Medicare Reimbursement for CPT 19284

This page covers CPT code 19284, a physician procedure code (the official AMA descriptor is not reproduced here due to licensing). It shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$181.70	$42.42
ALASKA* (AK)	$205.86	$57.53
ALABAMA (AL)	$161.94	$40.07
ARKANSAS (AR)	$159.43	$39.79
ARIZONA (AZ)	$176.67	$41.70
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$242.27	$45.88
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$247.31	$46.46
OXNARD-THOUSAND OAKS-VENTURA (CA)	$207.68	$43.04
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$208.40	$43.63
NAPA (CA)	$228.16	$44.59
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$242.39	$46.01
VALLEJO (CA)	$227.98	$44.41
BAKERSFIELD (CA)	$194.83	$42.18
CHICO (CA)	$194.50	$41.85
FRESNO (CA)	$194.50	$41.85
HANFORD-CORCORAN (CA)	$194.50	$41.85
MADERA (CA)	$194.50	$41.85
MERCED (CA)	$194.50	$41.85
MODESTO (CA)	$194.50	$41.85
REDDING (CA)	$194.50	$41.85
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$195.70	$43.05
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$204.86	$42.87
SALINAS (CA)	$204.11	$42.69
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$247.82	$46.97
SANTA CRUZ-WATSONVILLE (CA)	$211.92	$42.69
SANTA ROSA-PETALUMA (CA)	$214.11	$43.07
STOCKTON (CA)	$194.50	$41.85
VISALIA (CA)	$194.50	$41.85
YUBA CITY (CA)	$194.50	$41.85
EL CENTRO (CA)	$194.52	$41.87
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$209.48	$42.90
SAN LUIS OBISPO-PASO ROBLES (CA)	$200.75	$42.11
SANTA MARIA-SANTA BARBARA (CA)	$205.03	$42.63
REST OF CALIFORNIA (CA)	$194.50	$41.85
COLORADO (CO)	$190.59	$42.39
CONNECTICUT (CT)	$194.31	$44.31
DC + MD/VA SUBURBS (DC)	$209.75	$45.67
DELAWARE (DE)	$179.75	$42.14
FORT LAUDERDALE (FL)	$186.56	$45.47
MIAMI (FL)	$193.28	$48.28
REST OF FLORIDA (FL)	$177.16	$44.00
ATLANTA (GA)	$184.86	$43.35
REST OF GEORGIA (GA)	$166.71	$42.48
HAWAII, GUAM (HI)	$200.06	$41.70
IOWA (IA)	$167.14	$39.69
IDAHO (ID)	$168.14	$40.00
EAST ST. LOUIS (IL)	$173.80	$45.66
SUBURBAN CHICAGO (IL)	$188.69	$45.65
CHICAGO (IL)	$187.41	$47.44
REST OF ILLINOIS (IL)	$171.13	$43.96
INDIANA (IN)	$169.21	$40.09
KANSAS (KS)	$165.93	$40.02
KENTUCKY (KY)	$165.26	$41.44
NEW ORLEANS (LA)	$173.63	$42.56
REST OF LOUISIANA (LA)	$164.84	$41.57
METROPOLITAN BOSTON (MA)	$210.83	$44.52
REST OF MASSACHUSETTS (MA)	$189.18	$42.52
BALTIMORE/SURR. CNTYS (MD)	$193.70	$44.25
REST OF MARYLAND (MD)	$183.47	$42.52
SOUTHERN MAINE (ME)	$179.04	$41.01
REST OF MAINE (ME)	$168.69	$40.55
DETROIT (MI)	$179.14	$44.73
REST OF MICHIGAN (MI)	$169.53	$42.37
MINNESOTA (MN)	$183.33	$40.01
METROPOLITAN ST. LOUIS (MO)	$174.73	$42.14
METROPOLITAN KANSAS CITY (MO)	$172.75	$41.97
REST OF MISSOURI (MO)	$161.55	$41.49
MISSISSIPPI (MS)	$160.55	$40.62
MONTANA** (MT)	$181.69	$42.41
NORTH CAROLINA (NC)	$170.64	$40.69
NORTH DAKOTA** (ND)	$179.52	$40.24
NEBRASKA (NE)	$168.23	$39.67
NEW HAMPSHIRE (NH)	$187.20	$42.21
NORTHERN NJ (NJ)	$207.26	$45.69
REST OF NEW JERSEY (NJ)	$196.73	$44.64
NEW MEXICO (NM)	$170.38	$42.66
NEVADA** (NV)	$181.23	$41.81
MANHATTAN (NY)	$209.49	$47.64
NYC SUBURBS/LONG ISLAND (NY)	$214.41	$48.80
POUGHKPSIE/N NYC SUBURBS (NY)	$197.75	$45.23
QUEENS (NY)	$211.86	$47.23
REST OF NEW YORK (NY)	$173.34	$41.03
OHIO (OH)	$169.09	$41.93
OKLAHOMA (OK)	$165.34	$40.96
PORTLAND (OR)	$197.41	$42.67
REST OF OREGON (OR)	$180.03	$41.30
METROPOLITAN PHILADELPHIA (PA)	$188.96	$43.96
REST OF PENNSYLVANIA (PA)	$169.58	$41.72
PUERTO RICO (PR)	$183.24	$42.43
RHODE ISLAND (RI)	$186.72	$42.84
SOUTH CAROLINA (SC)	$170.11	$41.41
SOUTH DAKOTA** (SD)	$179.26	$39.98
TENNESSEE (TN)	$166.78	$40.17
BRAZORIA (TX)	$179.85	$41.82
DALLAS (TX)	$180.89	$42.17
GALVESTON (TX)	$180.31	$42.01
HOUSTON (TX)	$182.33	$44.02
BEAUMONT (TX)	$168.36	$41.62
FORT WORTH (TX)	$179.49	$42.16
AUSTIN (TX)	$189.77	$42.41
REST OF TEXAS (TX)	$173.93	$41.76
UTAH (UT)	$172.61	$41.68
VIRGINIA (VA)	$178.15	$41.24
VIRGIN ISLANDS (VI)	$183.24	$42.43
VERMONT (VT)	$178.43	$40.54
SEATTLE (KING CNTY) (WA)	$215.65	$44.75
REST OF WASHINGTON (WA)	$188.95	$42.29
WISCONSIN (WI)	$173.06	$39.62
WEST VIRGINIA (WV)	$164.25	$43.22
WYOMING** (WY)	$180.75	$41.46

