Medicare Reimbursement for CPT 22319

This page covers CPT code 22319, a physician procedure code defined by the AMA (descriptor not shown here due to licensing restrictions). It displays the Medicare Physician Fee Schedule (PFS) estimated allowed amount for 2026, both nationally and adjustable by locality, and compares non-facility and facility payment settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$1809.99	$1809.99
ALASKA* (AK)	$2107.29	$2107.29
ALABAMA (AL)	$1579.12	$1579.12
ARKANSAS (AR)	$1551.16	$1551.16
ARIZONA (AZ)	$1740.06	$1740.06
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$1948.74	$1948.74
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1971.71	$1971.71
OXNARD-THOUSAND OAKS-VENTURA (CA)	$1817.44	$1817.44
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$1843.10	$1843.10
NAPA (CA)	$1892.75	$1892.75
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$1960.60	$1960.60
VALLEJO (CA)	$1875.66	$1875.66
BAKERSFIELD (CA)	$1750.41	$1750.41
CHICO (CA)	$1723.30	$1723.30
FRESNO (CA)	$1723.30	$1723.30
HANFORD-CORCORAN (CA)	$1723.30	$1723.30
MADERA (CA)	$1723.30	$1723.30
MERCED (CA)	$1723.30	$1723.30
MODESTO (CA)	$1723.30	$1723.30
REDDING (CA)	$1723.30	$1723.30
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$1834.67	$1834.67
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$1781.61	$1781.61
SALINAS (CA)	$1774.94	$1774.94
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$2020.18	$2020.18
SANTA CRUZ-WATSONVILLE (CA)	$1802.32	$1802.32
SANTA ROSA-PETALUMA (CA)	$1818.02	$1818.02
STOCKTON (CA)	$1723.30	$1723.30
VISALIA (CA)	$1723.30	$1723.30
YUBA CITY (CA)	$1723.30	$1723.30
EL CENTRO (CA)	$1725.05	$1725.05
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$1799.75	$1799.75
SAN LUIS OBISPO-PASO ROBLES (CA)	$1750.66	$1750.66
SANTA MARIA-SANTA BARBARA (CA)	$1776.92	$1776.92
REST OF CALIFORNIA (CA)	$1723.30	$1723.30
COLORADO (CO)	$1784.25	$1784.25
CONNECTICUT (CT)	$1948.72	$1948.72
DC + MD/VA SUBURBS (DC)	$2007.21	$2007.21
DELAWARE (DE)	$1771.27	$1771.27
FORT LAUDERDALE (FL)	$2100.02	$2100.02
MIAMI (FL)	$2369.25	$2369.25
REST OF FLORIDA (FL)	$1957.40	$1957.40
ATLANTA (GA)	$1892.74	$1892.74
REST OF GEORGIA (GA)	$1808.23	$1808.23
HAWAII, GUAM (HI)	$1750.36	$1750.36
IOWA (IA)	$1545.64	$1545.64
IDAHO (ID)	$1575.32	$1575.32
EAST ST. LOUIS (IL)	$2112.68	$2112.68
SUBURBAN CHICAGO (IL)	$2102.15	$2102.15
CHICAGO (IL)	$2270.52	$2270.52
REST OF ILLINOIS (IL)	$1950.96	$1950.96
INDIANA (IN)	$1584.31	$1584.31
KANSAS (KS)	$1575.95	$1575.95
KENTUCKY (KY)	$1709.73	$1709.73
NEW ORLEANS (LA)	$1819.88	$1819.88
REST OF LOUISIANA (LA)	$1722.18	$1722.18
METROPOLITAN BOSTON (MA)	$1928.90	$1928.90
REST OF MASSACHUSETTS (MA)	$1786.13	$1786.13
BALTIMORE/SURR. CNTYS (MD)	$1952.29	$1952.29
REST OF MARYLAND (MD)	$1797.29	$1797.29
SOUTHERN MAINE (ME)	$1675.60	$1675.60
REST OF MAINE (ME)	$1627.28	$1627.28
DETROIT (MI)	$2026.94	$2026.94
REST OF MICHIGAN (MI)	$1799.62	$1799.62
MINNESOTA (MN)	$1582.96	$1582.96
METROPOLITAN ST. LOUIS (MO)	$1780.15	$1780.15
METROPOLITAN KANSAS CITY (MO)	$1763.16	$1763.16
REST OF MISSOURI (MO)	$1713.12	$1713.12
MISSISSIPPI (MS)	$1630.54	$1630.54
MONTANA** (MT)	$1809.30	$1809.30
NORTH CAROLINA (NC)	$1641.48	$1641.48
NORTH DAKOTA** (ND)	$1602.86	$1602.86
NEBRASKA (NE)	$1544.11	$1544.11
NEW HAMPSHIRE (NH)	$1792.49	$1792.49
NORTHERN NJ (NJ)	$1987.49	$1987.49
REST OF NEW JERSEY (NJ)	$1935.36	$1935.36
NEW MEXICO (NM)	$1827.27	$1827.27
NEVADA** (NV)	$1752.40	$1752.40
MANHATTAN (NY)	$2170.21	$2170.21
NYC SUBURBS/LONG ISLAND (NY)	$2281.89	$2281.89
POUGHKPSIE/N NYC SUBURBS (NY)	$1980.80	$1980.80
QUEENS (NY)	$2132.73	$2132.73
REST OF NEW YORK (NY)	$1674.61	$1674.61
OHIO (OH)	$1757.43	$1757.43
OKLAHOMA (OK)	$1664.15	$1664.15
PORTLAND (OR)	$1804.55	$1804.55
REST OF OREGON (OR)	$1703.88	$1703.88
METROPOLITAN PHILADELPHIA (PA)	$1918.23	$1918.23
REST OF PENNSYLVANIA (PA)	$1738.64	$1738.64
PUERTO RICO (PR)	$1811.76	$1811.76
RHODE ISLAND (RI)	$1809.01	$1809.01
SOUTH CAROLINA (SC)	$1709.33	$1709.33
SOUTH DAKOTA** (SD)	$1578.45	$1578.45
TENNESSEE (TN)	$1590.64	$1590.64
BRAZORIA (TX)	$1734.15	$1734.15
DALLAS (TX)	$1765.36	$1765.36
GALVESTON (TX)	$1752.16	$1752.16
HOUSTON (TX)	$1943.25	$1943.25
BEAUMONT (TX)	$1727.97	$1727.97
FORT WORTH (TX)	$1763.53	$1763.53
AUSTIN (TX)	$1808.80	$1808.80
REST OF TEXAS (TX)	$1743.72	$1743.72
UTAH (UT)	$1736.25	$1736.25
VIRGINIA (VA)	$1696.66	$1696.66
VIRGIN ISLANDS (VI)	$1811.76	$1811.76
VERMONT (VT)	$1631.37	$1631.37
SEATTLE (KING CNTY) (WA)	$1931.87	$1931.87
REST OF WASHINGTON (WA)	$1771.10	$1771.10
WISCONSIN (WI)	$1541.97	$1541.97
WEST VIRGINIA (WV)	$1876.93	$1876.93
WYOMING** (WY)	$1719.33	$1719.33

