Medicare Reimbursement for CPT 19367

CPT 19367 is a surgical procedure code reported to Medicare for payment purposes; the full code descriptor is licensed by the AMA and not reproduced here. This page shows the Medicare Physician Fee Schedule (PFS) estimated allowed amount at the national level and, where available, by locality, broken out for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1559.15	$1559.15
ALASKA* (AK)	$1956.89	$1956.89
ALABAMA (AL)	$1423.30	$1423.30
ARKANSAS (AR)	$1406.65	$1406.65
ARIZONA (AZ)	$1519.57	$1519.57
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1763.92	$1763.92
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1789.26	$1789.26
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1617.96	$1617.96
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1636.47	$1636.47
NAPA (CA)	$1701.19	$1701.19
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1769.43	$1769.43
VALLEJO (CA)	$1693.26	$1693.26
BAKERSFIELD (CA)	$1562.74	$1562.74
CHICO (CA)	$1549.17	$1549.17
FRESNO (CA)	$1549.17	$1549.17
HANFORD-CORCORAN (CA)	$1549.17	$1549.17
MADERA (CA)	$1549.17	$1549.17
MERCED (CA)	$1549.17	$1549.17
MODESTO (CA)	$1549.17	$1549.17
REDDING (CA)	$1549.17	$1549.17
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1601.39	$1601.39
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1600.88	$1600.88
SALINAS (CA)	$1594.42	$1594.42
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1811.78	$1811.78
SANTA CRUZ-WATSONVILLE (CA)	$1615.06	$1615.06
SANTA ROSA-PETALUMA (CA)	$1629.73	$1629.73
STOCKTON (CA)	$1549.17	$1549.17
VISALIA (CA)	$1549.17	$1549.17
YUBA CITY (CA)	$1549.17	$1549.17
EL CENTRO (CA)	$1549.98	$1549.98
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1613.92	$1613.92
SAN LUIS OBISPO-PASO ROBLES (CA)	$1571.72	$1571.72
SANTA MARIA-SANTA BARBARA (CA)	$1595.48	$1595.48
REST OF CALIFORNIA (CA)	$1549.17	$1549.17
COLORADO (CO)	$1567.71	$1567.71
CONNECTICUT (CT)	$1651.01	$1651.01
DC + MD/VA SUBURBS (DC)	$1717.93	$1717.93
DELAWARE (DE)	$1540.86	$1540.86
FORT LAUDERDALE (FL)	$1696.86	$1696.86
MIAMI (FL)	$1828.34	$1828.34
REST OF FLORIDA (FL)	$1617.56	$1617.56
ATLANTA (GA)	$1602.72	$1602.72
REST OF GEORGIA (GA)	$1533.62	$1533.62
HAWAII, GUAM (HI)	$1562.80	$1562.80
IOWA (IA)	$1416.90	$1416.90
IDAHO (ID)	$1431.83	$1431.83
EAST ST. LOUIS (IL)	$1681.46	$1681.46
SUBURBAN CHICAGO (IL)	$1704.48	$1704.48
CHICAGO (IL)	$1777.67	$1777.67
REST OF ILLINOIS (IL)	$1604.73	$1604.73
INDIANA (IN)	$1437.61	$1437.61
KANSAS (KS)	$1428.46	$1428.46
KENTUCKY (KY)	$1487.18	$1487.18
NEW ORLEANS (LA)	$1550.25	$1550.25
REST OF LOUISIANA (LA)	$1492.04	$1492.04
METROPOLITAN BOSTON (MA)	$1678.85	$1678.85
REST OF MASSACHUSETTS (MA)	$1568.03	$1568.03
BALTIMORE/SURR. CNTYS (MD)	$1649.79	$1649.79
REST OF MARYLAND (MD)	$1560.89	$1560.89
SOUTHERN MAINE (ME)	$1494.66	$1494.66
REST OF MAINE (ME)	$1455.97	$1455.97
DETROIT (MI)	$1651.93	$1651.93
REST OF MICHIGAN (MI)	$1534.43	$1534.43
MINNESOTA (MN)	$1460.32	$1460.32
METROPOLITAN ST. LOUIS (MO)	$1534.31	$1534.31
METROPOLITAN KANSAS CITY (MO)	$1523.44	$1523.44
REST OF MISSOURI (MO)	$1482.58	$1482.58
MISSISSIPPI (MS)	$1443.98	$1443.98
MONTANA** (MT)	$1558.83	$1558.83
NORTH CAROLINA (NC)	$1465.54	$1465.54
NORTH DAKOTA** (ND)	$1462.93	$1462.93
NEBRASKA (NE)	$1418.02	$1418.02
NEW HAMPSHIRE (NH)	$1560.40	$1560.40
NORTHERN NJ (NJ)	$1709.06	$1709.06
REST OF NEW JERSEY (NJ)	$1658.02	$1658.02
NEW MEXICO (NM)	$1548.19	$1548.19
NEVADA** (NV)	$1532.63	$1532.63
MANHATTAN (NY)	$1794.89	$1794.89
NYC SUBURBS/LONG ISLAND (NY)	$1852.95	$1852.95
POUGHKPSIE/N NYC SUBURBS (NY)	$1682.26	$1682.26
QUEENS (NY)	$1782.05	$1782.05
REST OF NEW YORK (NY)	$1484.82	$1484.82
OHIO (OH)	$1514.83	$1514.83
OKLAHOMA (OK)	$1466.92	$1466.92
PORTLAND (OR)	$1589.86	$1589.86
REST OF OREGON (OR)	$1508.94	$1508.94
METROPOLITAN PHILADELPHIA (PA)	$1627.63	$1627.63
REST OF PENNSYLVANIA (PA)	$1507.24	$1507.24
PUERTO RICO (PR)	$1562.49	$1562.49
RHODE ISLAND (RI)	$1575.55	$1575.55
SOUTH CAROLINA (SC)	$1495.00	$1495.00
SOUTH DAKOTA** (SD)	$1451.59	$1451.59
TENNESSEE (TN)	$1436.43	$1436.43
BRAZORIA (TX)	$1525.78	$1525.78
DALLAS (TX)	$1541.91	$1541.91
GALVESTON (TX)	$1534.60	$1534.60
HOUSTON (TX)	$1623.38	$1623.38
BEAUMONT (TX)	$1500.46	$1500.46
FORT WORTH (TX)	$1538.77	$1538.77
AUSTIN (TX)	$1572.85	$1572.85
REST OF TEXAS (TX)	$1516.70	$1516.70
UTAH (UT)	$1511.17	$1511.17
VIRGINIA (VA)	$1502.61	$1502.61
VIRGIN ISLANDS (VI)	$1562.49	$1562.49
VERMONT (VT)	$1473.88	$1473.88
SEATTLE (KING CNTY) (WA)	$1692.18	$1692.18
REST OF WASHINGTON (WA)	$1559.58	$1559.58
WISCONSIN (WI)	$1425.03	$1425.03
WEST VIRGINIA (WV)	$1560.28	$1560.28
WYOMING** (WY)	$1517.04	$1517.04

