Medicare Reimbursement for CPT 19342

CPT 19342 is a surgical procedure code reported to Medicare for payment purposes; the specific clinical description is not reproduced here due to AMA licensing restrictions. This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both at the national level and adjusted for locality, with separate figures for non-facility and facility settings. All amounts shown are estimates based on the current year's published rates.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$694.40	$694.40
ALASKA* (AK)	$855.24	$855.24
ALABAMA (AL)	$630.56	$630.56
ARKANSAS (AR)	$622.68	$622.68
ARIZONA (AZ)	$676.25	$676.25
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$808.74	$808.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$821.33	$821.33
OXNARD-THOUSAND OAKS-VENTURA (CA)	$732.56	$732.56
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$739.90	$739.90
NAPA (CA)	$776.50	$776.50
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$810.91	$810.91
VALLEJO (CA)	$773.38	$773.38
BAKERSFIELD (CA)	$703.71	$703.71
CHICO (CA)	$698.37	$698.37
FRESNO (CA)	$698.37	$698.37
HANFORD-CORCORAN (CA)	$698.37	$698.37
MADERA (CA)	$698.37	$698.37
MERCED (CA)	$698.37	$698.37
MODESTO (CA)	$698.37	$698.37
REDDING (CA)	$698.37	$698.37
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$718.94	$718.94
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$724.24	$724.24
SALINAS (CA)	$721.38	$721.38
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$830.20	$830.20
SANTA CRUZ-WATSONVILLE (CA)	$734.16	$734.16
SANTA ROSA-PETALUMA (CA)	$740.99	$740.99
STOCKTON (CA)	$698.37	$698.37
VISALIA (CA)	$698.37	$698.37
YUBA CITY (CA)	$698.37	$698.37
EL CENTRO (CA)	$698.69	$698.69
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$732.12	$732.12
SAN LUIS OBISPO-PASO ROBLES (CA)	$710.81	$710.81
SANTA MARIA-SANTA BARBARA (CA)	$722.38	$722.38
REST OF CALIFORNIA (CA)	$698.37	$698.37
COLORADO (CO)	$703.04	$703.04
CONNECTICUT (CT)	$736.90	$736.90
DC + MD/VA SUBURBS (DC)	$771.53	$771.53
DELAWARE (DE)	$686.20	$686.20
FORT LAUDERDALE (FL)	$749.71	$749.71
MIAMI (FL)	$803.81	$803.81
REST OF FLORIDA (FL)	$713.77	$713.77
ATLANTA (GA)	$712.88	$712.88
REST OF GEORGIA (GA)	$675.41	$675.41
HAWAII, GUAM (HI)	$707.17	$707.17
IOWA (IA)	$631.35	$631.35
IDAHO (ID)	$637.64	$637.64
EAST ST. LOUIS (IL)	$735.95	$735.95
SUBURBAN CHICAGO (IL)	$753.85	$753.85
CHICAGO (IL)	$780.86	$780.86
REST OF ILLINOIS (IL)	$705.16	$705.16
INDIANA (IN)	$640.50	$640.50
KANSAS (KS)	$634.99	$634.99
KENTUCKY (KY)	$656.88	$656.88
NEW ORLEANS (LA)	$686.02	$686.02
REST OF LOUISIANA (LA)	$658.46	$658.46
METROPOLITAN BOSTON (MA)	$757.50	$757.50
REST OF MASSACHUSETTS (MA)	$702.25	$702.25
BALTIMORE/SURR. CNTYS (MD)	$736.10	$736.10
REST OF MARYLAND (MD)	$696.06	$696.06
SOUTHERN MAINE (ME)	$668.26	$668.26
REST OF MAINE (ME)	$647.15	$647.15
DETROIT (MI)	$728.04	$728.04
REST OF MICHIGAN (MI)	$677.47	$677.47
MINNESOTA (MN)	$657.88	$657.88
METROPOLITAN ST. LOUIS (MO)	$680.65	$680.65
METROPOLITAN KANSAS CITY (MO)	$675.29	$675.29
REST OF MISSOURI (MO)	$652.83	$652.83
MISSISSIPPI (MS)	$637.55	$637.55
MONTANA** (MT)	$694.28	$694.28
NORTH CAROLINA (NC)	$651.99	$651.99
NORTH DAKOTA** (ND)	$656.51	$656.51
NEBRASKA (NE)	$632.45	$632.45
NEW HAMPSHIRE (NH)	$698.29	$698.29
NORTHERN NJ (NJ)	$766.53	$766.53
REST OF NEW JERSEY (NJ)	$740.86	$740.86
NEW MEXICO (NM)	$683.22	$683.22
NEVADA** (NV)	$684.04	$684.04
MANHATTAN (NY)	$800.49	$800.49
NYC SUBURBS/LONG ISLAND (NY)	$825.59	$825.59
POUGHKPSIE/N NYC SUBURBS (NY)	$750.64	$750.64
QUEENS (NY)	$797.09	$797.09
REST OF NEW YORK (NY)	$660.99	$660.99
OHIO (OH)	$669.75	$669.75
OKLAHOMA (OK)	$649.23	$649.23
PORTLAND (OR)	$715.64	$715.64
REST OF OREGON (OR)	$674.30	$674.30
METROPOLITAN PHILADELPHIA (PA)	$724.72	$724.72
REST OF PENNSYLVANIA (PA)	$667.18	$667.18
PUERTO RICO (PR)	$696.63	$696.63
RHODE ISLAND (RI)	$703.55	$703.55
SOUTH CAROLINA (SC)	$662.85	$662.85
SOUTH DAKOTA** (SD)	$652.04	$652.04
TENNESSEE (TN)	$638.55	$638.55
BRAZORIA (TX)	$680.50	$680.50
DALLAS (TX)	$687.26	$687.26
GALVESTON (TX)	$684.14	$684.14
HOUSTON (TX)	$719.10	$719.10
BEAUMONT (TX)	$663.84	$663.84
FORT WORTH (TX)	$685.20	$685.20
AUSTIN (TX)	$704.59	$704.59
REST OF TEXAS (TX)	$673.46	$673.46
UTAH (UT)	$670.54	$670.54
VIRGINIA (VA)	$670.73	$670.73
VIRGIN ISLANDS (VI)	$696.63	$696.63
VERMONT (VT)	$660.00	$660.00
SEATTLE (KING CNTY) (WA)	$765.46	$765.46
REST OF WASHINGTON (WA)	$698.93	$698.93
WISCONSIN (WI)	$638.11	$638.11
WEST VIRGINIA (WV)	$684.01	$684.01
WYOMING** (WY)	$677.82	$677.82

