Medicare Reimbursement for CPT 19318

CPT 19318 is a physician procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare allowed amount for this code nationally and by locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$980.32	$980.32
ALASKA* (AK)	$1220.31	$1220.31
ALABAMA (AL)	$892.48	$892.48
ARKANSAS (AR)	$881.69	$881.69
ARIZONA (AZ)	$954.94	$954.94
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1120.41	$1120.41
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1136.98	$1136.98
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1023.07	$1023.07
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1034.27	$1034.27
NAPA (CA)	$1078.85	$1078.85
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1123.78	$1123.78
VALLEJO (CA)	$1074.01	$1074.01
BAKERSFIELD (CA)	$986.08	$986.08
CHICO (CA)	$977.82	$977.82
FRESNO (CA)	$977.82	$977.82
HANFORD-CORCORAN (CA)	$977.82	$977.82
MADERA (CA)	$977.82	$977.82
MERCED (CA)	$977.82	$977.82
MODESTO (CA)	$977.82	$977.82
REDDING (CA)	$977.82	$977.82
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1009.68	$1009.68
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1011.82	$1011.82
SALINAS (CA)	$1007.77	$1007.77
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1150.72	$1150.72
SANTA CRUZ-WATSONVILLE (CA)	$1022.68	$1022.68
SANTA ROSA-PETALUMA (CA)	$1032.05	$1032.05
STOCKTON (CA)	$977.82	$977.82
VISALIA (CA)	$977.82	$977.82
YUBA CITY (CA)	$977.82	$977.82
EL CENTRO (CA)	$978.31	$978.31
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1021.14	$1021.14
SAN LUIS OBISPO-PASO ROBLES (CA)	$993.27	$993.27
SANTA MARIA-SANTA BARBARA (CA)	$1008.72	$1008.72
REST OF CALIFORNIA (CA)	$977.82	$977.82
COLORADO (CO)	$987.93	$987.93
CONNECTICUT (CT)	$1039.19	$1039.19
DC + MD/VA SUBURBS (DC)	$1083.65	$1083.65
DELAWARE (DE)	$968.63	$968.63
FORT LAUDERDALE (FL)	$1064.87	$1064.87
MIAMI (FL)	$1146.22	$1146.22
REST OF FLORIDA (FL)	$1014.23	$1014.23
ATLANTA (GA)	$1007.51	$1007.51
REST OF GEORGIA (GA)	$960.48	$960.48
HAWAII, GUAM (HI)	$987.93	$987.93
IOWA (IA)	$890.15	$890.15
IDAHO (ID)	$899.46	$899.46
EAST ST. LOUIS (IL)	$1051.82	$1051.82
SUBURBAN CHICAGO (IL)	$1070.00	$1070.00
CHICAGO (IL)	$1113.80	$1113.80
REST OF ILLINOIS (IL)	$1004.71	$1004.71
INDIANA (IN)	$903.26	$903.26
KANSAS (KS)	$896.78	$896.78
KENTUCKY (KY)	$932.02	$932.02
NEW ORLEANS (LA)	$972.56	$972.56
REST OF LOUISIANA (LA)	$934.83	$934.83
METROPOLITAN BOSTON (MA)	$1060.57	$1060.57
REST OF MASSACHUSETTS (MA)	$987.65	$987.65
BALTIMORE/SURR. CNTYS (MD)	$1038.34	$1038.34
REST OF MARYLAND (MD)	$981.74	$981.74
SOUTHERN MAINE (ME)	$940.60	$940.60
REST OF MAINE (ME)	$914.19	$914.19
DETROIT (MI)	$1035.56	$1035.56
REST OF MICHIGAN (MI)	$961.80	$961.80
MINNESOTA (MN)	$921.14	$921.14
METROPOLITAN ST. LOUIS (MO)	$963.26	$963.26
METROPOLITAN KANSAS CITY (MO)	$956.12	$956.12
REST OF MISSOURI (MO)	$928.15	$928.15
MISSISSIPPI (MS)	$904.56	$904.56
MONTANA** (MT)	$980.12	$980.12
NORTH CAROLINA (NC)	$920.55	$920.55
NORTH DAKOTA** (ND)	$921.59	$921.59
NEBRASKA (NE)	$891.15	$891.15
NEW HAMPSHIRE (NH)	$982.69	$982.69
NORTHERN NJ (NJ)	$1077.43	$1077.43
REST OF NEW JERSEY (NJ)	$1043.85	$1043.85
NEW MEXICO (NM)	$970.36	$970.36
NEVADA** (NV)	$964.17	$964.17
MANHATTAN (NY)	$1129.89	$1129.89
NYC SUBURBS/LONG ISLAND (NY)	$1166.38	$1166.38
POUGHKPSIE/N NYC SUBURBS (NY)	$1058.71	$1058.71
QUEENS (NY)	$1122.84	$1122.84
REST OF NEW YORK (NY)	$932.98	$932.98
OHIO (OH)	$949.84	$949.84
OKLAHOMA (OK)	$919.81	$919.81
PORTLAND (OR)	$1003.25	$1003.25
REST OF OREGON (OR)	$949.52	$949.52
METROPOLITAN PHILADELPHIA (PA)	$1023.53	$1023.53
REST OF PENNSYLVANIA (PA)	$945.41	$945.41
PUERTO RICO (PR)	$982.79	$982.79
RHODE ISLAND (RI)	$991.42	$991.42
SOUTH CAROLINA (SC)	$938.17	$938.17
SOUTH DAKOTA** (SD)	$914.67	$914.67
TENNESSEE (TN)	$901.84	$901.84
BRAZORIA (TX)	$959.51	$959.51
DALLAS (TX)	$969.54	$969.54
GALVESTON (TX)	$964.97	$964.97
HOUSTON (TX)	$1019.15	$1019.15
BEAUMONT (TX)	$940.95	$940.95
FORT WORTH (TX)	$967.23	$967.23
AUSTIN (TX)	$990.93	$990.93
REST OF TEXAS (TX)	$952.40	$952.40
UTAH (UT)	$948.67	$948.67
VIRGINIA (VA)	$945.14	$945.14
VIRGIN ISLANDS (VI)	$982.79	$982.79
VERMONT (VT)	$927.88	$927.88
SEATTLE (KING CNTY) (WA)	$1069.91	$1069.91
REST OF WASHINGTON (WA)	$982.52	$982.52
WISCONSIN (WI)	$896.81	$896.81
WEST VIRGINIA (WV)	$975.85	$975.85
WYOMING** (WY)	$954.61	$954.61

