Medicare Reimbursement for CPT 19364

CPT 19364 is a physician procedure code reported to Medicare under the Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount nationally and by locality, broken out for non-facility and facility settings. Because this is a CPT code, the official procedure descriptor is not reproduced here due to AMA licensing restrictions.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$2369.46	$2369.46
ALASKA* (AK)	$2990.59	$2990.59
ALABAMA (AL)	$2164.78	$2164.78
ARKANSAS (AR)	$2139.79	$2139.79
ARIZONA (AZ)	$2309.07	$2309.07
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$2643.20	$2643.20
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$2679.55	$2679.55
OXNARD-THOUSAND OAKS-VENTURA (CA)	$2439.07	$2439.07
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$2468.68	$2468.68
NAPA (CA)	$2554.77	$2554.77
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$2652.20	$2652.20
VALLEJO (CA)	$2541.79	$2541.79
BAKERSFIELD (CA)	$2361.15	$2361.15
CHICO (CA)	$2339.04	$2339.04
FRESNO (CA)	$2339.04	$2339.04
HANFORD-CORCORAN (CA)	$2339.04	$2339.04
MADERA (CA)	$2339.04	$2339.04
MERCED (CA)	$2339.04	$2339.04
MODESTO (CA)	$2339.04	$2339.04
REDDING (CA)	$2339.04	$2339.04
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$2424.39	$2424.39
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$2413.48	$2413.48
SALINAS (CA)	$2403.68	$2403.68
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2716.37	$2716.37
SANTA CRUZ-WATSONVILLE (CA)	$2430.01	$2430.01
SANTA ROSA-PETALUMA (CA)	$2451.82	$2451.82
STOCKTON (CA)	$2339.04	$2339.04
VISALIA (CA)	$2339.04	$2339.04
YUBA CITY (CA)	$2339.04	$2339.04
EL CENTRO (CA)	$2340.37	$2340.37
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$2430.44	$2430.44
SAN LUIS OBISPO-PASO ROBLES (CA)	$2369.91	$2369.91
SANTA MARIA-SANTA BARBARA (CA)	$2404.54	$2404.54
REST OF CALIFORNIA (CA)	$2339.04	$2339.04
COLORADO (CO)	$2374.03	$2374.03
CONNECTICUT (CT)	$2508.09	$2508.09
DC + MD/VA SUBURBS (DC)	$2602.04	$2602.04
DELAWARE (DE)	$2341.03	$2341.03
FORT LAUDERDALE (FL)	$2592.81	$2592.81
MIAMI (FL)	$2803.87	$2803.87
REST OF FLORIDA (FL)	$2471.11	$2471.11
ATLANTA (GA)	$2438.34	$2438.34
REST OF GEORGIA (GA)	$2342.79	$2342.79
HAWAII, GUAM (HI)	$2356.29	$2356.29
IOWA (IA)	$2148.73	$2148.73
IDAHO (ID)	$2172.45	$2172.45
EAST ST. LOUIS (IL)	$2580.61	$2580.61
SUBURBAN CHICAGO (IL)	$2603.03	$2603.03
CHICAGO (IL)	$2725.76	$2725.76
REST OF ILLINOIS (IL)	$2456.13	$2456.13
INDIANA (IN)	$2180.92	$2180.92
KANSAS (KS)	$2169.18	$2169.18
KENTUCKY (KY)	$2267.27	$2267.27
NEW ORLEANS (LA)	$2363.13	$2363.13
REST OF LOUISIANA (LA)	$2275.79	$2275.79
METROPOLITAN BOSTON (MA)	$2536.43	$2536.43
REST OF MASSACHUSETTS (MA)	$2375.92	$2375.92
BALTIMORE/SURR. CNTYS (MD)	$2506.82	$2506.82
REST OF MARYLAND (MD)	$2370.22	$2370.22
SOUTHERN MAINE (ME)	$2265.26	$2265.26
REST OF MAINE (ME)	$2211.92	$2211.92
DETROIT (MI)	$2526.04	$2526.04
REST OF MICHIGAN (MI)	$2341.18	$2341.18
MINNESOTA (MN)	$2203.81	$2203.81
METROPOLITAN ST. LOUIS (MO)	$2335.54	$2335.54
METROPOLITAN KANSAS CITY (MO)	$2319.58	$2319.58
REST OF MISSOURI (MO)	$2263.52	$2263.52
MISSISSIPPI (MS)	$2200.56	$2200.56
MONTANA** (MT)	$2368.93	$2368.93
NORTH CAROLINA (NC)	$2225.75	$2225.75
NORTH DAKOTA** (ND)	$2212.13	$2212.13
NEBRASKA (NE)	$2149.44	$2149.44
NEW HAMPSHIRE (NH)	$2365.78	$2365.78
NORTHERN NJ (NJ)	$2589.69	$2589.69
REST OF NEW JERSEY (NJ)	$2516.66	$2516.66
NEW MEXICO (NM)	$2363.12	$2363.12
NEVADA** (NV)	$2325.94	$2325.94
MANHATTAN (NY)	$2729.71	$2729.71
NYC SUBURBS/LONG ISLAND (NY)	$2820.87	$2820.87
POUGHKPSIE/N NYC SUBURBS (NY)	$2555.68	$2555.68
QUEENS (NY)	$2705.92	$2705.92
REST OF NEW YORK (NY)	$2254.90	$2254.90
OHIO (OH)	$2309.13	$2309.13
OKLAHOMA (OK)	$2233.59	$2233.59
PORTLAND (OR)	$2403.52	$2403.52
REST OF OREGON (OR)	$2287.92	$2287.92
METROPOLITAN PHILADELPHIA (PA)	$2474.97	$2474.97
REST OF PENNSYLVANIA (PA)	$2296.03	$2296.03
PUERTO RICO (PR)	$2373.38	$2373.38
RHODE ISLAND (RI)	$2390.89	$2390.89
SOUTH CAROLINA (SC)	$2275.18	$2275.18
SOUTH DAKOTA** (SD)	$2193.59	$2193.59
TENNESSEE (TN)	$2181.51	$2181.51
BRAZORIA (TX)	$2315.82	$2315.82
DALLAS (TX)	$2341.46	$2341.46
GALVESTON (TX)	$2329.97	$2329.97
HOUSTON (TX)	$2475.12	$2475.12
BEAUMONT (TX)	$2286.05	$2286.05
FORT WORTH (TX)	$2337.72	$2337.72
AUSTIN (TX)	$2383.67	$2383.67
REST OF TEXAS (TX)	$2307.16	$2307.16
UTAH (UT)	$2299.38	$2299.38
VIRGINIA (VA)	$2279.39	$2279.39
VIRGIN ISLANDS (VI)	$2373.38	$2373.38
VERMONT (VT)	$2231.44	$2231.44
SEATTLE (KING CNTY) (WA)	$2553.27	$2553.27
REST OF WASHINGTON (WA)	$2362.23	$2362.23
WISCONSIN (WI)	$2156.02	$2156.02
WEST VIRGINIA (WV)	$2389.59	$2389.59
WYOMING** (WY)	$2300.59	$2300.59

