Medicare Reimbursement for CPT Code 19296

CPT code 19296 is a procedure code defined by the American Medical Association; its specific clinical descriptor is not reproduced here due to licensing. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code 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)	$3993.41	$193.73
ALASKA* (AK)	$4288.97	$242.30
ALABAMA (AL)	$3499.73	$175.00
ARKANSAS (AR)	$3436.67	$172.74
ARIZONA (AZ)	$3869.88	$187.99
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$5563.86	$206.30
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$5687.83	$208.68
OXNARD-THOUSAND OAKS-VENTURA (CA)	$4685.20	$193.97
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$4691.81	$196.79
NAPA (CA)	$5208.82	$200.83
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$5564.88	$207.32
VALLEJO (CA)	$5207.34	$199.36
BAKERSFIELD (CA)	$4353.04	$188.58
CHICO (CA)	$4350.60	$186.15
FRESNO (CA)	$4350.60	$186.15
HANFORD-CORCORAN (CA)	$4350.60	$186.15
MADERA (CA)	$4350.60	$186.15
MERCED (CA)	$4350.60	$186.15
MODESTO (CA)	$4350.60	$186.15
REDDING (CA)	$4350.60	$186.15
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$4360.25	$195.80
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$4610.47	$191.44
SALINAS (CA)	$4594.50	$190.67
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$5692.01	$212.86
SANTA CRUZ-WATSONVILLE (CA)	$4808.65	$192.03
SANTA ROSA-PETALUMA (CA)	$4859.70	$193.68
STOCKTON (CA)	$4350.60	$186.15
VISALIA (CA)	$4350.60	$186.15
YUBA CITY (CA)	$4350.60	$186.15
EL CENTRO (CA)	$4350.75	$186.30
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$4736.83	$192.41
SAN LUIS OBISPO-PASO ROBLES (CA)	$4515.94	$188.10
SANTA MARIA-SANTA BARBARA (CA)	$4621.06	$190.63
REST OF CALIFORNIA (CA)	$4350.60	$186.15
COLORADO (CO)	$4234.33	$191.47
CONNECTICUT (CT)	$4298.16	$205.90
DC + MD/VA SUBURBS (DC)	$4687.62	$211.59
DELAWARE (DE)	$3944.83	$190.74
FORT LAUDERDALE (FL)	$4067.69	$218.60
MIAMI (FL)	$4197.02	$241.55
REST OF FLORIDA (FL)	$3839.35	$206.85
ATLANTA (GA)	$4061.33	$200.85
REST OF GEORGIA (GA)	$3583.91	$194.59
HAWAII, GUAM (HI)	$4507.54	$187.29
IOWA (IA)	$3648.45	$171.74
IDAHO (ID)	$3669.96	$174.25
EAST ST. LOUIS (IL)	$3716.28	$220.57
SUBURBAN CHICAGO (IL)	$4121.26	$218.99
CHICAGO (IL)	$4052.39	$233.71
REST OF ILLINOIS (IL)	$3675.81	$206.70
INDIANA (IN)	$3697.27	$174.96
KANSAS (KS)	$3609.37	$174.45
KENTUCKY (KY)	$3564.05	$186.13
NEW ORLEANS (LA)	$3770.64	$195.13
REST OF LOUISIANA (LA)	$3549.96	$187.24
METROPOLITAN BOSTON (MA)	$4740.90	$204.08
REST OF MASSACHUSETTS (MA)	$4192.99	$191.92
BALTIMORE/SURR. CNTYS (MD)	$4283.12	$206.06
REST OF MARYLAND (MD)	$4038.27	$192.99
SOUTHERN MAINE (ME)	$3947.71	$182.22
REST OF MAINE (ME)	$3674.44	$178.73
DETROIT (MI)	$3879.45	$212.76
REST OF MICHIGAN (MI)	$3662.76	$193.65
MINNESOTA (MN)	$4083.76	$173.88
METROPOLITAN ST. LOUIS (MO)	$3808.91	$191.60
METROPOLITAN KANSAS CITY (MO)	$3758.17	$190.26
REST OF MISSOURI (MO)	$3462.00	$186.67
MISSISSIPPI (MS)	$3451.10	$179.57
MONTANA** (MT)	$3993.35	$193.67
NORTH CAROLINA (NC)	$3724.94	$179.83
NORTH DAKOTA** (ND)	$3975.56	$175.87
NEBRASKA (NE)	$3678.64	$171.53
NEW HAMPSHIRE (NH)	$4147.30	$191.83
NORTHERN NJ (NJ)	$4618.12	$210.49
REST OF NEW JERSEY (NJ)	$4354.81	$205.55
NEW MEXICO (NM)	$3680.31	$196.00
NEVADA** (NV)	$3992.24	$188.75
MANHATTAN (NY)	$4641.50	$226.27
NYC SUBURBS/LONG ISLAND (NY)	$4753.47	$235.64
POUGHKPSIE/N NYC SUBURBS (NY)	$4370.33	$209.67
QUEENS (NY)	$4714.08	$222.85
REST OF NEW YORK (NY)	$3792.23	$182.53
OHIO (OH)	$3659.13	$190.01
OKLAHOMA (OK)	$3575.28	$182.16
PORTLAND (OR)	$4414.42	$192.96
REST OF OREGON (OR)	$3969.10	$184.62
METROPOLITAN PHILADELPHIA (PA)	$4158.99	$203.52
REST OF PENNSYLVANIA (PA)	$3676.46	$188.35
PUERTO RICO (PR)	$4035.26	$193.77
RHODE ISLAND (RI)	$4119.30	$194.22
SOUTH CAROLINA (SC)	$3696.67	$185.76
SOUTH DAKOTA** (SD)	$3973.45	$173.76
TENNESSEE (TN)	$3629.59	$175.67
BRAZORIA (TX)	$3953.14	$187.65
DALLAS (TX)	$3974.83	$190.34
GALVESTON (TX)	$3962.27	$189.18
HOUSTON (TX)	$3978.74	$205.66
BEAUMONT (TX)	$3645.22	$187.50
FORT WORTH (TX)	$3936.77	$190.28
AUSTIN (TX)	$4213.24	$193.17
REST OF TEXAS (TX)	$3794.40	$188.49
UTAH (UT)	$3759.64	$187.93
VIRGINIA (VA)	$3919.21	$184.12
VIRGIN ISLANDS (VI)	$4035.26	$193.77
VERMONT (VT)	$3940.11	$178.42
SEATTLE (KING CNTY) (WA)	$4866.66	$204.45
REST OF WASHINGTON (WA)	$4191.56	$190.49
WISCONSIN (WI)	$3811.11	$171.02
WEST VIRGINIA (WV)	$3502.66	$200.73
WYOMING** (WY)	$3985.60	$185.91

