Facility $238.83
Boston, MA (Locality 14212-01)
13.8% above the national baseline ($500.01)
Office (non-facility) $569.04
Boston, MA (Locality 14212-01)
6.9% above the national baseline ($223.45)
CMS RVU26DOctober 1 – December 31, 2026revision 2
( Work4.46 × 1.041 + Practice exp.10.00 × 1.194 + Malpractice0.51 × 0.890 ) × Conv. factor$33.4009 = $569.04
F Work RVU
4.46
G Non‑facility PE RVU
10.00
K MP RVU
0.51
Z Conversion factor
33.4009
E Work GPCI
1.041
F PE GPCI
1.194
G MP GPCI
0.890
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Physician relative value file (PPRRVU) · PPRRVU2026_Oct_nonQPP.csv row 5,520 in rvu26d-updated-08-26-2026.zip Download from CMS
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Geographic practice cost indices (GPCI) · GPCI2026.csv row 62 in rvu26d-updated-08-26-2026.zip Download from CMS
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CMS RVU26DOctober 1 – December 31, 2026revision 2
( Work4.46 × 1.041 + Practice exp.1.72 × 1.194 + Malpractice0.51 × 0.890 ) × Conv. factor$33.4009 = $238.83
F Work RVU
4.46
I Facility PE RVU
1.72
K MP RVU
0.51
Z Conversion factor
33.4009
E Work GPCI
1.041
F PE GPCI
1.194
G MP GPCI
0.890
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Physician relative value file (PPRRVU) · PPRRVU2026_Oct_nonQPP.csv row 5,520 in rvu26d-updated-08-26-2026.zip Download from CMS
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Geographic practice cost indices (GPCI) · GPCI2026.csv row 62 in rvu26d-updated-08-26-2026.zip Download from CMS
Loading rows 60–64 of GPCI2026.csv…
Participating provider, no modifiers, whole service, before sequestration. Change these
Report a problemThe Medicare allowed amount is $569.04 in the Office (non-facility) setting and $238.83 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.
What Medicare locality is Boston, MA in? Copy link
Boston, MA is in CMS payment locality Metropolitan Boston (14212-01). The same amount applies everywhere in it.
Confirm the locality before using this amount. A split ZIP needs ZIP+4 for an exact match.
ZIP codes in this payment locality (258)
The CMS ZIP-to-locality crosswalk maps 258 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.
158 more ZIP codes map to this locality. The Boston, MA locality page lists the full set.
Which ZIP codes does the Boston, MA rate for 45385 cover?
The CMS ZIP-to-locality crosswalk maps 258 ZIP codes to this payment locality, and 45385 has the same amount in every one of them. Examples include 01431, 01432, 01434, 01450, 01460, 01463. Of these, 2 span more than one payment locality and need ZIP+4 for an exact match.
How the Boston, MA amount is calculated Copy link
How locality affects the amount Copy link
Office (non-facility) · Q4 2026 · Participating · Whole service
Boston, MA's $569.04 compares with the $500.01 national PFS baseline (GPCI 1.000). Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Boston, MA 13.8% above the national baseline.
Boston, MA ranks #14 of 109 Medicare payment localities for 45385, where #1 has the highest allowed amount. Within Massachusetts it's #1 of 2: $52.40 (10.1%) higher than Rest of Massachusetts ($516.64).
Each figure is that GPCI's share of the +$69.03 gap from the national baseline: its RVUs for 45385 × (GPCI − 1.000) × the conversion factor. Practice expense accounts for the most, +$64.80.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows
Show the full calculation and CMS rows
For the office (non-facility) amount, each of 45385's RVU components is multiplied by its Boston, MA GPCI; the products are summed and multiplied by the conversion factor.
- Code
- 45385
- DOS
- Not selected; uses this release’s rates
- Locality
- Metropolitan Boston (14212-01)
- 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.
| Component | RVU | × GPCI | = Adjusted |
|---|---|---|---|
| Work | 4.46 | × 1.041 | 4.6429 |
| Practice expense · Office (non-facility) | 10.00 | × 1.194 | 11.9400 |
| Malpractice | 0.51 | × 0.890 | 0.4539 |
| Sum of adjusted RVUs | 17.0368 | ||
| × 33.4009 conversion factor = formula amount | $569.04 | ||
Component subtotals show four decimals. The formula amount is rounded to cents before any later adjustment.
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Locality-adjusted allowed amount $569.04
After applicable fee-schedule adjustments; sequestration excluded
Citations
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45385’s RVUs, PFS status and conversion factor
Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2
PPRRVU2026_Oct_nonQPP.csv row 5,520 in rvu26d-updated-08-26-2026.zip
- A HCPCS
- 45385
- B Modifier
- blank
- D Status code
- A
- F Work RVU
- 4.46
- G Non-facility PE RVU
- 10.00
- K MP RVU
- 0.51
- Z Conversion factor
- 33.4009
In the CMS file
Loading rows 5,518–5,522 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626 -
Locality 14212-01’s GPCIs
Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2
GPCI2026.csv row 62 in rvu26d-updated-08-26-2026.zip
- A MAC
- 14212
- C Locality number
- 01
- E Work GPCI
- 1.041
- F PE GPCI
- 1.194
- G MP GPCI
- 0.890
In the CMS file
Loading rows 60–64 of GPCI2026.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264
Why is the 45385 rate in Boston, MA 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 1.041, practice expense 1.194, malpractice 0.890—scale each RVU component before the conversion factor is applied, which is why the Boston, MA amount is higher than the $500.01 baseline.
