Medicare Reimbursement for CPT Code 19286

CPT code 19286 is a physician procedure code valued under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount for this code nationally and 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)	$286.58	$36.07
ALASKA* (AK)	$315.72	$48.93
ALABAMA (AL)	$253.29	$34.10
ARKANSAS (AR)	$249.05	$33.86
ARIZONA (AZ)	$278.22	$35.47
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$392.38	$39.17
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$400.90	$39.67
OXNARD-THOUSAND OAKS-VENTURA (CA)	$332.79	$36.69
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$333.53	$37.18
NAPA (CA)	$368.21	$38.04
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$392.49	$39.27
VALLEJO (CA)	$368.06	$37.89
BAKERSFIELD (CA)	$310.49	$35.94
CHICO (CA)	$310.22	$35.66
FRESNO (CA)	$310.22	$35.66
HANFORD-CORCORAN (CA)	$310.22	$35.66
MADERA (CA)	$310.22	$35.66
MERCED (CA)	$310.22	$35.66
MODESTO (CA)	$310.22	$35.66
REDDING (CA)	$310.22	$35.66
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$311.20	$36.64
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$327.89	$36.55
SALINAS (CA)	$326.72	$36.39
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$401.32	$40.09
SANTA CRUZ-WATSONVILLE (CA)	$340.78	$36.41
SANTA ROSA-PETALUMA (CA)	$344.35	$36.73
STOCKTON (CA)	$310.22	$35.66
VISALIA (CA)	$310.22	$35.66
YUBA CITY (CA)	$310.22	$35.66
EL CENTRO (CA)	$310.23	$35.68
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$336.18	$36.58
SAN LUIS OBISPO-PASO ROBLES (CA)	$321.22	$35.89
SANTA MARIA-SANTA BARBARA (CA)	$328.43	$36.34
REST OF CALIFORNIA (CA)	$310.22	$35.66
COLORADO (CO)	$302.63	$36.09
CONNECTICUT (CT)	$307.47	$37.67
DC + MD/VA SUBURBS (DC)	$333.96	$38.86
DELAWARE (DE)	$283.34	$35.84
FORT LAUDERDALE (FL)	$292.33	$38.57
MIAMI (FL)	$301.67	$40.89
REST OF FLORIDA (FL)	$276.83	$37.35
ATLANTA (GA)	$291.36	$36.85
REST OF GEORGIA (GA)	$259.52	$36.07
HAWAII, GUAM (HI)	$320.37	$35.54
IOWA (IA)	$263.02	$33.81
IDAHO (ID)	$264.53	$34.06
EAST ST. LOUIS (IL)	$269.16	$38.69
SUBURBAN CHICAGO (IL)	$296.00	$38.73
CHICAGO (IL)	$291.95	$40.19
REST OF ILLINOIS (IL)	$266.01	$37.30
INDIANA (IN)	$266.36	$34.14
KANSAS (KS)	$260.53	$34.07
KENTUCKY (KY)	$257.92	$35.22
NEW ORLEANS (LA)	$271.89	$36.17
REST OF LOUISIANA (LA)	$257.03	$35.33
METROPOLITAN BOSTON (MA)	$337.02	$37.92
REST OF MASSACHUSETTS (MA)	$299.97	$36.19
BALTIMORE/SURR. CNTYS (MD)	$306.41	$37.62
REST OF MARYLAND (MD)	$289.68	$36.17
SOUTHERN MAINE (ME)	$283.17	$34.92
REST OF MAINE (ME)	$264.98	$34.51
DETROIT (MI)	$279.69	$37.95
REST OF MICHIGAN (MI)	$264.71	$36.00
MINNESOTA (MN)	$291.88	$34.11
METROPOLITAN ST. LOUIS (MO)	$274.30	$35.82
METROPOLITAN KANSAS CITY (MO)	$270.90	$35.68
REST OF MISSOURI (MO)	$251.19	$35.26
MISSISSIPPI (MS)	$250.23	$34.55
MONTANA** (MT)	$286.57	$36.07
NORTH CAROLINA (NC)	$268.35	$34.63
NORTH DAKOTA** (ND)	$284.79	$34.29
NEBRASKA (NE)	$265.01	$33.79
NEW HAMPSHIRE (NH)	$296.69	$35.92
NORTHERN NJ (NJ)	$329.47	$38.88
REST OF NEW JERSEY (NJ)	$311.52	$37.97
NEW MEXICO (NM)	$265.95	$36.23
NEVADA** (NV)	$286.33	$35.58
MANHATTAN (NY)	$331.56	$40.47
NYC SUBURBS/LONG ISLAND (NY)	$339.29	$41.43
POUGHKPSIE/N NYC SUBURBS (NY)	$312.76	$38.46
QUEENS (NY)	$336.25	$40.15
REST OF NEW YORK (NY)	$272.89	$34.91
OHIO (OH)	$264.34	$35.63
OKLAHOMA (OK)	$258.53	$34.83
PORTLAND (OR)	$314.65	$36.34
REST OF OREGON (OR)	$284.66	$35.16
METROPOLITAN PHILADELPHIA (PA)	$298.15	$37.37
REST OF PENNSYLVANIA (PA)	$265.43	$35.47
PUERTO RICO (PR)	$289.35	$36.09
RHODE ISLAND (RI)	$295.22	$36.45
SOUTH CAROLINA (SC)	$266.68	$35.22
SOUTH DAKOTA** (SD)	$284.58	$34.08
TENNESSEE (TN)	$261.91	$34.19
BRAZORIA (TX)	$283.84	$35.59
DALLAS (TX)	$285.38	$35.87
GALVESTON (TX)	$284.49	$35.74
HOUSTON (TX)	$286.14	$37.39
BEAUMONT (TX)	$263.34	$35.38
FORT WORTH (TX)	$282.86	$35.86
AUSTIN (TX)	$301.13	$36.10
REST OF TEXAS (TX)	$273.24	$35.51
UTAH (UT)	$270.92	$35.45
VIRGINIA (VA)	$281.35	$35.10
VIRGIN ISLANDS (VI)	$289.35	$36.09
VERMONT (VT)	$282.54	$34.53
SEATTLE (KING CNTY) (WA)	$345.49	$38.12
REST OF WASHINGTON (WA)	$299.78	$36.00
WISCONSIN (WI)	$273.75	$33.77
WEST VIRGINIA (WV)	$254.36	$36.67
WYOMING** (WY)	$285.80	$35.29