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit 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

The Medicare PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — that are each adjusted by Geographic Practice Cost Indices (GPCIs) specific to a locality to reflect regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar allowed 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 same code can have two different allowed amounts depending on place of service. The resulting figure is the Medicare-approved amount before the standard beneficiary cost-sharing is applied.

RVUs — work 3.54, practice expense 115.12 (non-facility) / 1.36 (facility), malpractice 0.9 — × 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 approved amount after the annual Part B deductible is met; the remaining 20% is patient or secondary-payer responsibility.
Actual payment varies by locality, applicable modifiers, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage policy with your Medicare Administrative Contractor (MAC).

Frequently asked

Why are there two different amounts for this code?

Medicare pays differently depending on place of service. The non-facility amount applies when the procedure is performed in a setting like a physician office, where the billing provider incurs the practice-expense overhead. The facility amount applies when performed in a hospital or other facility that bills its own overhead separately.

Does this amount reflect what Medicare actually pays?

It reflects the Medicare-approved amount under the Physician Fee Schedule. Medicare generally reimburses 80% of this amount after the deductible is met, with the remaining 20% coming from the beneficiary or secondary insurance.

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

Medicare applies locality-specific Geographic Practice Cost Indices (GPCIs) to the RVUs to account for regional differences in wages, rent, and malpractice costs, so the same code can pay more or less depending on where the service is furnished.

Can modifiers or policy changes affect this amount?

Yes. Modifiers (such as those for bilateral procedures or reduced services), annual conversion factor updates, sequestration, and budget-neutrality adjustments can all change the final payment amount from year to year.

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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.