Medicare Reimbursement for CPT 19285
CPT 19285 is a procedure code recognized by the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code at the national level and by locality, broken out for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $350.38 | $71.81 |
| ALASKA* (AK) | $394.18 | $97.51 |
| ALABAMA (AL) | $311.65 | $67.91 |
| ARKANSAS (AR) | $306.72 | $67.44 |
| ARIZONA (AZ) | $340.55 | $70.63 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $470.64 | $77.87 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $480.55 | $78.86 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $402.24 | $72.98 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $403.50 | $73.96 |
| NAPA (CA) | $442.79 | $75.64 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $470.85 | $78.07 |
| VALLEJO (CA) | $442.49 | $75.35 |
| BAKERSFIELD (CA) | $376.81 | $71.51 |
| CHICO (CA) | $376.26 | $70.96 |
| FRESNO (CA) | $376.26 | $70.96 |
| HANFORD-CORCORAN (CA) | $376.26 | $70.96 |
| MADERA (CA) | $376.26 | $70.96 |
| MERCED (CA) | $376.26 | $70.96 |
| MODESTO (CA) | $376.26 | $70.96 |
| REDDING (CA) | $376.26 | $70.96 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $378.23 | $72.92 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $396.68 | $72.71 |
| SALINAS (CA) | $395.24 | $72.39 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $481.39 | $79.70 |
| SANTA CRUZ-WATSONVILLE (CA) | $410.87 | $72.41 |
| SANTA ROSA-PETALUMA (CA) | $415.12 | $73.05 |
| STOCKTON (CA) | $376.26 | $70.96 |
| VISALIA (CA) | $376.26 | $70.96 |
| YUBA CITY (CA) | $376.26 | $70.96 |
| EL CENTRO (CA) | $376.29 | $70.99 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $405.91 | $72.75 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $388.69 | $71.40 |
| SANTA MARIA-SANTA BARBARA (CA) | $397.10 | $72.29 |
| REST OF CALIFORNIA (CA) | $376.26 | $70.96 |
| COLORADO (CO) | $368.21 | $71.82 |
| CONNECTICUT (CT) | $374.99 | $74.98 |
| DC + MD/VA SUBURBS (DC) | $405.48 | $77.33 |
| DELAWARE (DE) | $346.58 | $71.36 |
| FORT LAUDERDALE (FL) | $358.99 | $76.80 |
| MIAMI (FL) | $371.41 | $81.43 |
| REST OF FLORIDA (FL) | $340.69 | $74.38 |
| ATLANTA (GA) | $356.37 | $73.35 |
| REST OF GEORGIA (GA) | $320.33 | $71.85 |
| HAWAII, GUAM (HI) | $387.43 | $70.70 |
| IOWA (IA) | $322.19 | $67.31 |
| IDAHO (ID) | $324.09 | $67.82 |
| EAST ST. LOUIS (IL) | $333.36 | $77.08 |
| SUBURBAN CHICAGO (IL) | $363.21 | $77.12 |
| CHICAGO (IL) | $359.99 | $80.04 |
| REST OF ILLINOIS (IL) | $328.62 | $74.30 |
| INDIANA (IN) | $326.19 | $67.97 |
| KANSAS (KS) | $319.66 | $67.84 |
| KENTUCKY (KY) | $317.79 | $70.15 |
| NEW ORLEANS (LA) | $334.15 | $72.02 |
| REST OF LOUISIANA (LA) | $316.90 | $70.37 |
| METROPOLITAN BOSTON (MA) | $408.04 | $75.43 |
| REST OF MASSACHUSETTS (MA) | $365.35 | $72.03 |
| BALTIMORE/SURR. CNTYS (MD) | $373.78 | $74.88 |
| REST OF MARYLAND (MD) | $353.90 | $72.00 |
| SOUTHERN MAINE (ME) | $345.56 | $69.50 |
| REST OF MAINE (ME) | $324.99 | $68.71 |
| DETROIT (MI) | $344.39 | $75.57 |
| REST OF MICHIGAN (MI) | $326.02 | $71.69 |
| MINNESOTA (MN) | $354.52 | $67.88 |
| METROPOLITAN ST. LOUIS (MO) | $336.52 | $71.33 |
| METROPOLITAN KANSAS CITY (MO) | $332.61 | $71.04 |
| REST OF MISSOURI (MO) | $310.35 | $70.23 |
| MISSISSIPPI (MS) | $308.65 | $68.80 |
| MONTANA** (MT) | $350.36 | $71.80 |
| NORTH CAROLINA (NC) | $328.85 | $68.95 |
| NORTH DAKOTA** (ND) | $346.80 | $68.24 |
| NEBRASKA (NE) | $324.39 | $67.28 |
| NEW HAMPSHIRE (NH) | $361.47 | $71.48 |
| NORTHERN NJ (NJ) | $400.50 | $77.37 |
| REST OF NEW JERSEY (NJ) | $379.76 | $75.57 |
| NEW MEXICO (NM) | $327.60 | $72.16 |
| NEVADA** (NV) | $349.66 | $70.82 |
| MANHATTAN (NY) | $404.25 | $80.56 |
