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Medicare Physician Fee Schedule Effective Locality 14412-01 CMS RVU26D Updated

CPT 12001 Medicare rate in Providence, RI

The Medicare allowed amount is $116.42 in the Office (non-facility) setting and $44.31 in a facility, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.

12001 Q4 2026
Locality-adjusted allowed amount
$116.42
in a doctor’s own office or clinic

Providence, RI flag Providence, RI (Locality 14412-01)

2.2% above the national baseline ($113.90)

CMS RVU26DOctober 1 – December 31, 2026revision 2

( Work0.82 × 1.019 + Practice exp.2.41 × 1.033 + Malpractice0.18 × 0.892 ) × Conv. factor$33.4009 = $116.42

row 1,396

F Work RVU

0.82

G Non‑facility PE RVU

2.41

K MP RVU

0.18

Z Conversion factor

33.4009

row 92

E Work GPCI

1.019

F PE GPCI

1.033

G MP GPCI

0.892

The Medicare allowed amount is $116.42 in the Office (non-facility) setting and $44.31 in a facility, under the Q4 2026 Physician Fee Schedule. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied—not necessarily what a specific claim pays.

Assumes a participating provider, no modifiers, the whole service, before sequestration.

Customize service date, participation, and modifiers Check service-location ZIP CMS sources and method

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What Medicare locality is Providence, RI in? Copy link

CMS prices all of Rhode Island as one Medicare payment locality, so this amount applies statewide, including Warwick, Cranston and Pawtucket—not only in Providence, RI.

Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.

ZIP codes in this payment locality (91)

The CMS ZIP-to-locality crosswalk maps 91 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality.

02801 02802 02804 02806 02807 02808 02809 02812 02813 02814 02815 02816 02817 02818 02822 02823 02824 02825 02826 02827 02828 02829 02830 02831 02832 02833 02835 02836 02837 02838 02839 02840 02841 02842 02852 02854 02857 02858 02859 02860 02861 02862 02863 02864 02865 02871 02872 02873 02874 02875 02876 02877 02878 02879 02880 02881 02882 02883 02885 02886 02887 02888 02889 02891 02892 02893 02894 02895 02896 02898 02901 02902 02903 02904 02905 02906 02907 02908 02909 02910 02911 02912 02914 02915 02916 02917 02918 02919 02920 02921 02940
Which ZIP codes does the Providence, RI rate for 12001 cover?

The CMS ZIP-to-locality crosswalk maps 91 ZIP codes to this payment locality, and 12001 has the same amount in every one of them. Examples include 02801, 02802, 02804, 02806, 02807, 02808.

Does this 12001 rate apply everywhere in Rhode Island?

Yes. CMS prices Rhode Island as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Providence, RI. That includes Warwick, Cranston and Pawtucket. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.

How locality affects the amount Copy link

Office (non-facility) · Q4 2026 · Participating · Whole service

Providence, RI (this locality)
$116.42
National PFS baseline (GPCI 1.000)
$113.90

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Providence, RI 2.2% above the national baseline.

Work GPCI
1.019
Practice expense GPCI
1.033
Malpractice GPCI
0.892
2026 conversion factor
$33.4009

CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows

Why is the 12001 rate in Providence, RI 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 1.019, practice expense 1.033, malpractice 0.892—scale each RVU component before the conversion factor is applied, which is why the Providence, RI amount is higher than the $113.90 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 12001's RVU components is multiplied by its Providence, RI GPCI; the products are summed and multiplied by the conversion factor.

Code
12001
DOS
Not selected; uses this release’s rates
Locality
RHODE ISLAND (RI)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q4 2026, revision 2
Sequestration
Shown separately from the allowed amount

Formula

(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor

Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from.

RVU × GPCI components of Providence, RI allowed amount for 12001
Component RVU × GPCI = Adjusted
Work 0.82 × 1.019 0.8356
Practice expense · Office (non-facility) 2.41 × 1.033 2.4895
Malpractice 0.18 × 0.892 0.1606
Sum of adjusted RVUs 3.4857
× 33.4009 conversion factor = formula amount $116.42

Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.

