Medicare Reimbursement for CPT 19297
CPT 19297 is a procedure code defined by the American Medical Association; its specific descriptor is not reproduced here due to licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount for this code, both nationally and adjusted for locality, and distinguishes non-facility (e.g., office) from facility (e.g., hospital) settings where applicable.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $83.17 | $83.17 |
| ALASKA* (AK) | $105.94 | $105.94 |
| ALABAMA (AL) | $75.55 | $75.55 |
| ARKANSAS (AR) | $74.64 | $74.64 |
| ARIZONA (AZ) | $80.78 | $80.78 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $86.10 | $86.10 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $86.99 | $86.99 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $82.01 | $82.01 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $83.31 | $83.31 |
| NAPA (CA) | $84.21 | $84.21 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $86.57 | $86.57 |
| VALLEJO (CA) | $83.54 | $83.54 |
| BAKERSFIELD (CA) | $80.16 | $80.16 |
| CHICO (CA) | $79.05 | $79.05 |
| FRESNO (CA) | $79.05 | $79.05 |
| HANFORD-CORCORAN (CA) | $79.05 | $79.05 |
| MADERA (CA) | $79.05 | $79.05 |
| MERCED (CA) | $79.05 | $79.05 |
| MODESTO (CA) | $79.05 | $79.05 |
| REDDING (CA) | $79.05 | $79.05 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $83.45 | $83.45 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $81.01 | $81.01 |
| SALINAS (CA) | $80.68 | $80.68 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $88.89 | $88.89 |
| SANTA CRUZ-WATSONVILLE (CA) | $80.86 | $80.86 |
| SANTA ROSA-PETALUMA (CA) | $81.54 | $81.54 |
| STOCKTON (CA) | $79.05 | $79.05 |
| VISALIA (CA) | $79.05 | $79.05 |
| YUBA CITY (CA) | $79.05 | $79.05 |
| EL CENTRO (CA) | $79.12 | $79.12 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $81.20 | $81.20 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $79.63 | $79.63 |
| SANTA MARIA-SANTA BARBARA (CA) | $80.60 | $80.60 |
| REST OF CALIFORNIA (CA) | $79.05 | $79.05 |
| COLORADO (CO) | $81.70 | $81.70 |
| CONNECTICUT (CT) | $88.20 | $88.20 |
| DC + MD/VA SUBURBS (DC) | $90.12 | $90.12 |
| DELAWARE (DE) | $81.91 | $81.91 |
| FORT LAUDERDALE (FL) | $94.41 | $94.41 |
| MIAMI (FL) | $104.65 | $104.65 |
| REST OF FLORIDA (FL) | $89.47 | $89.47 |
| ATLANTA (GA) | $86.30 | $86.30 |
| REST OF GEORGIA (GA) | $84.35 | $84.35 |
| HAWAII, GUAM (HI) | $79.23 | $79.23 |
| IOWA (IA) | $73.77 | $73.77 |
| IDAHO (ID) | $74.88 | $74.88 |
| EAST ST. LOUIS (IL) | $95.99 | $95.99 |
| SUBURBAN CHICAGO (IL) | $94.49 | $94.49 |
| CHICAGO (IL) | $101.36 | $101.36 |
| REST OF ILLINOIS (IL) | $89.72 | $89.72 |
| INDIANA (IN) | $75.15 | $75.15 |
| KANSAS (KS) | $75.09 | $75.09 |
| KENTUCKY (KY) | $80.52 | $80.52 |
| NEW ORLEANS (LA) | $84.24 | $84.24 |
| REST OF LOUISIANA (LA) | $81.06 | $81.06 |
| METROPOLITAN BOSTON (MA) | $86.55 | $86.55 |
| REST OF MASSACHUSETTS (MA) | $81.99 | $81.99 |
| BALTIMORE/SURR. CNTYS (MD) | $88.29 | $88.29 |
| REST OF MARYLAND (MD) | $82.77 | $82.77 |
| SOUTHERN MAINE (ME) | $77.99 | $77.99 |
| REST OF MAINE (ME) | $76.92 | $76.92 |
| DETROIT (MI) | $92.09 | $92.09 |
| REST OF MICHIGAN (MI) | $83.77 | $83.77 |
| MINNESOTA (MN) | $73.91 | $73.91 |
| METROPOLITAN ST. LOUIS (MO) | $82.55 | $82.55 |
| METROPOLITAN KANSAS CITY (MO) | $82.04 | $82.04 |
| REST OF MISSOURI (MO) | $80.97 | $80.97 |
| MISSISSIPPI (MS) | $77.74 | $77.74 |
| MONTANA** (MT) | $83.14 | $83.14 |
| NORTH CAROLINA (NC) | $77.33 | $77.33 |
| NORTH DAKOTA** (ND) | $75.03 | $75.03 |
| NEBRASKA (NE) | $73.62 | $73.62 |
| NEW HAMPSHIRE (NH) | $82.00 | $82.00 |
| NORTHERN NJ (NJ) | $89.77 | $89.77 |
| REST OF NEW JERSEY (NJ) | $87.97 | $87.97 |
