Medicare Reimbursement for CPT 19396
CPT 19396 is a physician procedure code reimbursed under the Medicare Physician Fee Schedule (PFS). This page shows the estimated Medicare-allowed amount nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.
Medicare allowed amount (2026)
| Locality | Non-facility | Facility |
|---|---|---|
| National (unadjusted) | $291.59 | $126.26 |
| ALASKA* (AK) | $334.65 | $158.57 |
| ALABAMA (AL) | $259.97 | $115.30 |
| ARKANSAS (AR) | $255.98 | $113.96 |
| ARIZONA (AZ) | $283.27 | $123.06 |
| SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA) | $376.01 | $142.88 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA) | $383.35 | $144.94 |
| OXNARD-THOUSAND OAKS-VENTURA (CA) | $326.47 | $131.05 |
| LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA) | $328.14 | $132.54 |
| NAPA (CA) | $355.71 | $137.80 |
| SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA) | $376.45 | $143.33 |
| VALLEJO (CA) | $355.07 | $137.16 |
| BAKERSFIELD (CA) | $307.79 | $126.58 |
| CHICO (CA) | $306.69 | $125.49 |
| FRESNO (CA) | $306.69 | $125.49 |
| HANFORD-CORCORAN (CA) | $306.69 | $125.49 |
| MADERA (CA) | $306.69 | $125.49 |
| MERCED (CA) | $306.69 | $125.49 |
| MODESTO (CA) | $306.69 | $125.49 |
| REDDING (CA) | $306.69 | $125.49 |
| RIVERSIDE-SAN BERNARDINO-ONTARIO (CA) | $310.89 | $129.69 |
| SACRAMENTO-ROSEVILLE-FOLSOM (CA) | $321.96 | $129.67 |
| SALINAS (CA) | $320.77 | $129.15 |
| SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA) | $385.16 | $146.75 |
| SANTA CRUZ-WATSONVILLE (CA) | $331.70 | $130.82 |
| SANTA ROSA-PETALUMA (CA) | $335.04 | $132.01 |
| STOCKTON (CA) | $306.69 | $125.49 |
| VISALIA (CA) | $306.69 | $125.49 |
| YUBA CITY (CA) | $306.69 | $125.49 |
| EL CENTRO (CA) | $306.76 | $125.55 |
| SAN DIEGO-CHULA VISTA-CARLSBAD (CA) | $328.47 | $130.73 |
| SAN LUIS OBISPO-PASO ROBLES (CA) | $315.63 | $127.31 |
| SANTA MARIA-SANTA BARBARA (CA) | $322.02 | $129.24 |
| REST OF CALIFORNIA (CA) | $306.69 | $125.49 |
| COLORADO (CO) | $302.88 | $126.97 |
| CONNECTICUT (CT) | $311.74 | $133.67 |
| DC + MD/VA SUBURBS (DC) | $333.87 | $139.10 |
| DELAWARE (DE) | $288.14 | $124.78 |
| FORT LAUDERDALE (FL) | $304.82 | $137.33 |
| MIAMI (FL) | $320.03 | $147.91 |
| REST OF FLORIDA (FL) | $289.00 | $130.94 |
| ATLANTA (GA) | $297.74 | $129.76 |
| REST OF GEORGIA (GA) | $271.65 | $124.18 |
| HAWAII, GUAM (HI) | $314.57 | $126.58 |
| IOWA (IA) | $266.08 | $114.79 |
| IDAHO (ID) | $268.10 | $116.00 |
| EAST ST. LOUIS (IL) | $288.18 | $136.07 |
| SUBURBAN CHICAGO (IL) | $307.75 | $137.95 |
| CHICAGO (IL) | $309.99 | $143.83 |
| REST OF ILLINOIS (IL) | $280.85 | $129.90 |
| INDIANA (IN) | $269.73 | $116.46 |
| KANSAS (KS) | $265.18 | $115.72 |
| KENTUCKY (KY) | $267.42 | $120.44 |
| NEW ORLEANS (LA) | $281.10 | $125.52 |
| REST OF LOUISIANA (LA) | $267.15 | $120.83 |
| METROPOLITAN BOSTON (MA) | $333.36 | $135.96 |
| REST OF MASSACHUSETTS (MA) | $301.09 | $126.99 |
| BALTIMORE/SURR. CNTYS (MD) | $310.98 | $133.57 |
| REST OF MARYLAND (MD) | $293.72 | $126.40 |
| SOUTHERN MAINE (ME) | $284.91 | $121.07 |
| REST OF MAINE (ME) | $270.05 | $117.94 |
| DETROIT (MI) | $293.25 | $133.71 |
| REST OF MICHIGAN (MI) | $275.20 | $124.25 |
| MINNESOTA (MN) | $288.44 | $118.32 |
| METROPOLITAN ST. LOUIS (MO) | $281.64 | $124.25 |
| METROPOLITAN KANSAS CITY (MO) | $278.62 | $123.37 |
| REST OF MISSOURI (MO) | $262.58 | $120.06 |
| MISSISSIPPI (MS) | $259.31 | $116.96 |
| MONTANA** (MT) | $291.56 | $126.23 |
| NORTH CAROLINA (NC) | $272.97 | $118.71 |
| NORTH DAKOTA** (ND) | $283.85 | $118.52 |
