
VIRGINIA (VA)	$136.38	$136.38
VIRGIN ISLANDS (VI)	$143.86	$143.86
VERMONT (VT)	$131.67	$131.67
SEATTLE (KING CNTY) (WA)	$149.73	$149.73
REST OF WASHINGTON (WA)	$140.65	$140.65
WISCONSIN (WI)	$126.08	$126.08
WEST VIRGINIA (WV)	$151.32	$151.32
WYOMING** (WY)	$137.62	$137.62

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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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) that reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual Conversion Factor (CF) to produce a dollar amount. Non-facility and facility payments can differ because the practice-expense RVU is typically higher in non-facility (e.g., office) settings, where the provider bears more overhead, versus facility settings (e.g., hospital) where overhead is billed separately by the facility. The result is the Medicare-allowed amount before any applicable modifiers, sequestration, or beneficiary cost-sharing are applied.

RVUs — work 2.86, practice expense 0.72 (non-facility) / 0.72 (facility), malpractice 0.73 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only — actual Medicare payment may differ based on locality, place of service, and claim-specific modifiers.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the beneficiary or secondary payer is responsible for the remainder.
Amounts are subject to mandatory federal sequestration reductions and annual budget-neutrality adjustments set by CMS.
Always verify the exact allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a claim.

Frequently asked

Why does the facility rate differ from the non-facility rate for this code?

The practice-expense RVU component is usually lower in facility settings because the facility itself bills separately for overhead, equipment, and supplies, while non-facility rates assume the provider covers those costs directly.

Does this amount reflect what Medicare actually pays?

No — this is the PFS allowed amount before the standard 80/20 cost-sharing split, deductible status, sequestration, and any applicable modifiers are applied.

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

Geographic Practice Cost Indices (GPCIs) adjust the work, practice expense, and malpractice RVUs for regional differences in wages, rent, and liability costs, which can raise or lower the final rate compared to the national average.

Can modifiers change this amount?

Yes — modifiers such as those indicating bilateral procedures, reduced services, or assistant-at-surgery involvement can increase or decrease the final allowed amount relative to the base rate shown here.

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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.