Medicare Reimbursement for CPT 19281

This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this procedure code (CPT 19281), both as a national average and adjusted for your locality. Amounts are shown separately for non-facility (e.g., office) and facility (e.g., hospital) settings, since resource costs differ between the two.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$234.81	$83.17
ALASKA* (AK)	$275.14	$113.64
ALABAMA (AL)	$211.64	$78.95
ARKANSAS (AR)	$208.70	$78.44
ARIZONA (AZ)	$228.83	$81.89
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$304.31	$90.50
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$310.34	$91.67
OXNARD-THOUSAND OAKS-VENTURA (CA)	$263.97	$84.73
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$265.24	$85.85
NAPA (CA)	$287.73	$87.87
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$304.53	$90.72
VALLEJO (CA)	$287.42	$87.56
BAKERSFIELD (CA)	$249.24	$83.05
CHICO (CA)	$248.65	$82.45
FRESNO (CA)	$248.65	$82.45
HANFORD-CORCORAN (CA)	$248.65	$82.45
MADERA (CA)	$248.65	$82.45
MERCED (CA)	$248.65	$82.45
MODESTO (CA)	$248.65	$82.45
REDDING (CA)	$248.65	$82.45
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$250.73	$84.53
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$260.83	$84.47
SALINAS (CA)	$259.85	$84.10
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$311.22	$92.56
SANTA CRUZ-WATSONVILLE (CA)	$268.35	$84.10
SANTA ROSA-PETALUMA (CA)	$271.06	$84.84
STOCKTON (CA)	$248.65	$82.45
VISALIA (CA)	$248.65	$82.45
YUBA CITY (CA)	$248.65	$82.45
EL CENTRO (CA)	$248.68	$82.48
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$265.87	$84.51
SAN LUIS OBISPO-PASO ROBLES (CA)	$255.67	$82.96
SANTA MARIA-SANTA BARBARA (CA)	$260.80	$83.99
REST OF CALIFORNIA (CA)	$248.65	$82.45
COLORADO (CO)	$244.65	$83.31
CONNECTICUT (CT)	$250.02	$86.70
DC + MD/VA SUBURBS (DC)	$268.12	$89.48
DELAWARE (DE)	$232.53	$82.71
FORT LAUDERDALE (FL)	$242.06	$88.45
MIAMI (FL)	$251.21	$93.35
REST OF FLORIDA (FL)	$230.81	$85.85
ATLANTA (GA)	$238.89	$84.83
REST OF GEORGIA (GA)	$218.39	$83.12
HAWAII, GUAM (HI)	$254.51	$82.10
IOWA (IA)	$217.10	$78.35
IDAHO (ID)	$218.40	$78.89
EAST ST. LOUIS (IL)	$228.18	$88.67
SUBURBAN CHICAGO (IL)	$244.57	$88.84
CHICAGO (IL)	$244.30	$91.90
REST OF ILLINOIS (IL)	$224.17	$85.72
INDIANA (IN)	$219.62	$79.05
KANSAS (KS)	$215.98	$78.90
KENTUCKY (KY)	$216.14	$81.33
NEW ORLEANS (LA)	$226.03	$83.34
REST OF LOUISIANA (LA)	$215.76	$81.56
METROPOLITAN BOSTON (MA)	$268.47	$87.41
REST OF MASSACHUSETTS (MA)	$243.22	$83.54
BALTIMORE/SURR. CNTYS (MD)	$249.28	$86.57
REST OF MARYLAND (MD)	$236.90	$83.44
SOUTHERN MAINE (ME)	$231.00	$80.72
REST OF MAINE (ME)	$219.34	$79.83
DETROIT (MI)	$233.45	$87.11
REST OF MICHIGAN (MI)	$221.42	$82.97
MINNESOTA (MN)	$235.08	$79.04
METROPOLITAN ST. LOUIS (MO)	$226.98	$82.62
METROPOLITAN KANSAS CITY (MO)	$224.70	$82.31
REST OF MISSOURI (MO)	$212.10	$81.39
MISSISSIPPI (MS)	$210.45	$79.89
MONTANA** (MT)	$234.80	$83.16
NORTH CAROLINA (NC)	$221.57	$80.09
NORTH DAKOTA** (ND)	$231.04	$79.40
NEBRASKA (NE)	$218.28	$78.32
NEW HAMPSHIRE (NH)	$240.71	$82.85
NORTHERN NJ (NJ)	$265.48	$89.57
REST OF NEW JERSEY (NJ)	$253.06	$87.46
NEW MEXICO (NM)	$222.53	$83.47
NEVADA** (NV)	$233.91	$82.12
MANHATTAN (NY)	$269.16	$92.95
NYC SUBURBS/LONG ISLAND (NY)	$275.28	$94.98
POUGHKPSIE/N NYC SUBURBS (NY)	$254.59	$88.54
QUEENS (NY)	$271.51	$92.27
REST OF NEW YORK (NY)	$224.76	$80.70
OHIO (OH)	$220.65	$82.20
OKLAHOMA (OK)	$215.92	$80.50
PORTLAND (OR)	$252.36	$83.88
REST OF OREGON (OR)	$232.27	$81.24
METROPOLITAN PHILADELPHIA (PA)	$243.90	$86.04
REST OF PENNSYLVANIA (PA)	$221.07	$81.86
PUERTO RICO (PR)	$236.51	$83.20
RHODE ISLAND (RI)	$240.75	$84.11
SOUTH CAROLINA (SC)	$221.44	$81.33
SOUTH DAKOTA** (SD)	$230.59	$78.95
TENNESSEE (TN)	$217.01	$79.17
BRAZORIA (TX)	$232.46	$82.19
DALLAS (TX)	$233.84	$82.81
GALVESTON (TX)	$233.09	$82.52
HOUSTON (TX)	$236.57	$85.99
BEAUMONT (TX)	$219.66	$81.67
FORT WORTH (TX)	$232.29	$82.77
AUSTIN (TX)	$243.69	$83.25
REST OF TEXAS (TX)	$225.86	$81.96
UTAH (UT)	$224.36	$81.82
VIRGINIA (VA)	$230.17	$81.10
VIRGIN ISLANDS (VI)	$236.51	$83.20
VERMONT (VT)	$230.04	$79.92
SEATTLE (KING CNTY) (WA)	$273.98	$87.92
REST OF WASHINGTON (WA)	$242.79	$83.12
WISCONSIN (WI)	$223.56	$78.29
WEST VIRGINIA (WV)	$216.15	$84.37
WYOMING** (WY)	$233.16	$81.52

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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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to this code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Non-facility and facility rates differ mainly in the practice-expense RVU, since facility settings assume the facility (not the billing physician) bears most overhead and supply costs.

RVUs — work 1.95, practice expense 4.89 (non-facility) / 0.35 (facility), malpractice 0.19 — × 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 patient's deductible is met; the patient or secondary insurer is responsible for the remainder.
Actual payment can vary based on locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility amount differ from the non-facility amount?

The facility rate uses a lower practice-expense RVU because the facility, not the billing provider, absorbs most overhead, equipment, and supply costs in that setting.

Does this amount include the patient's share?

No. The figures shown are the total Medicare-allowed amount; Medicare generally pays 80% after the deductible, with the remaining 20% typically owed by the patient or secondary coverage.

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

The national amount uses an average GPCI, while your locality's amount reflects area-specific wage and cost adjustments applied to the RVUs before the conversion factor is applied.

Can modifiers change this amount?

Yes. Modifiers (e.g., bilateral, reduced services, or professional/technical component splits) can increase or decrease the allowed amount from 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.