Medicare Reimbursement for CPT 19294

CPT 19294 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code nationally and, where available, by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$147.97	$147.97
ALASKA* (AK)	$187.11	$187.11
ALABAMA (AL)	$133.86	$133.86
ARKANSAS (AR)	$132.17	$132.17
ARIZONA (AZ)	$143.54	$143.54
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$152.80	$152.80
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$154.35	$154.35
OXNARD-THOUSAND OAKS-VENTURA (CA)	$145.63	$145.63
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$147.97	$147.97
NAPA (CA)	$149.50	$149.50
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$153.66	$153.66
VALLEJO (CA)	$148.26	$148.26
BAKERSFIELD (CA)	$142.27	$142.27
CHICO (CA)	$140.22	$140.22
FRESNO (CA)	$140.22	$140.22
HANFORD-CORCORAN (CA)	$140.22	$140.22
MADERA (CA)	$140.22	$140.22
MERCED (CA)	$140.22	$140.22
MODESTO (CA)	$140.22	$140.22
REDDING (CA)	$140.22	$140.22
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$148.37	$148.37
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$143.74	$143.74
SALINAS (CA)	$143.15	$143.15
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$157.88	$157.88
SANTA CRUZ-WATSONVILLE (CA)	$143.56	$143.56
SANTA ROSA-PETALUMA (CA)	$144.76	$144.76
STOCKTON (CA)	$140.22	$140.22
VISALIA (CA)	$140.22	$140.22
YUBA CITY (CA)	$140.22	$140.22
EL CENTRO (CA)	$140.35	$140.35
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$144.12	$144.12
SAN LUIS OBISPO-PASO ROBLES (CA)	$141.29	$141.29
SANTA MARIA-SANTA BARBARA (CA)	$143.03	$143.03
REST OF CALIFORNIA (CA)	$140.22	$140.22
COLORADO (CO)	$145.16	$145.16
CONNECTICUT (CT)	$157.16	$157.16
DC + MD/VA SUBURBS (DC)	$160.52	$160.52
DELAWARE (DE)	$145.59	$145.59
FORT LAUDERDALE (FL)	$168.80	$168.80
MIAMI (FL)	$187.79	$187.79
REST OF FLORIDA (FL)	$159.65	$159.65
ATLANTA (GA)	$153.76	$153.76
REST OF GEORGIA (GA)	$150.17	$150.17
HAWAII, GUAM (HI)	$140.67	$140.67
IOWA (IA)	$130.56	$130.56
IDAHO (ID)	$132.61	$132.61
EAST ST. LOUIS (IL)	$171.73	$171.73
SUBURBAN CHICAGO (IL)	$168.92	$168.92
CHICAGO (IL)	$181.65	$181.65
REST OF ILLINOIS (IL)	$160.11	$160.11
INDIANA (IN)	$133.11	$133.11
KANSAS (KS)	$133.00	$133.00
KENTUCKY (KY)	$143.06	$143.06
NEW ORLEANS (LA)	$149.96	$149.96
REST OF LOUISIANA (LA)	$144.06	$144.06
METROPOLITAN BOSTON (MA)	$153.98	$153.98
REST OF MASSACHUSETTS (MA)	$145.69	$145.69
BALTIMORE/SURR. CNTYS (MD)	$157.35	$157.35
REST OF MARYLAND (MD)	$147.16	$147.16
SOUTHERN MAINE (ME)	$138.38	$138.38
REST OF MAINE (ME)	$136.39	$136.39
DETROIT (MI)	$164.51	$164.51
REST OF MICHIGAN (MI)	$149.09	$149.09
MINNESOTA (MN)	$130.81	$130.81
METROPOLITAN ST. LOUIS (MO)	$146.83	$146.83
METROPOLITAN KANSAS CITY (MO)	$145.87	$145.87
REST OF MISSOURI (MO)	$143.90	$143.90
MISSISSIPPI (MS)	$137.90	$137.90
MONTANA** (MT)	$147.92	$147.92
NORTH CAROLINA (NC)	$137.15	$137.15
NORTH DAKOTA** (ND)	$132.89	$132.89
NEBRASKA (NE)	$130.27	$130.27
NEW HAMPSHIRE (NH)	$145.81	$145.81
NORTHERN NJ (NJ)	$159.81	$159.81
REST OF NEW JERSEY (NJ)	$156.62	$156.62
NEW MEXICO (NM)	$151.02	$151.02
NEVADA** (NV)	$143.75	$143.75
MANHATTAN (NY)	$173.11	$173.11
NYC SUBURBS/LONG ISLAND (NY)	$180.66	$180.66
POUGHKPSIE/N NYC SUBURBS (NY)	$160.05	$160.05
QUEENS (NY)	$169.95	$169.95
REST OF NEW YORK (NY)	$139.19	$139.19
OHIO (OH)	$146.02	$146.02
OKLAHOMA (OK)	$139.66	$139.66
PORTLAND (OR)	$145.78	$145.78
REST OF OREGON (OR)	$140.33	$140.33
METROPOLITAN PHILADELPHIA (PA)	$155.64	$155.64
REST OF PENNSYLVANIA (PA)	$144.54	$144.54
PUERTO RICO (PR)	$147.86	$147.86
RHODE ISLAND (RI)	$147.90	$147.90
SOUTH CAROLINA (SC)	$142.28	$142.28
SOUTH DAKOTA** (SD)	$131.11	$131.11
TENNESSEE (TN)	$133.96	$133.96
BRAZORIA (TX)	$142.94	$142.94
DALLAS (TX)	$145.14	$145.14
GALVESTON (TX)	$144.21	$144.21
HOUSTON (TX)	$158.12	$158.12
BEAUMONT (TX)	$143.94	$143.94
FORT WORTH (TX)	$145.23	$145.23
AUSTIN (TX)	$146.70	$146.70
REST OF TEXAS (TX)	$144.24	$144.24
UTAH (UT)	$143.89	$143.89
VIRGINIA (VA)	$140.08	$140.08
VIRGIN ISLANDS (VI)	$147.86	$147.86
VERMONT (VT)	$135.18	$135.18
SEATTLE (KING CNTY) (WA)	$153.82	$153.82
REST OF WASHINGTON (WA)	$144.48	$144.48
WISCONSIN (WI)	$129.36	$129.36
WEST VIRGINIA (WV)	$155.67	$155.67
WYOMING** (WY)	$141.37	$141.37