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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 fee schedule amount is 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 Index (GPCI) for the specific locality to reflect regional cost differences, and 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 (e.g., office) and facility (e.g., hospital) settings because overhead costs differ, which is why the two settings typically show different allowed amounts. The resulting figure represents the full Medicare-approved amount before patient cost-sharing is applied.

RVUs — work 0.98, practice expense 4.35 (non-facility) / 0.18 (facility), malpractice 0.11 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the approved amount after the patient's Part B deductible is met; the patient or secondary payer is generally responsible for the remainder.
Modifiers, sequestration, multiple-procedure reductions, and annual budget-neutrality adjustments can change the actual paid amount.
Local Medicare Administrative Contractor (MAC) policies, coverage determinations, and place-of-service rules may affect whether and how this code is paid.
Always verify current-year figures and locality-specific rates directly with your MAC before billing or appealing a denial.

Frequently asked

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

Facility and non-facility amounts differ because the practice expense RVU component is lower in facility settings, since Medicare assumes the facility (not the billing physician) is absorbing overhead and supply costs.

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

Each locality has its own GPCI values for work, practice expense, and malpractice, which adjust the RVUs to reflect local labor and cost conditions, producing a different final amount than the national average.

Does this amount reflect what the patient will owe?

No. This is the total Medicare-approved amount; after deductible, Medicare generally pays 80%, leaving a 20% coinsurance plus any unmet deductible as the patient's or secondary payer's responsibility.

Can this estimate change during the year?

Yes. CMS can apply mid-year corrections, sequestration adjustments, or budget-neutrality changes, and MAC-specific pricing can also vary from the national PFS 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.