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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's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — assigned to each code. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is performed, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Non-facility (e.g., office) and facility (e.g., hospital) settings can have different practice-expense RVUs, which is why the two amounts may differ, since practice expense costs vary based on who bears overhead costs.

RVUs — work 26.13, practice expense 15.7 (non-facility) / 15.7 (facility), malpractice 4.85 — × 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 allowed amount after the annual Part B deductible is met; the patient or secondary insurer is generally responsible for the rest.
Actual payment can vary due to locality-specific GPCIs, applicable modifiers, claim-specific adjustments, sequestration, and annual budget-neutrality adjustments to RVUs or the conversion factor.
Always verify the current allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the amount shown differ from what my MAC actually paid?

The PFS amount here is a national/locality-level estimate using standard RVUs, GPCIs, and the conversion factor. Your MAC's actual payment may reflect additional adjustments such as modifiers, site-of-service differentials, sequestration, or local coverage determinations.

Why is there a difference (or no difference) between non-facility and facility amounts?

The difference, when present, comes from the practice-expense RVU component, which accounts for who incurs the overhead costs of performing the service — the physician's office versus a facility like a hospital.

Does this amount include the patient's share?

No. The figure represents the total Medicare-allowed amount. Medicare generally pays 80% of this after the deductible, with the remainder owed by the patient or secondary coverage.

Will this amount change during the year?

The conversion factor and RVUs are set annually but can be affected by legislative or budget-neutrality adjustments, so amounts should be periodically reverified against current CMS files.

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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.