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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 Physician Fee Schedule 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 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. Practice-expense RVUs often differ between non-facility (e.g., physician office) and facility (e.g., hospital) settings, which can cause the allowed amount to vary by place of service. For this code, the non-facility and facility PE RVUs shown are equal, so the resulting national amounts match in this case.

RVUs — work 24.7, practice expense 19.05 (non-facility) / 19.05 (facility), malpractice 10.44 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, based on the national conversion factor and standard RVUs; actual payment depends on your specific Medicare Administrative Contractor (MAC) and locality GPCIs.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the beneficiary or secondary payer is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Always verify current rates and coverage rules with your MAC before billing or appealing a claim.

Frequently asked

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

The national figure uses a GPCI value of 1.0 for all cost categories, while actual payments apply your locality's specific GPCI adjustments for work, practice expense, and malpractice, which can raise or lower the amount.

Does this amount reflect what Medicare will actually pay?

No. Medicare generally reimburses 80% of the allowed amount after the deductible is met, and the billed or allowed amount can be further adjusted by modifiers or claim-specific factors.

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

Because the practice-expense RVUs provided for facility and non-facility settings are identical for this code, the calculated national amounts are the same; this is not true for all codes.

What causes the conversion factor to change each year?

CMS updates the conversion factor annually based on statutory formulas, budget-neutrality adjustments, and any legislative changes, which can increase or decrease all PFS payments nationwide.

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.