  1. Locality-adjusted allowed amount $116.42

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • 12001’s RVUs, PFS status and conversion factor

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

    PPRRVU2026_Oct_nonQPP.csv row 1,396 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    12001
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    0.82
    G Non-facility PE RVU
    2.41
    K MP RVU
    0.18
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 1,394–1,398 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

  • Locality 14412-01’s GPCIs

    Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2

    GPCI2026.csv row 92 in rvu26d-updated-08-26-2026.zip

    A MAC
    14412
    C Locality number
    01
    E Work GPCI
    1.019
    F PE GPCI
    1.033
    G MP GPCI
    0.892
    In the CMS file

    Loading rows 90–94 of GPCI2026.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

CMS RVU26DOctober 1 – December 31, 2026revision 2

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 12001 in Providence, RI is $44.31, versus $116.42 in the Office (non-facility) setting. Only the practice-expense RVU changes with the setting: the facility bills its own fee for overhead, so the professional amount is lower. See which setting applies to your place of service.

What is the Facility amount for 12001 in Providence, RI?

$44.31 in a facility, versus $116.42 in the Office (non-facility) setting—a $72.11 difference. Only the practice-expense RVU changes with the setting: in the Office (non-facility) setting the practice carries the overhead, so the professional amount is higher; in a hospital or ASC the facility bills its own fee.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Providence, RI. Medicare pays part of the allowed amount and the patient pays the rest; the rows below show each figure. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 12001 in Providence, RI
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $116.42
Non-participating allowed amount 95% of the participating amount. $110.60
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $127.19
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $93.14
Patient coinsurance The remaining 20%. $23.28
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $1.86
Net Medicare payment Medicare's share after the sequestration reduction. $91.28
What is the non-participating amount and limiting charge for 12001 in Providence, RI?

A non-participating provider is paid $110.60—95% of the $116.42 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $127.19, which is 115% of the non-participating amount.

How much of the Providence, RI 12001 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($93.14) once the annual Part B deductible is met, and the beneficiary owes 20% ($23.28). Sequestration reduces Medicare's share by about 2% ($1.86), leaving $91.28. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Providence, RI Copy link

Commercial contracts are often written as a percentage of the Medicare fee schedule. The part that gets misread is which Medicare amount: a contract benchmarked to the fee schedule prices off this locality's allowed amount—$116.42 in the office (non-facility) setting—not the $113.90 national baseline.

Opens the calculator set to Providence, RI and your selected setting, where you can also compare what a payer paid against the expected amount. See how to find your contract's actual percentage.

12001 in nearby payment localities Copy link

Payment localities in the same region as Providence, RI, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 12001. Neighboring localities often differ.

Percentages are against Providence, RI. Every payment locality nationwide is on the CPT 12001 rate map.

Other codes priced in Providence, RI Copy link

Office (non-facility) allowed amounts in this same payment locality, Q4 2026.

Other curated codes and their allowed amounts in Providence, RI
Code and service Allowed vs. national
17000 Precancerous Skin Spot Removal $68.10 +2.5%
11102 Skin Biopsy, Initial Lesion $98.10 +2.7%
17110 Destruction of Benign Skin Lesions $114.25 +2.7%
10060 Dermatology and skin lesions $131.67 +2.4%
11400 Dermatology and skin lesions $131.22 +2.6%
99213 Routine Follow-Up Office Visit $97.30 +2.2%
99214 Long Follow-Up Office Visit $138.53 +2.2%
66984 Cataract Surgery $471.97 +2.0%
92014 Full Eye Exam, Returning Patient $130.60 +2.6%
99204 Long New Patient Office Visit $180.87 +2.0%
99212 Brief Follow-Up Office Visit $60.81 +2.3%
99215 Longest Follow-Up Office Visit $196.44 +2.1%

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q4 2026 release: this code's RVUs from the relative value file, multiplied by payment locality 14412-01's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q4 2026 release. Past releases are never edited, so an amount for an earlier quarter always matches what CMS published for it. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 1,396)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 92)
ZIP code to carrier locality crosswalk (Q4 2026) · zip-code-carrier-locality-file-updated-08-13-2026.zip (ZIP5_OCT2026.txt)

Working a claim with an earlier date of service? The calculator prices 12001 in Providence, RI against the release in effect on that date. Dates of service this quarter don't need an account; earlier dates need a free account.

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