Look up another code or locality →

Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. 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 — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. These locality-adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility and facility settings can differ because practice-expense RVUs account for whether overhead costs (equipment, supplies, staff) are borne by the billing practice or by a facility such as a hospital. The final figure represents the full allowed amount before any patient cost-sharing is applied.

RVUs — work 15.63, practice expense 10.76 (non-facility) / 10.76 (facility), malpractice 2.96 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This amount is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the patient's 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 actual paid amount.
Locality-specific GPCIs mean the amount can vary significantly by geographic region.
Always confirm current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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

The two amounts can differ because practice-expense RVUs account for where overhead costs are incurred — in a physician's own office versus a hospital or facility setting. For some codes these amounts are equal, as shown here, while for others they diverge based on typical site-of-service costs.

Is this the amount my practice will actually receive?

No. This is the Medicare PFS allowed amount estimate. Actual reimbursement depends on your specific locality GPCIs, any applicable modifiers, sequestration, secondary payer coordination, and the patient meeting their deductible.

Why do amounts change from year to year?

RVUs, GPCIs, and the conversion factor are reviewed and updated annually by CMS, often due to budget-neutrality adjustments, coding changes, or legislative action, which can raise or lower the allowed amount.

Where can I verify the exact rate for my area?

Your Medicare Administrative Contractor (MAC) publishes locality-specific fee schedules and can confirm the exact allowed amount for your billing region.

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.