Medicare Reimbursement for CPT 19355

CPT 19355 is a physician procedure code (the specific descriptor is not shown here due to AMA licensing restrictions on CPT text). This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount 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)	$813.98	$562.14
ALASKA* (AK)	$961.36	$693.15
ALABAMA (AL)	$731.14	$510.77
ARKANSAS (AR)	$720.77	$504.43
ARIZONA (AZ)	$791.58	$547.54
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1009.94	$654.84
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1028.21	$665.05
OXNARD-THOUSAND OAKS-VENTURA (CA)	$890.81	$593.13
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$897.00	$599.07
NAPA (CA)	$960.65	$628.72
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1011.68	$656.58
VALLEJO (CA)	$958.15	$626.22
BAKERSFIELD (CA)	$845.86	$569.84
CHICO (CA)	$841.58	$565.56
FRESNO (CA)	$841.58	$565.56
HANFORD-CORCORAN (CA)	$841.58	$565.56
MADERA (CA)	$841.58	$565.56
MERCED (CA)	$841.58	$565.56
MODESTO (CA)	$841.58	$565.56
REDDING (CA)	$841.58	$565.56
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$858.05	$582.03
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$879.37	$586.47
SALINAS (CA)	$876.04	$584.15
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1035.31	$672.15
SANTA CRUZ-WATSONVILLE (CA)	$900.44	$594.45
SANTA ROSA-PETALUMA (CA)	$909.25	$599.98
STOCKTON (CA)	$841.58	$565.56
VISALIA (CA)	$841.58	$565.56
YUBA CITY (CA)	$841.58	$565.56
EL CENTRO (CA)	$841.83	$565.81
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$894.02	$592.82
SAN LUIS OBISPO-PASO ROBLES (CA)	$862.45	$575.60
SANTA MARIA-SANTA BARBARA (CA)	$878.60	$584.95
REST OF CALIFORNIA (CA)	$841.58	$565.56
COLORADO (CO)	$837.18	$569.22
CONNECTICUT (CT)	$867.63	$596.40
DC + MD/VA SUBURBS (DC)	$921.13	$624.46
DELAWARE (DE)	$804.38	$555.56
FORT LAUDERDALE (FL)	$861.58	$606.46
MIAMI (FL)	$912.01	$649.85
REST OF FLORIDA (FL)	$818.33	$577.57
ATLANTA (GA)	$832.85	$576.98
REST OF GEORGIA (GA)	$771.38	$546.73
HAWAII, GUAM (HI)	$858.95	$572.61
IOWA (IA)	$741.91	$511.48
IDAHO (ID)	$748.22	$516.53
EAST ST. LOUIS (IL)	$826.97	$595.28
SUBURBAN CHICAGO (IL)	$868.48	$609.84
CHICAGO (IL)	$884.53	$631.43
REST OF ILLINOIS (IL)	$800.53	$570.60
INDIANA (IN)	$752.28	$518.83
KANSAS (KS)	$742.04	$514.38
KENTUCKY (KY)	$755.77	$531.88
NEW ORLEANS (LA)	$792.30	$555.31
REST OF LOUISIANA (LA)	$756.02	$533.14
METROPOLITAN BOSTON (MA)	$913.89	$613.19
REST OF MASSACHUSETTS (MA)	$833.77	$568.58
BALTIMORE/SURR. CNTYS (MD)	$865.96	$595.73
REST OF MARYLAND (MD)	$818.39	$563.52
SOUTHERN MAINE (ME)	$790.75	$541.18
REST OF MAINE (ME)	$755.84	$524.14
DETROIT (MI)	$832.05	$589.02
REST OF MICHIGAN (MI)	$778.35	$548.42
MINNESOTA (MN)	$792.08	$532.93
METROPOLITAN ST. LOUIS (MO)	$790.79	$551.03
METROPOLITAN KANSAS CITY (MO)	$783.20	$546.72
REST OF MISSOURI (MO)	$745.68	$528.59
MISSISSIPPI (MS)	$733.18	$516.35
MONTANA** (MT)	$813.88	$562.03
NORTH CAROLINA (NC)	$763.02	$528.05
NORTH DAKOTA** (ND)	$783.62	$531.78
NEBRASKA (NE)	$744.82	$512.37
NEW HAMPSHIRE (NH)	$827.49	$565.32
NORTHERN NJ (NJ)	$912.59	$620.45
REST OF NEW JERSEY (NJ)	$874.69	$599.68
NEW MEXICO (NM)	$783.97	$553.03
NEVADA** (NV)	$805.93	$553.84
MANHATTAN (NY)	$940.31	$647.67
NYC SUBURBS/LONG ISLAND (NY)	$967.26	$667.82
POUGHKPSIE/N NYC SUBURBS (NY)	$883.31	$607.54
QUEENS (NY)	$942.66	$644.98
REST OF NEW YORK (NY)	$774.54	$535.29
OHIO (OH)	$772.17	$542.23
OKLAHOMA (OK)	$750.66	$525.76
PORTLAND (OR)	$859.21	$579.41
REST OF OREGON (OR)	$796.86	$546.03
METROPOLITAN PHILADELPHIA (PA)	$848.74	$586.57
REST OF PENNSYLVANIA (PA)	$771.37	$540.18
PUERTO RICO (PR)	$818.55	$563.94
RHODE ISLAND (RI)	$829.75	$569.60
SOUTH CAROLINA (SC)	$769.43	$536.73
SOUTH DAKOTA** (SD)	$780.05	$528.20
TENNESSEE (TN)	$746.16	$517.23
BRAZORIA (TX)	$800.59	$551.01
DALLAS (TX)	$807.28	$556.44
GALVESTON (TX)	$804.01	$553.93
HOUSTON (TX)	$832.02	$581.94
BEAUMONT (TX)	$766.67	$537.50
FORT WORTH (TX)	$803.09	$554.77
AUSTIN (TX)	$836.86	$570.41
REST OF TEXAS (TX)	$784.27	$545.27
UTAH (UT)	$779.65	$542.92
VIRGINIA (VA)	$790.71	$543.14
VIRGIN ISLANDS (VI)	$818.55	$563.94
VERMONT (VT)	$783.88	$534.56
SEATTLE (KING CNTY) (WA)	$928.67	$619.66
REST OF WASHINGTON (WA)	$831.10	$565.91
WISCONSIN (WI)	$758.23	$516.97
WEST VIRGINIA (WV)	$772.43	$553.58
WYOMING** (WY)	$800.69	$548.85