| NEW MEXICO (NM) | $84.81 | $84.81 |
| NEVADA** (NV) | $80.89 | $80.89 |
| MANHATTAN (NY) | $96.95 | $96.95 |
| NYC SUBURBS/LONG ISLAND (NY) | $101.02 | $101.02 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $89.84 | $89.84 |
| QUEENS (NY) | $95.24 | $95.24 |
| REST OF NEW YORK (NY) | $78.43 | $78.43 |
| OHIO (OH) | $82.12 | $82.12 |
| OKLAHOMA (OK) | $78.68 | $78.68 |
| PORTLAND (OR) | $82.04 | $82.04 |
| REST OF OREGON (OR) | $79.05 | $79.05 |
| METROPOLITAN PHILADELPHIA (PA) | $87.37 | $87.37 |
| REST OF PENNSYLVANIA (PA) | $81.32 | $81.32 |
| PUERTO RICO (PR) | $83.11 | $83.11 |
| RHODE ISLAND (RI) | $83.20 | $83.20 |
| SOUTH CAROLINA (SC) | $80.10 | $80.10 |
| SOUTH DAKOTA** (SD) | $74.08 | $74.08 |
| TENNESSEE (TN) | $75.61 | $75.61 |
| BRAZORIA (TX) | $80.48 | $80.48 |
| DALLAS (TX) | $81.68 | $81.68 |
| GALVESTON (TX) | $81.17 | $81.17 |
| HOUSTON (TX) | $88.67 | $88.67 |
| BEAUMONT (TX) | $80.99 | $80.99 |
| FORT WORTH (TX) | $81.72 | $81.72 |
| AUSTIN (TX) | $82.49 | $82.49 |
| REST OF TEXAS (TX) | $81.16 | $81.16 |
| UTAH (UT) | $80.97 | $80.97 |
| VIRGINIA (VA) | $78.91 | $78.91 |
| VIRGIN ISLANDS (VI) | $83.11 | $83.11 |
| VERMONT (VT) | $76.27 | $76.27 |
| SEATTLE (KING CNTY) (WA) | $86.50 | $86.50 |
| REST OF WASHINGTON (WA) | $81.33 | $81.33 |
| WISCONSIN (WI) | $73.13 | $73.13 |
| WEST VIRGINIA (WV) | $87.32 | $87.32 |
| WYOMING** (WY) | $79.61 | $79.61 |
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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) — physician work, practice expense, and malpractice — which are each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed. The adjusted RVUs are summed and multiplied by the annual conversion factor (a national dollar figure set by CMS) to produce the allowed amount. Practice-expense RVUs typically differ between non-facility and facility settings because facility settings assume some costs are borne by the facility rather than the billing physician; for this code, the practice-expense RVU is the same in both settings, so the estimated payment does not differ by place of service. Conversion factors and RVUs are updated annually and can shift due to legislation or budget-neutrality adjustments.
RVUs — work 1.68, practice expense 0.4 (non-facility) / 0.4 (facility), malpractice 0.41 — × 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 patient meets their annual deductible; the patient or secondary payer is responsible for the remainder.
- Actual payment may vary due to modifiers, sequestration, locality-specific adjustments, and annual budget-neutrality changes.
- Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.
Frequently asked
Why is the non-facility and facility amount the same for this code?
For this particular code, the practice-expense RVU is identical in both settings, so the calculated allowed amount does not change based on place of service.
Why does the Medicare payment for this code vary by location?
Geographic Practice Cost Indices (GPCIs) adjust the work, practice-expense, and malpractice RVUs to reflect regional differences in costs of living and practice, so the same code can price differently across localities.
Does this page show what the patient or secondary insurer will pay?
No. This page shows the Medicare-allowed amount only. Medicare generally covers 80% after the deductible, with the remaining 20% owed by the patient or a secondary payer.
Why might the amount change from year to year?
CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments or legislative changes can alter the final allowed amount even if the code's RVUs stay the same.
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.
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