45385 in Boston, MA since Q4 2025 Copy link
Office (non-facility) · Participating · Whole service
The allowed amount went from $492.75 in Q4 2025 to $569.04 in Q4 2026, +$76.29 (+15.5%). The national baseline moved +14.8% over the same period.
| What moved | Effect |
|---|---|
| Conversion factor National: the dollar multiplier CMS sets each year. | +$16.06 |
| 45385's RVUs National: CMS revalued the code itself. | +$61.45 |
| Boston, MA's GPCIs Local: this payment locality's cost indices. | −$1.22 |
| Total change | +$76.29 |
A derived breakdown of the two releases' formula inputs, applied in order: the conversion factor on Q4 2025's RVUs and GPCIs, then 45385's new RVUs, then this locality's new GPCIs. A different order moves a few cents between rows; the total is exact.
Which amount applies to your claim? Copy link
Facility vs. Office (non-facility) Copy link
In a facility (hospital outpatient department or ASC), the allowed amount for 45385 in Boston, MA is $238.83, versus $569.04 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 45385 in Boston, MA?
$238.83 in a facility, versus $569.04 in the Office (non-facility) setting—a $330.21 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.
Who pays what Copy link
Medicare pays part of the Boston, MA allowed amount and the patient pays the rest. A provider who doesn’t participate in Medicare is allowed less, and can bill the patient up to a ceiling.
Computed from the Q4 2026 CMS release
- Allowed amount
- $569.04
- Medicare's share
- $455.23
- Sequestration
- -$9.10
- What Medicare pays
- $446.13
- Patient coinsurance
- $113.81
- Non-participating amount
- $540.59
- Limiting charge
- $621.68
The fee-schedule amount for 45385 in the Office (non-facility) setting in Boston, MA. A participating provider accepts it as payment in full, and every figure below starts from it.
80% of the allowed amount, once the annual Part B deductible is met.
The 2% cut to Medicare’s share. It never reduces the allowed amount or the patient’s coinsurance.
Medicare’s share after sequestration.
The remaining 20%. Medigap or Medicaid often covers it.
What a provider who doesn’t participate in Medicare is allowed on an assigned claim: 95% of the allowed amount.
The most a non-participating provider can bill the patient on an unassigned claim: 115% of the non-participating amount.
What is the non-participating amount and limiting charge for 45385 in Boston, MA?
A non-participating provider is paid $540.59—95% of the $569.04 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $621.68, which is 115% of the non-participating amount.
How much of the Boston, MA 45385 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($455.23) once the annual Part B deductible is met, and the beneficiary owes 20% ($113.81). Sequestration reduces Medicare's share by about 2% ($9.10), leaving $446.13. Sequestration never changes the allowed amount itself, which is why it is shown separately here.
Who’s billing it in Boston, MA Copy link
The allowed amount depends on who bills the service: NPs and PAs get 85% of the fee schedule amount, social workers and counselors 75%. These are Boston, MA’s Q4 2026 amounts.
| Billed by | Office (non-facility) | Facility |
|---|---|---|
| Physician (MD/DO) The full fee schedule amount. Open in calculator | $569.04 | $238.83 |
| Physician assisting at surgery (-80, -81, -82) Medicare doesn’t pay for an assistant at surgery on this code. Source: Pub. 100-04 ch. 12 §20.4.3 Open in calculator | Not payable | Not payable |
There’s no CMS utilization data on file for 45385, so only the physician amounts are shown. Each percentage applies before the 80/20 split and sequestration.
Contract rates and comparisons Copy link
Contracted rate: % of Medicare in Boston, MA 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—$569.04 in the office (non-facility) setting—not the $500.01 national baseline.
Opens the calculator set to Boston, MA 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.
45385 in nearby payment localities Copy link
Payment localities in the same region as Boston, MA, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 45385. Neighboring localities often differ.
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Boston, MA · this page $569.04
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Providence, RI $512.02 -10.0%
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Hartford, CT $532.29 -6.5%
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Portland, ME $490.72 -13.8%
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New York City, NY $573.64 +0.8%
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Long Island, NY $587.27 +3.2%
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Queens, NY $577.86 +1.5%
Percentages are against Boston, MA. Every payment locality nationwide is on the CPT 45385 rate map.
Other codes priced in Boston, MA Copy link
Office (non-facility) allowed amounts in this same payment locality, Q4 2026.
| Code and service | Allowed | vs. national |
|---|---|---|
| 99213 Routine Follow-Up Office Visit | $106.10 | +11.5% |
| 99214 Long Follow-Up Office Visit | $150.68 | +11.1% |
| 66984 Cataract Surgery | $510.22 | +10.3% |
| 92014 Full Eye Exam, Returning Patient | $144.28 | +13.4% |
| 99204 Long New Patient Office Visit | $196.04 | +10.5% |
| 99215 Longest Follow-Up Office Visit | $213.27 | +10.9% |
| 97110 Physical Therapy Exercises | $32.29 | +11.1% |
| 99203 New Patient Office Visit | $130.58 | +11.1% |
| 93000 Heart Tracing | $17.27 | +12.4% |
| 93306 Heart Ultrasound | $226.83 | +15.3% |
| 77067 Screening Mammogram | $146.46 | +16.0% |
| 27447 Knee Replacement | $1,245.78 | +7.5% |
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 14212-01'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.
Working a claim with an earlier date of service? The calculator prices 45385 in Boston, MA 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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