| NYC SUBURBS/LONG ISLAND (NY) | $413.68 | $82.47 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $381.58 | $76.55 |
| QUEENS (NY) | $409.16 | $79.90 |
| REST OF NEW YORK (NY) | $334.14 | $69.51 |
| OHIO (OH) | $325.29 | $70.96 |
| OKLAHOMA (OK) | $318.12 | $69.36 |
| PORTLAND (OR) | $381.79 | $72.31 |
| REST OF OREGON (OR) | $347.43 | $69.98 |
| METROPOLITAN PHILADELPHIA (PA) | $364.38 | $74.39 |
| REST OF PENNSYLVANIA (PA) | $326.35 | $70.63 |
| PUERTO RICO (PR) | $353.46 | $71.84 |
| RHODE ISLAND (RI) | $360.31 | $72.56 |
| SOUTH CAROLINA (SC) | $327.52 | $70.12 |
| SOUTH DAKOTA** (SD) | $346.38 | $67.82 |
| TENNESSEE (TN) | $321.30 | $68.09 |
| BRAZORIA (TX) | $346.90 | $70.84 |
| DALLAS (TX) | $348.87 | $71.42 |
| GALVESTON (TX) | $347.76 | $71.15 |
| HOUSTON (TX) | $351.06 | $74.44 |
| BEAUMONT (TX) | $323.95 | $70.45 |
| FORT WORTH (TX) | $346.05 | $71.39 |
| AUSTIN (TX) | $366.56 | $71.84 |
| REST OF TEXAS (TX) | $335.06 | $70.70 |
| UTAH (UT) | $332.43 | $70.58 |
| VIRGINIA (VA) | $343.70 | $69.87 |
| VIRGIN ISLANDS (VI) | $353.46 | $71.84 |
| VERMONT (VT) | $344.52 | $68.74 |
| SEATTLE (KING CNTY) (WA) | $417.63 | $75.83 |
| REST OF WASHINGTON (WA) | $364.97 | $71.64 |
| WISCONSIN (WI) | $334.08 | $67.22 |
| WEST VIRGINIA (WV) | $315.12 | $73.05 |
| WYOMING** (WY) | $348.81 | $70.25 |
Look up another code or locality →
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) 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 local cost differences, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Non-facility and facility settings use different practice-expense RVUs because overhead costs differ depending on where the service is performed, which is why the same code can have two different allowed amounts. The conversion factor is updated annually and applies uniformly across all codes before locality adjustments are applied.
RVUs — work 1.66, practice expense 8.65 (non-facility) / 0.31 (facility), malpractice 0.18 — × the locality GPCIs × the 2026 conversion factor of $33.40.
Good to know
- All figures are estimates based on the national PFS formula; actual payment can differ.
- Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary insurer is responsible for the remainder.
- Modifiers, place-of-service codes, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why does CPT 19285 have different amounts for non-facility and facility settings?
The practice-expense RVU is lower in the facility setting because the facility (e.g., hospital) absorbs certain overhead and resource costs separately, while in a non-facility setting the billing provider covers those costs directly.
Is this the amount Medicare will actually pay?
No. This is an estimate based on the standard PFS formula. Actual payment depends on the patient's specific locality, applicable modifiers, deductible status, and any sequestration or budget-neutrality adjustments in effect.
Why does the amount change by locality?
Medicare adjusts RVUs using Geographic Practice Cost Indices (GPCIs) to account for regional differences in labor, rent, and malpractice insurance costs, so the same code can yield different allowed amounts in different areas.
Where can I find the official CPT descriptor for this code?
CPT code descriptors are copyrighted by the American Medical Association (AMA). Refer to your AMA CPT codebook or licensed coding software for the official description.
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.
Bill accurately, get paid faster
Join providers across the country delivering modern virtual care with CareNiva. Free to start, ready in minutes.
100% Satisfaction Guaranteed — try it risk-free