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

Medicare's PFS amount is built from three Relative Value Units (RVUs): physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is furnished, accounting for regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar amount set by CMS) to produce the allowed amount. Non-facility and facility rates differ primarily in the practice-expense RVU, reflecting whether the provider or the facility bears the overhead costs of performing the service.

RVUs — work 10.22, practice expense 8.66 (non-facility) / 8.66 (facility), malpractice 1.91 — × 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 annual deductible is met; the patient or secondary payer is responsible for the remainder.
Actual payment can vary by locality, applicable modifiers, claim-specific adjustments, and sequestration reductions.
Annual budget-neutrality adjustments and RVU updates can change this amount from year to year.
Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

Why does the facility rate differ from the non-facility rate for this code?

The practice-expense RVU component differs because non-facility settings (like a physician's office) include overhead costs that facility settings (like a hospital) do not bill separately for.

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

Local wage and cost indices (GPCIs) adjust each RVU component to reflect the relative cost of providing care in that specific geographic area.

Does this amount reflect what Medicare actually pays?

No. This is the allowed amount before patient responsibility; Medicare generally pays 80% of it after the deductible, with the remainder owed by the patient or secondary insurance.

Can modifiers change this amount?

Yes. Certain modifiers (e.g., for bilateral procedures or reduced services) can increase or decrease the final payment relative to the base PFS amount shown here.

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.