| NEBRASKA (NE) | $267.49 | $114.89 |
| NEW HAMPSHIRE (NH) | $298.48 | $126.37 |
| NORTHERN NJ (NJ) | $330.18 | $138.39 |
| REST OF NEW JERSEY (NJ) | $314.80 | $134.25 |
| NEW MEXICO (NM) | $276.96 | $125.35 |
| NEVADA** (NV) | $289.62 | $124.12 |
| MANHATTAN (NY) | $337.41 | $145.29 |
| NYC SUBURBS/LONG ISLAND (NY) | $346.55 | $149.97 |
| POUGHKPSIE/N NYC SUBURBS (NY) | $317.25 | $136.21 |
| QUEENS (NY) | $339.69 | $144.27 |
| REST OF NEW YORK (NY) | $277.33 | $120.27 |
| OHIO (OH) | $273.62 | $122.67 |
| OKLAHOMA (OK) | $266.46 | $118.81 |
| PORTLAND (OR) | $312.45 | $128.76 |
| REST OF OREGON (OR) | $286.89 | $122.22 |
| METROPOLITAN PHILADELPHIA (PA) | $303.90 | $131.78 |
| REST OF PENNSYLVANIA (PA) | $273.84 | $122.06 |
| PUERTO RICO (PR) | $293.68 | $126.53 |
| RHODE ISLAND (RI) | $298.38 | $127.59 |
| SOUTH CAROLINA (SC) | $273.85 | $121.08 |
| SOUTH DAKOTA** (SD) | $282.94 | $117.61 |
| TENNESSEE (TN) | $266.65 | $116.36 |
| BRAZORIA (TX) | $287.42 | $123.57 |
| DALLAS (TX) | $289.55 | $124.87 |
| GALVESTON (TX) | $288.46 | $124.28 |
| HOUSTON (TX) | $295.60 | $131.42 |
| BEAUMONT (TX) | $271.97 | $121.51 |
| FORT WORTH (TX) | $287.64 | $124.62 |
| AUSTIN (TX) | $302.30 | $127.37 |
| REST OF TEXAS (TX) | $279.73 | $122.83 |
| UTAH (UT) | $277.80 | $122.38 |
| VIRGINIA (VA) | $284.23 | $121.70 |
| VIRGIN ISLANDS (VI) | $293.68 | $126.53 |
| VERMONT (VT) | $283.08 | $119.40 |
| SEATTLE (KING CNTY) (WA) | $339.91 | $137.04 |
| REST OF WASHINGTON (WA) | $300.41 | $126.31 |
| WISCONSIN (WI) | $273.85 | $115.46 |
| WEST VIRGINIA (WV) | $269.99 | $126.31 |
| WYOMING** (WY) | $288.20 | $122.87 |
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 PFS amounts are 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, then the adjusted RVUs are summed and multiplied by the annual Medicare conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (equipment, supplies, staff) are treated differently depending on where the service is rendered, which is why the two allowed amounts differ. These figures are recalculated annually and can shift due to CMS rule changes.
RVUs — work 2.12, practice expense 6.22 (non-facility) / 1.27 (facility), malpractice 0.39 — × 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 patient meets the annual Part B deductible; the patient or secondary insurer is responsible for the remainder.
- Actual payment can vary based on modifiers, place of service, sequestration reductions, and annual budget-neutrality adjustments.
- Always verify the final allowed amount with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.
Frequently asked
Why is the facility amount lower than the non-facility amount?
The facility rate uses lower practice-expense RVUs because Medicare assumes the facility (e.g., hospital) — not the physician's office — is absorbing certain overhead costs like equipment and supplies.
Does this amount apply in my locality?
No. The national figures are averages; the actual allowed amount depends on your locality's GPCI values, which adjust the RVUs for regional cost differences.
Will modifiers change this amount?
Yes, modifiers (such as bilateral, multiple procedure, or professional/technical component modifiers) can increase or decrease the allowed amount from the base PFS calculation shown here.
Why might the amount change next year?
CMS updates RVUs, GPCIs, and the conversion factor annually, and budget-neutrality adjustments required by law can shift allowed amounts even when RVUs stay the same.
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.
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