Medicare Reimbursement for CPT 19301

CPT 19301 is a surgical procedure code reported to Medicare for physician and outpatient billing. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code at the national level and adjusted for your locality, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$632.61	$632.61
ALASKA* (AK)	$773.68	$773.68
ALABAMA (AL)	$568.57	$568.57
ARKANSAS (AR)	$560.76	$560.76
ARIZONA (AZ)	$613.65	$613.65
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$704.47	$704.47
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$714.01	$714.01
OXNARD-THOUSAND OAKS-VENTURA (CA)	$649.50	$649.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$657.49	$657.49
NAPA (CA)	$680.91	$680.91
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$707.35	$707.35
VALLEJO (CA)	$676.76	$676.76
BAKERSFIELD (CA)	$626.62	$626.62
CHICO (CA)	$619.76	$619.76
FRESNO (CA)	$619.76	$619.76
HANFORD-CORCORAN (CA)	$619.76	$619.76
MADERA (CA)	$619.76	$619.76
MERCED (CA)	$619.76	$619.76
MODESTO (CA)	$619.76	$619.76
REDDING (CA)	$619.76	$619.76
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$646.99	$646.99
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$640.63	$640.63
SALINAS (CA)	$638.10	$638.10
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$725.80	$725.80
SANTA CRUZ-WATSONVILLE (CA)	$647.00	$647.00
SANTA ROSA-PETALUMA (CA)	$652.80	$652.80
STOCKTON (CA)	$619.76	$619.76
VISALIA (CA)	$619.76	$619.76
YUBA CITY (CA)	$619.76	$619.76
EL CENTRO (CA)	$620.19	$620.19
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$646.34	$646.34
SAN LUIS OBISPO-PASO ROBLES (CA)	$629.13	$629.13
SANTA MARIA-SANTA BARBARA (CA)	$638.64	$638.64
REST OF CALIFORNIA (CA)	$619.76	$619.76
COLORADO (CO)	$631.93	$631.93
CONNECTICUT (CT)	$673.80	$673.80
DC + MD/VA SUBURBS (DC)	$698.78	$698.78
DELAWARE (DE)	$623.08	$623.08
FORT LAUDERDALE (FL)	$703.99	$703.99
MIAMI (FL)	$771.26	$771.26
REST OF FLORIDA (FL)	$665.70	$665.70
ATLANTA (GA)	$654.14	$654.14
REST OF GEORGIA (GA)	$625.38	$625.38
HAWAII, GUAM (HI)	$626.73	$626.73
IOWA (IA)	$562.94	$562.94
IDAHO (ID)	$570.48	$570.48
EAST ST. LOUIS (IL)	$701.22	$701.22
SUBURBAN CHICAGO (IL)	$706.30	$706.30
CHICAGO (IL)	$745.88	$745.88
REST OF ILLINOIS (IL)	$661.43	$661.43
INDIANA (IN)	$573.11	$573.11
KANSAS (KS)	$569.63	$569.63
KENTUCKY (KY)	$601.23	$601.23
NEW ORLEANS (LA)	$631.30	$631.30
REST OF LOUISIANA (LA)	$604.01	$604.01
METROPOLITAN BOSTON (MA)	$679.06	$679.06
REST OF MASSACHUSETTS (MA)	$632.21	$632.21
BALTIMORE/SURR. CNTYS (MD)	$673.90	$673.90
REST OF MARYLAND (MD)	$631.57	$631.57
SOUTHERN MAINE (ME)	$599.35	$599.35
REST OF MAINE (ME)	$583.12	$583.12
DETROIT (MI)	$683.19	$683.19
REST OF MICHIGAN (MI)	$624.61	$624.61
MINNESOTA (MN)	$579.20	$579.20
METROPOLITAN ST. LOUIS (MO)	$622.33	$622.33
METROPOLITAN KANSAS CITY (MO)	$617.38	$617.38
REST OF MISSOURI (MO)	$600.35	$600.35
MISSISSIPPI (MS)	$580.20	$580.20
MONTANA** (MT)	$632.44	$632.44
NORTH CAROLINA (NC)	$587.40	$587.40
NORTH DAKOTA** (ND)	$582.22	$582.22
NEBRASKA (NE)	$563.08	$563.08
NEW HAMPSHIRE (NH)	$630.94	$630.94
NORTHERN NJ (NJ)	$694.02	$694.02
REST OF NEW JERSEY (NJ)	$674.08	$674.08
NEW MEXICO (NM)	$631.59	$631.59
NEVADA** (NV)	$618.66	$618.66
MANHATTAN (NY)	$738.73	$738.73
NYC SUBURBS/LONG ISLAND (NY)	$767.60	$767.60
POUGHKPSIE/N NYC SUBURBS (NY)	$685.97	$685.97
QUEENS (NY)	$730.87	$730.87
REST OF NEW YORK (NY)	$596.53	$596.53
OHIO (OH)	$614.35	$614.35
OKLAHOMA (OK)	$590.39	$590.39
PORTLAND (OR)	$640.35	$640.35
REST OF OREGON (OR)	$606.54	$606.54
METROPOLITAN PHILADELPHIA (PA)	$663.86	$663.86
REST OF PENNSYLVANIA (PA)	$610.09	$610.09
PUERTO RICO (PR)	$633.74	$633.74
RHODE ISLAND (RI)	$636.91	$636.91
SOUTH CAROLINA (SC)	$603.34	$603.34
SOUTH DAKOTA** (SD)	$576.28	$576.28
TENNESSEE (TN)	$573.52	$573.52
BRAZORIA (TX)	$614.63	$614.63
DALLAS (TX)	$622.66	$622.66
GALVESTON (TX)	$619.14	$619.14
HOUSTON (TX)	$665.63	$665.63
BEAUMONT (TX)	$606.99	$606.99
FORT WORTH (TX)	$621.59	$621.59
AUSTIN (TX)	$636.23	$636.23
REST OF TEXAS (TX)	$613.28	$613.28
UTAH (UT)	$610.89	$610.89
VIRGINIA (VA)	$603.97	$603.97
VIRGIN ISLANDS (VI)	$633.74	$633.74
VERMONT (VT)	$588.53	$588.53
SEATTLE (KING CNTY) (WA)	$683.02	$683.02
REST OF WASHINGTON (WA)	$628.17	$628.17
WISCONSIN (WI)	$564.76	$564.76
WEST VIRGINIA (WV)	$640.65	$640.65
WYOMING** (WY)	$610.56	$610.56

