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Medicare Physician Fee Schedule · Q4 2026 release

CPT 20605 in Denver, CO

20605 Q4 2026 · Denver, CO flag04112-01
Locality-adjusted allowed amount
$58.87
in a doctor’s own office or clinic

103.1% of the $57.12 national baseline

( Work0.66 × 1.012 + Practice exp.0.97 × 1.064 + Malpractice0.08 × 0.781 ) × Conv. factor$33.4009 = $58.87

row 1,768

F Work RVU

0.66

G Non‑facility PE RVU

0.97

K MP RVU

0.08

Z Conversion factor

33.4009

row 37

E Work GPCI

1.012

F PE GPCI

1.064

G MP GPCI

0.781

CMS RVU26DOctober 1 – December 31, 2026revision 2

The Medicare allowed amount is $58.87 in the Office (non-facility) setting and $32.21 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.

Q4 2026 · Locality 04112-01 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Denver, CO in? Copy link

CMS prices all of Colorado as one Medicare payment locality, so this amount applies statewide, including Colorado Springs, Aurora and Fort Collins—not only in Denver, CO.

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

ZIP codes in this payment locality (677)

The CMS ZIP-to-locality crosswalk maps 677 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 2 span more than one locality and need ZIP+4 for an exact match.

80001 80002 80003 80004 80005 80006 80007 80010 80011 80012 80013 80014 80015 80016 80017 80018 80019 80020 80021 80022 80023 80024 80025 80026 80027 80028 80030 80031 80033 80034 80035 80036 80037 80038 80040 80041 80042 80044 80045 80046 80047 80101 80102 80103 80104 80105 80106 80107 80108 80109 80110 80111 80112 80113 80116 80117 80118 80120 80121 80122 80123 80124 80125 80126 80127 80128 80129 80130 80131 80132 80133 80134 80135 80136 80137 80138 80150 80151 80154 80155 80160 80161 80162 80163 80165 80166 80201 80202 80203 80204 80205 80206 80207 80208 80209 80210 80211 80212 80214 80215

577 more ZIP codes map to this locality. The Denver, CO locality page lists the full set.

Which ZIP codes does the Denver, CO rate for 20605 cover?

The CMS ZIP-to-locality crosswalk maps 677 ZIP codes to this payment locality, and 20605 has the same amount in every one of them. Examples include 80001, 80002, 80003, 80004, 80005, 80006. Of these, 2 span more than one payment locality and need ZIP+4 for an exact match.

Does this 20605 rate apply everywhere in Colorado?

Yes. CMS prices Colorado as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Denver, CO. That includes Colorado Springs, Aurora and Fort Collins. 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

Denver, CO (this locality)
$58.87
National PFS baseline (GPCI 1.000)
$57.12

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Denver, CO 3.1% above the national baseline.

Work GPCI
1.012
Practice expense GPCI
1.064
Malpractice GPCI
0.781
2026 conversion factor
$33.4009

CMS RVU26DOctober 1 – December 31, 2026revision 2 See citations

Why is the 20605 rate in Denver, CO 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 1.012, practice expense 1.064, malpractice 0.781—scale each RVU component before the conversion factor is applied, which is why the Denver, CO amount is higher than the $57.12 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 20605's RVU components is multiplied by its Denver, CO GPCI; the products are summed and multiplied by the conversion factor.

Code
20605
DOS
Not selected; uses this release’s rates
Locality
COLORADO (CO)
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 Denver, CO allowed amount for 20605
Component RVU × GPCI = Adjusted
Work 0.66 × 1.012 0.6679
Practice expense · Office (non-facility) 0.97 × 1.064 1.0321
Malpractice 0.08 × 0.781 0.0625
Sum of adjusted RVUs 1.7625
× 33.4009 conversion factor = formula amount $58.87

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

  1. Locality-adjusted allowed amount $58.87

    After applicable fee-schedule adjustments; sequestration excluded

Citations

Every input comes from a published CMS file. Open the same file at the row shown and the values match.

  • 20605’s RVUs, PFS status and conversion factor

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

    PPRRVU2026_Oct_nonQPP.csv row 1,768 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    20605
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    0.66
    G Non-facility PE RVU
    0.97
    K MP RVU
    0.08
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 1,766–1,770 of PPRRVU2026_Oct_nonQPP.csv…

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

  • Locality 04112-01’s GPCIs

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

    GPCI2026.csv row 37 in rvu26d-updated-08-26-2026.zip

    A MAC
    04112
    C Locality number
    01
    E Work GPCI
    1.012
    F PE GPCI
    1.064
    G MP GPCI
    0.781
    In the CMS file

    Loading rows 35–39 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 20605 in Denver, CO is $32.21, versus $58.87 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 20605 in Denver, CO?

$32.21 in a facility, versus $58.87 in the Office (non-facility) setting—a $26.66 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 Denver, CO. 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 20605 in Denver, CO
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $58.87
Non-participating allowed amount 95% of the participating amount. $55.93
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $64.32
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $47.10
Patient coinsurance The remaining 20%. $11.77
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $0.94
Net Medicare payment Medicare's share after the sequestration reduction. $46.16
What is the non-participating amount and limiting charge for 20605 in Denver, CO?

A non-participating provider is paid $55.93—95% of the $58.87 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $64.32, which is 115% of the non-participating amount.

How much of the Denver, CO 20605 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($47.10) once the annual Part B deductible is met, and the beneficiary owes 20% ($11.77). Sequestration reduces Medicare's share by about 2% ($0.94), leaving $46.16. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Denver, CO 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—$58.87 in the office (non-facility) setting—not the $57.12 national baseline.

Opens the calculator set to Denver, CO 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.

Compare 20605 in nearby payment localities

Payment localities in the same region as Denver, CO, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 20605. Neighboring localities often differ.

20605 allowed amount in payment localities near Denver, CO
Metro Allowed amount vs. Denver, CO
Salt Lake City, UT $54.90 -6.7%
Albuquerque, NM $54.96 -6.6%
Wichita, KS $52.68 -10.5%
Omaha, NE $52.96 -10.0%
Oklahoma City, OK $53.05 -9.9%
Phoenix, AZ $55.73 -5.3%

Every payment locality nationwide is on the CPT 20605 rate map.

Other codes priced in Denver, CO Copy link

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

Other curated codes and their allowed amounts in Denver, CO
Code and service Allowed vs. national
20610 Major Joint Injection or Aspiration $70.64 +2.7%
96372 Therapeutic Injection Administration $15.96 +3.9%
64483 Lumbar or Sacral Transforaminal Epidural Injection $277.00 +4.6%
62323 Lumbar or Sacral Epidural Injection $286.04 +4.7%
20600 Injections and pain management $57.84 +3.1%
99213 Routine Follow-Up Office Visit $98.18 +3.1%
99214 Long Follow-Up Office Visit $139.63 +3.0%
66984 Cataract Surgery $474.65 +2.6%
92014 Full Eye Exam, Returning Patient $132.56 +4.2%
99204 Long New Patient Office Visit $181.93 +2.6%
99212 Brief Follow-Up Office Visit $61.48 +3.4%
99215 Longest Follow-Up Office Visit $197.85 +2.8%

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 04112-01'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 1,768)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 37)
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 20605 in Denver, CO 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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