Medicare Reimbursement for CPT Code 19288

This page covers a CPT procedure code (descriptor not shown due to AMA licensing restrictions) and how Medicare's Physician Fee Schedule (PFS) prices it. It displays the estimated national allowed amount as well as locality-adjusted figures, shown separately for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$456.92	$53.44
ALASKA* (AK)	$502.73	$73.02
ALABAMA (AL)	$403.79	$50.74
ARKANSAS (AR)	$397.01	$50.41
ARIZONA (AZ)	$443.60	$52.63
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$627.16	$58.25
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$640.84	$59.01
OXNARD-THOUSAND OAKS-VENTURA (CA)	$531.41	$54.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$532.53	$55.21
NAPA (CA)	$588.33	$56.54
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$627.30	$58.39
VALLEJO (CA)	$588.14	$56.35
BAKERSFIELD (CA)	$495.62	$53.41
CHICO (CA)	$495.25	$53.03
FRESNO (CA)	$495.25	$53.03
HANFORD-CORCORAN (CA)	$495.25	$53.03
MADERA (CA)	$495.25	$53.03
MERCED (CA)	$495.25	$53.03
MODESTO (CA)	$495.25	$53.03
REDDING (CA)	$495.25	$53.03
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$496.56	$54.34
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$523.59	$54.34
SALINAS (CA)	$521.73	$54.10
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$641.39	$59.57
SANTA CRUZ-WATSONVILLE (CA)	$544.34	$54.11
SANTA ROSA-PETALUMA (CA)	$550.06	$54.59
STOCKTON (CA)	$495.25	$53.03
VISALIA (CA)	$495.25	$53.03
YUBA CITY (CA)	$495.25	$53.03
EL CENTRO (CA)	$495.27	$53.05
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$536.93	$54.36
SAN LUIS OBISPO-PASO ROBLES (CA)	$512.93	$53.36
SANTA MARIA-SANTA BARBARA (CA)	$524.49	$54.03
REST OF CALIFORNIA (CA)	$495.25	$53.03
COLORADO (CO)	$482.86	$53.56
CONNECTICUT (CT)	$490.26	$55.71
DC + MD/VA SUBURBS (DC)	$532.82	$57.52
DELAWARE (DE)	$451.79	$53.15
FORT LAUDERDALE (FL)	$465.51	$56.78
MIAMI (FL)	$479.91	$59.88
REST OF FLORIDA (FL)	$440.85	$55.12
ATLANTA (GA)	$464.43	$54.50
REST OF GEORGIA (GA)	$413.29	$53.38
HAWAII, GUAM (HI)	$511.57	$52.81
IOWA (IA)	$419.56	$50.37
IDAHO (ID)	$421.92	$50.71
EAST ST. LOUIS (IL)	$428.10	$56.89
SUBURBAN CHICAGO (IL)	$471.41	$57.04
CHICAGO (IL)	$464.46	$58.96
REST OF ILLINOIS (IL)	$423.41	$55.03
INDIANA (IN)	$424.85	$50.82
KANSAS (KS)	$415.46	$50.72
KENTUCKY (KY)	$410.94	$52.25
NEW ORLEANS (LA)	$433.21	$53.53
REST OF LOUISIANA (LA)	$409.47	$52.39
METROPOLITAN BOSTON (MA)	$537.96	$56.20
REST OF MASSACHUSETTS (MA)	$478.57	$53.70
BALTIMORE/SURR. CNTYS (MD)	$488.56	$55.62
REST OF MARYLAND (MD)	$461.95	$53.62
SOUTHERN MAINE (ME)	$451.74	$51.89
REST OF MAINE (ME)	$422.52	$51.31
DETROIT (MI)	$445.28	$55.92
REST OF MICHIGAN (MI)	$421.67	$53.29
MINNESOTA (MN)	$466.03	$50.84
METROPOLITAN ST. LOUIS (MO)	$437.20	$53.08
METROPOLITAN KANSAS CITY (MO)	$431.75	$52.88
REST OF MISSOURI (MO)	$400.08	$52.28
MISSISSIPPI (MS)	$398.73	$51.33
MONTANA** (MT)	$456.92	$53.43
NORTH CAROLINA (NC)	$427.93	$51.48
NORTH DAKOTA** (ND)	$454.54	$51.06
NEBRASKA (NE)	$422.77	$50.36
NEW HAMPSHIRE (NH)	$473.28	$53.26
NORTHERN NJ (NJ)	$525.61	$57.57
REST OF NEW JERSEY (NJ)	$496.81	$56.21
NEW MEXICO (NM)	$423.60	$53.61
NEVADA** (NV)	$456.67	$52.78
MANHATTAN (NY)	$528.55	$59.71
NYC SUBURBS/LONG ISLAND (NY)	$540.74	$61.00
POUGHKPSIE/N NYC SUBURBS (NY)	$498.71	$56.89
QUEENS (NY)	$536.20	$59.28
REST OF NEW YORK (NY)	$435.18	$51.87
OHIO (OH)	$421.19	$52.81
OKLAHOMA (OK)	$412.04	$51.73
PORTLAND (OR)	$502.21	$53.94
REST OF OREGON (OR)	$454.09	$52.22
METROPOLITAN PHILADELPHIA (PA)	$475.31	$55.28
REST OF PENNSYLVANIA (PA)	$422.99	$52.59
PUERTO RICO (PR)	$461.39	$53.47
RHODE ISLAND (RI)	$470.85	$54.06
SOUTH CAROLINA (SC)	$425.07	$52.26
SOUTH DAKOTA** (SD)	$454.26	$50.78
TENNESSEE (TN)	$417.65	$50.89
BRAZORIA (TX)	$452.68	$52.82
DALLAS (TX)	$455.09	$53.22
GALVESTON (TX)	$453.69	$53.03
HOUSTON (TX)	$455.89	$55.23
BEAUMONT (TX)	$419.63	$52.47
FORT WORTH (TX)	$451.03	$53.19
AUSTIN (TX)	$480.40	$53.51
REST OF TEXAS (TX)	$435.57	$52.66
UTAH (UT)	$431.85	$52.57
VIRGINIA (VA)	$448.76	$52.13
VIRGIN ISLANDS (VI)	$461.39	$53.47
VERMONT (VT)	$450.83	$51.38
SEATTLE (KING CNTY) (WA)	$551.61	$56.54
REST OF WASHINGTON (WA)	$478.30	$53.43
WISCONSIN (WI)	$436.88	$50.35
WEST VIRGINIA (WV)	$404.79	$54.16
WYOMING** (WY)	$455.88	$52.40