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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 a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Index (GPCI) values for the specific locality where the service is furnished, reflecting local cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce the allowed amount. Non-facility and facility rates can differ because practice-expense RVUs are typically lower in a facility setting, where the facility itself bears more of the overhead cost.

RVUs — work 2.93, practice expense 0.74 (non-facility) / 0.74 (facility), malpractice 0.76 — × 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 beneficiary or secondary payer is responsible for the remainder.
Modifiers, place of service, sequestration, and annual budget-neutrality adjustments can change the actual paid amount.
Locality-specific GPCIs can cause real payment to differ meaningfully from the national average shown here.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC).

Frequently asked

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

The two amounts differ because practice-expense RVUs are generally lower in facility settings, since the facility (not the billing physician) absorbs a larger share of overhead costs like equipment and staff.

Does this amount reflect what my specific Medicare contractor will pay?

Not exactly. The figure shown is derived from the national PFS formula; actual payment depends on your locality's GPCIs, any applicable modifiers, and current MAC policies.

Why isn't the CPT code description shown here?

CPT code descriptors are copyrighted and licensed by the American Medical Association, so this page cannot reproduce the official descriptor text.

Will the patient's cost-sharing reduce what the practice collects?

Yes. Medicare generally pays 80% of the allowed amount after the deductible, with the patient or a secondary payer typically responsible for the remaining 20%.

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.