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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: 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 PFS amounts are built from three Relative Value Units (RVUs) assigned to a code: physician work, practice expense, and malpractice. Each RVU component is adjusted by the Geographic Practice Cost Indices (GPCIs) for the specific locality to reflect local cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar 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 two amounts shown differ. National figures use a GPCI value of 1.00 across all components and serve as a baseline before locality adjustment.

RVUs — work 8.31, practice expense 14.53 (non-facility) / 6.99 (facility), malpractice 1.53 — × 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 patient meets the annual Part B deductible; the patient or secondary payer is generally responsible for the rest.
Actual payment can vary by locality, applicable modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
Always verify current rates and coverage rules with your local Medicare Administrative Contractor (MAC).

Frequently asked

Why is the facility amount lower than the non-facility amount?

In the facility setting, Medicare assumes the facility (e.g., hospital) bears more of the overhead costs, so the practice-expense RVU used for this code is lower, resulting in a lower calculated amount.

Why might my local payment differ from the national figure shown?

The national amount assumes a GPCI of 1.00 for all cost components. Actual locality amounts are adjusted using local GPCIs for work, practice expense, and malpractice, which can raise or lower the total compared to the national baseline.

Does this amount include any modifier adjustments?

No. The figures shown reflect the base fee schedule calculation only; modifiers (e.g., bilateral, multiple procedure, assistant surgeon) can increase or decrease the final paid amount.

Will this be the exact amount my practice is paid?

Not necessarily. Sequestration, annual budget-neutrality adjustments, secondary payer rules, and contractor-specific policies can all affect the final reimbursement.

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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.