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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 Physician Fee Schedule amount is built from three Relative Value Units (RVUs) — physician work, practice expense (PE), and malpractice (MP) — assigned to the code. Each RVU component is adjusted by a locality-specific Geographic Practice Cost Index (GPCI) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. The practice-expense RVU typically differs between non-facility (e.g., physician office) and facility (e.g., hospital) settings, which is why the two allowed amounts can differ — though for some codes, including this one, the practice-expense RVU is the same in both settings, resulting in equal estimates. These figures represent the full Medicare-approved amount before patient cost-sharing is applied.

RVUs — work 41.52, practice expense 21.49 (non-facility) / 21.49 (facility), malpractice 7.93 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on current-year RVUs, GPCIs, and the conversion factor — actual claim payment may differ.
Medicare typically pays 80% of the allowed amount after the patient's Part B deductible is met; the patient or secondary payer is generally responsible for the remainder.
Modifiers, multiple-procedure reductions, bilateral billing, sequestration, and mid-year budget-neutrality adjustments can all change the final paid amount.
Allowed amounts vary by locality; the figure shown for a specific locality may not match the national average.
Always confirm final payment policy and amounts with your Medicare Administrative Contractor (MAC).

Frequently asked

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

When the practice-expense RVU is identical for both settings, the calculated allowed amount comes out the same for non-facility and facility claims.

Does this amount reflect what Medicare actually pays?

It reflects the Medicare-allowed amount before cost-sharing. Medicare generally pays 80% of this amount after the deductible, with the remainder owed by the patient or a secondary payer.

Why might my MAC's payment differ from this estimate?

Local coverage policies, applied modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality changes can all cause the actual payment to differ from this calculated estimate.

Where can I find the official description for CPT 19364?

CPT code descriptors are copyrighted by the American Medical Association; consult the current CPT codebook or your practice management/coding software for the official language.

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.