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Medicare Physician Fee Schedule · Q3 2026 release

CPT 11400 in San Antonio, TX 04412-99

11400 2026 C · San Antonio, TX flag04412-99 A Active
Allowed amount
$122.73
in a doctor’s own office or clinic

95.9% of the $127.93 national baseline

Medicare payment
$98.18
Patient / secondary
$24.55
Expected total to provider
$122.73

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

How much does Medicare allow for CPT 11400 in San Antonio, TX? Copy link

The Medicare allowed amount is $122.73 in the office (non-facility) setting and $73.92 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 4.1% below the national baseline, and the facility amount is 3.4% below the national baseline. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied — not necessarily what a specific claim pays.

What Medicare locality is San Antonio, TX in? Copy link

CMS calls this locality Rest of Texas — the remainder of the state after the metros CMS carved out separately. The same amount applies across all of it, including El Paso, McAllen, Lubbock and Corpus Christi.

Why San Antonio, TX differs from the national amount Copy link

San Antonio, TX (this locality)
$122.73
National PFS baseline (GPCI 1.000)
$127.93

The national figure is a baseline, not an amount any provider is paid. This locality's geographic practice cost indices scale each RVU component before the conversion factor is applied, which puts San Antonio, TX at 4.1% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.949
Malpractice GPCI
0.903
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 11400 in San Antonio, TX: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the San Antonio, TX allowed amount for 11400
Component RVU × GPCI = Adjusted RVU
Work 0.88 1.000 0.8800
Practice expense 2.84 0.949 2.6952
Malpractice 0.11 0.903 0.0993
Sum of adjusted RVUs 3.6745
× $33.4009 2026 conversion factor $122.73

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), San Antonio, TX allows $73.92 for 11400, versus $122.73 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in San Antonio, TX. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 11400 in San Antonio, TX
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $122.73
Non-participating allowed amount 95% of the participating amount. $116.59
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $134.08
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $98.18
Beneficiary coinsurance The remaining 20%. $24.55
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $1.96
Medicare pays after sequestration Program payment net of the sequestration reduction. $96.22

Contracted rate: % of Medicare in San Antonio, TX Copy link

Commercial contracts are usually written as a percentage of the Medicare fee schedule. Which Medicare amount they mean is the part that gets misread: a contract benchmarked to the fee schedule prices off this locality's allowed amount — $122.73 in the office (non-facility) setting — not the $127.93 national baseline.

Opens the calculator already set to San Antonio, TX and the office (non-facility) setting. It also compares what a payer actually paid against the expected amount. See how to find your contract's actual percentage.

ZIP codes this San Antonio, TX rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 2,045 ZIP codes to this payment locality. 11400 prices identically in every one of them. 38 of them span more than one locality and need ZIP+4 for an exact match.

73960 75002 75007 75008 75009 75010 75013 75020 75021 75022 75023 75024 75025 75026 75027 75028 75029 75032 75033 75034 75035 75036 75056 75057 75058 75065 75067 75068 75069 75070 75071 75072 75074 75075 75076 75077 75078 75086 75087 75090 75091 75092 75093 75094 75097 75098 75101 75102 75103 75105 75109 75110 75114 75117 75118 75119 75120 75121 75124 75125 75126 75127 75132 75135 75140 75142 75143 75144 75147 75148 75151 75152 75153 75154 75155 75156 75157 75158 75160 75161 75163 75164 75165 75166 75167 75168 75169 75173 75189 75252 75287 75401 75402 75403 75404 75407 75409 75410 75411 75412

1,945 more ZIP codes map to this locality. The San Antonio, TX locality page lists the full set.

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

11400 in nearby payment localities Copy link

Payment localities in the same region as San Antonio, TX, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 11400. Proximity doesn't imply similar pricing — neighbouring localities often differ.

11400 allowed amount in payment localities near San Antonio, TX
Metro Allowed amount vs. San Antonio, TX
Austin, TX $133.07 +8.4%
Houston, TX $128.88 +5.0%
Dallas, TX $127.29 +3.7%
Fort Worth, TX $126.39 +3.0%
Oklahoma City, OK $116.96 -4.7%
Albuquerque, NM $120.79 -1.6%

Every payment locality nationwide is on the CPT 11400 rate map.

Other codes priced in San Antonio, TX Copy link

Office (non-facility) allowed amounts in this same payment locality, Q3 2026.

Other curated codes and their allowed amounts in San Antonio, TX
Code Service San Antonio, TX vs. national
17000 Precancerous Skin Spot Removal $63.99 -3.7%
11102 Skin Biopsy, Initial Lesion $91.65 -4.1%
17110 Destruction of Benign Skin Lesions $106.60 -4.2%
10060 Dermatology and skin lesions $123.86 -3.7%
12001 Dermatology and skin lesions $109.21 -4.1%
99213 Routine Follow-Up Office Visit $92.41 -2.9%
99214 Long Follow-Up Office Visit $131.75 -2.8%
66984 Cataract Surgery $450.39 -2.6%
92014 Full Eye Exam, Returning Patient $123.12 -3.3%
99204 Long New Patient Office Visit $172.37 -2.8%
99212 Brief Follow-Up Office Visit $57.52 -3.2%
99215 Longest Follow-Up Office Visit $187.02 -2.8%

Common questions Copy link

Which ZIP codes does the San Antonio, TX rate for 11400 cover?
The CMS ZIP-to-locality crosswalk maps 2,045 ZIP codes to this payment locality, and every one of them prices 11400 identically. Examples include 73960, 75002, 75007, 75008, 75009, 75010. 38 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 11400 rate in San Antonio, TX different from the national amount?
The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices — work 1.000, practice expense 0.949, malpractice 0.903 — scale each RVU component before the conversion factor is applied, which is why San Antonio, TX allows less than the $127.93 baseline.
Which cities does the San Antonio, TX rate for 11400 cover?
CMS calls this locality "REST OF TEXAS" — it is the remainder of the state after the metros CMS carved out into their own localities. The same allowed amount applies across all of it, including El Paso, McAllen, Lubbock and Corpus Christi. San Antonio, TX is the label used here because it is the largest metro in the locality, not because it is priced separately.
What is the facility rate for 11400 in San Antonio, TX?
$73.92 in a facility, versus $122.73 in the office (non-facility) setting — a $48.81 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 11400 in San Antonio, TX?
A non-participating provider is paid $116.59 — 95% of the $122.73 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $134.08, which is 115% of the non-participating amount.
How much of the San Antonio, TX 11400 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($98.18) once the annual Part B deductible is met, and the beneficiary owes 20% ($24.55). Sequestration reduces Medicare's share by about 2% ($1.96), leaving $96.22. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q3 2026 release : this code's RVUs from the relative value file, multiplied by payment locality 04412-99's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release . Releases are immutable: an amount retrieved for a past quarter always reflects that PFS release. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 1,249)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 103)
ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Working a claim with an earlier date of service? The calculator prices 11400 in San Antonio, TX against the release that governed that date. The last 12 months price without an account; older dates of service need a free account.

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