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Medicare Physician Fee Schedule · Q3 2026 release

CPT 57455 in Northern New Jersey, NJ 12402-01

57455 2026 C · Northern New Jersey, NJ flag12402-01 A Active
Allowed amount
$179.36
in a doctor’s own office or clinic

111.4% of the $160.99 national baseline

Medicare payment
$143.49
Patient / secondary
$35.87
Expected total to provider
$179.36

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 57455 in Northern New Jersey, NJ? Copy link

The Medicare allowed amount is $179.36 in the office (non-facility) setting and $104.58 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 11.4% above the national baseline, and the facility amount is 8.3% above 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 Northern New Jersey, NJ in? Copy link

CMS payment locality Northern Nj (12402-01). Every location in it is priced identically.

Why Northern New Jersey, NJ differs from the national amount Copy link

Northern New Jersey, NJ (this locality)
$179.36
National PFS baseline (GPCI 1.000)
$160.99

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 Northern New Jersey, NJ at 11.4% above the national baseline.

Work GPCI
1.063
Practice expense GPCI
1.160
Malpractice GPCI
1.068
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 57455 in Northern New Jersey, NJ: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Northern New Jersey, NJ allowed amount for 57455
Component RVU × GPCI = Adjusted RVU
Work 1.94 1.063 2.0622
Practice expense 2.52 1.160 2.9232
Malpractice 0.36 1.068 0.3845
Sum of adjusted RVUs 5.3699
× $33.4009 2026 conversion factor $179.36

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Northern New Jersey, NJ allows $104.58 for 57455, versus $179.36 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 Northern New Jersey, NJ. 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 57455 in Northern New Jersey, NJ
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $179.36
Non-participating allowed amount 95% of the participating amount. $170.39
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $195.95
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $143.49
Beneficiary coinsurance The remaining 20%. $35.87
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $2.87
Medicare pays after sequestration Program payment net of the sequestration reduction. $140.62

Contracted rate: % of Medicare in Northern New Jersey, NJ 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 — $179.36 in the office (non-facility) setting — not the $160.99 national baseline.

Opens the calculator already set to Northern New Jersey, NJ 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 Northern New Jersey, NJ rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 429 ZIP codes to this payment locality. 57455 prices identically in every one of them. 4 of them span more than one locality and need ZIP+4 for an exact match.

07001 07002 07003 07004 07005 07006 07007 07008 07009 07010 07011 07012 07013 07014 07015 07016 07017 07018 07019 07020 07021 07022 07023 07024 07026 07027 07028 07029 07030 07031 07032 07033 07034 07035 07036 07039 07040 07041 07042 07043 07044 07045 07046 07047 07050 07051 07052 07054 07055 07057 07058 07059 07060 07061 07062 07063 07064 07065 07066 07067 07068 07069 07070 07071 07072 07073 07074 07075 07076 07077 07078 07079 07080 07081 07082 07083 07086 07087 07088 07090 07091 07092 07093 07094 07095 07096 07097 07099 07101 07102 07103 07104 07105 07106 07107 07108 07109 07110 07111 07112

329 more ZIP codes map to this locality. The Northern New Jersey, NJ locality page lists the full set.

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

57455 in nearby payment localities Copy link

Payment localities in the same region as Northern New Jersey, NJ, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 57455. Proximity doesn't imply similar pricing — neighbouring localities often differ.

57455 allowed amount in payment localities near Northern New Jersey, NJ
Metro Allowed amount vs. Northern New Jersey, NJ
New York City, NY $185.82 +3.6%
Queens, NY $185.77 +3.6%
Philadelphia, PA $167.93 -6.4%
Long Island, NY $191.35 +6.7%
Hartford, CT $171.29 -4.5%
Baltimore, MD $171.02 -4.6%

Every payment locality nationwide is on the CPT 57455 rate map.

Other codes priced in Northern New Jersey, NJ Copy link

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

Other curated codes and their allowed amounts in Northern New Jersey, NJ
Code Service Northern New Jersey, NJ vs. national
58558 Women's health $1,457.69 +14.8%
58100 Women's health $109.44 +11.4%
99213 Routine Follow-Up Office Visit $105.93 +11.3%
99214 Long Follow-Up Office Visit $150.65 +11.1%
66984 Cataract Surgery $511.73 +10.6%
92014 Full Eye Exam, Returning Patient $142.90 +12.3%
99204 Long New Patient Office Visit $196.57 +10.8%
99212 Brief Follow-Up Office Visit $66.51 +11.9%
99215 Longest Follow-Up Office Visit $213.45 +10.9%
97110 Physical Therapy Exercises $32.22 +10.9%
99203 New Patient Office Visit $130.71 +11.2%
93010 Heart Tracing Reading $9.10 +9.0%

Common questions Copy link

Which ZIP codes does the Northern New Jersey, NJ rate for 57455 cover?
The CMS ZIP-to-locality crosswalk maps 429 ZIP codes to this payment locality, and every one of them prices 57455 identically. Examples include 07001, 07002, 07003, 07004, 07005, 07006. 4 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 57455 rate in Northern New Jersey, NJ 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 1.063, practice expense 1.160, malpractice 1.068 — scale each RVU component before the conversion factor is applied, which is why Northern New Jersey, NJ allows more than the $160.99 baseline.
What is the facility rate for 57455 in Northern New Jersey, NJ?
$104.58 in a facility, versus $179.36 in the office (non-facility) setting — a $74.78 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 57455 in Northern New Jersey, NJ?
A non-participating provider is paid $170.39 — 95% of the $179.36 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $195.95, which is 115% of the non-participating amount.
How much of the Northern New Jersey, NJ 57455 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($143.49) once the annual Part B deductible is met, and the beneficiary owes 20% ($35.87). Sequestration reduces Medicare's share by about 2% ($2.87), leaving $140.62. 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 12402-01'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 6,433)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 75)
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 57455 in Northern New Jersey, NJ 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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