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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 PFS amount is built from 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 Medicare conversion factor to produce a dollar amount. Non-facility and facility rates differ mainly because the practice-expense RVU is higher in non-facility settings, reflecting the overhead a provider absorbs when a service is not performed in a hospital or facility setting. The national amount uses a GPCI of 1.0 for all components, while locality-specific amounts reflect local cost variations.

RVUs — work 1.25, practice expense 12.31 (non-facility) / 0.23 (facility), malpractice 0.12 — × 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 insurer is responsible for the remainder.
Actual payment can vary based on locality, applicable modifiers, place of service, 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 is the facility amount lower than the non-facility amount?

In a facility setting, the hospital or facility bears most of the overhead costs (equipment, supplies, staff), so the practice-expense RVU assigned to the physician's service is lower, resulting in a lower PFS payment to the billing provider.

Does this amount reflect what my practice will actually be paid?

Not exactly. It's a PFS estimate based on national or locality-specific GPCIs and the current conversion factor; your actual payment may differ due to your specific locality, any applicable modifiers, and other adjustments like sequestration.

Why can't you show the CPT code's official description?

CPT code descriptors are copyrighted by the American Medical Association (AMA) and cannot be reproduced without a license, so this page refers to the code generically.

What is the conversion factor and why does it matter?

The conversion factor is a dollar multiplier set annually by CMS that converts the total adjusted RVUs into a payment amount; it changes each year and directly affects every PFS-priced code.

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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.