Look up another code or locality →

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 pricing is based on three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, then the adjusted RVUs are summed and multiplied by the annual conversion factor to produce a dollar amount. Practice-expense RVUs differ depending on whether the service is reported in a non-facility (e.g., physician office) or facility (e.g., hospital outpatient) setting, which is why the two allowed amounts differ. These RVU values and the conversion factor are updated annually by CMS and are subject to budget-neutrality adjustments.

RVUs — work 0.83, practice expense 7.66 (non-facility) / 0.16 (facility), malpractice 0.09 — × 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 annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary based on locality, applicable modifiers, sequestration, site-of-service, and other claim-specific factors.
Annual budget-neutrality adjustments and conversion factor changes can shift amounts from one year to the next.
Always verify final payment amounts with your Medicare Administrative Contractor (MAC) or official CMS PFS lookup tool.

Frequently asked

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

In facility settings, the facility (e.g., hospital) typically bills separately for overhead and supplies, so the physician's practice-expense RVU component is lower, resulting in a lower total payment to the billing physician.

Does this amount apply in my state?

No. The national amount is a baseline; actual Medicare payment depends on your specific locality's GPCIs, which adjust work, practice expense, and malpractice costs for regional cost differences.

Will modifiers change this amount?

Yes. Modifiers such as those indicating bilateral procedures, multiple procedures, or reduced services can increase or decrease the allowed amount from the base fee schedule rate shown here.

Why might the amount change next year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, so the allowed amount for this code can increase or decrease from year to year.

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.