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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

Medicare's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The locality-adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce the allowed amount. Practice expense RVUs typically differ between non-facility (e.g., office) and facility (e.g., hospital) settings, since overhead costs differ; for this code those values happen to be the same, so the non-facility and facility totals shown are equal. Work and malpractice RVUs generally do not change by place of service.

RVUs — work 9.88, practice expense 6.52 (non-facility) / 6.52 (facility), malpractice 2.54 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a payment guarantee.
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.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Locality assignment and GPCI values can shift year to year and affect the final figure.
Always confirm the current allowed amount and any applicable edits with your Medicare Administrative Contractor (MAC).

Frequently asked

Why do the non-facility and facility amounts look the same for this code?

The practice expense RVU used for this code is identical in both settings this year, so the calculated non-facility and facility allowed amounts come out equal. This can change in future years if CMS updates the RVUs.

Will my actual payment match the national amount shown?

Not necessarily. The national figure uses standardized GPCI inputs; your actual Medicare payment depends on the GPCIs for your specific locality, plus any modifiers or adjustments on the claim.

Does this amount reflect what the patient owes?

No. The allowed amount is the total Medicare-approved rate. After the deductible is met, Medicare generally pays 80%, and the patient or supplemental insurance covers the remaining 20%.

Why does the fee schedule amount change every year?

CMS updates RVUs, GPCIs, and the conversion factor annually, and may apply budget-neutrality adjustments, so the allowed amount for the same code can rise or fall 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.