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Medicare Physician Fee Schedule · Q3 2026 release

CPT 58100 in Fresno, CA 01112-56

58100 2026 C · Fresno, CA flag01112-56 A Active
Allowed amount
$100.58
in a doctor’s own office or clinic

102.4% of the $98.20 national baseline

Medicare payment
$80.46
Patient / secondary
$20.12
Expected total to provider
$100.58

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 58100 in Fresno, CA? Copy link

The Medicare allowed amount is $100.58 in the office (non-facility) setting and $53.36 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 2.4% above the national baseline, and the facility amount is 3.2% 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 Fresno, CA in? Copy link

CMS payment locality Fresno (01112-56). Every location in it is priced identically.

Why Fresno, CA differs from the national amount Copy link

Fresno, CA (this locality)
$100.58
National PFS baseline (GPCI 1.000)
$98.20

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 Fresno, CA at 2.4% above the national baseline.

Work GPCI
1.017
Practice expense GPCI
1.096
Malpractice GPCI
0.536
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 58100 in Fresno, CA: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Fresno, CA allowed amount for 58100
Component RVU × GPCI = Adjusted RVU
Work 1.18 1.017 1.2001
Practice expense 1.55 1.096 1.6988
Malpractice 0.21 0.536 0.1126
Sum of adjusted RVUs 3.0114
× $33.4009 2026 conversion factor $100.58

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Fresno, CA allows $53.36 for 58100, versus $100.58 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 Fresno, CA. 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 58100 in Fresno, CA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $100.58
Non-participating allowed amount 95% of the participating amount. $95.55
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $109.88
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $80.46
Beneficiary coinsurance The remaining 20%. $20.12
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $1.61
Medicare pays after sequestration Program payment net of the sequestration reduction. $78.85

Contracted rate: % of Medicare in Fresno, CA 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 — $100.58 in the office (non-facility) setting — not the $98.20 national baseline.

Opens the calculator already set to Fresno, CA 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 Fresno, CA rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 105 ZIP codes to this payment locality. 58100 prices identically in every one of them. 11 of them span more than one locality and need ZIP+4 for an exact match.

93210 93234 93242 93602 93605 93606 93607 93608 93609 93611 93612 93613 93616 93619 93621 93622 93624 93625 93626 93627 93628 93629 93630 93631 93634 93640 93641 93642 93646 93648 93649 93650 93651 93652 93654 93656 93657 93660 93662 93664 93667 93668 93675 93701 93702 93703 93704 93705 93706 93707 93708 93709 93710 93711 93712 93714 93715 93716 93717 93718 93720 93721 93722 93723 93724 93725 93726 93727 93728 93729 93730 93737 93740 93741 93744 93745 93747 93750 93755 93759 93760 93761 93762 93764 93765 93771 93772 93773 93774 93775 93776 93777 93778 93779 93780 93782 93784 93786 93790 93791

5 more ZIP codes map to this locality. The Fresno, CA locality page lists the full set.

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

58100 in nearby payment localities Copy link

Payment localities in the same region as Fresno, CA, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 58100. Proximity doesn't imply similar pricing — neighbouring localities often differ.

58100 allowed amount in payment localities near Fresno, CA
Metro Allowed amount vs. Fresno, CA
Bakersfield, CA $101.18 +0.6%
San Jose, CA $121.19 +20.5%
Sacramento, CA $104.80 +4.2%
San Francisco, CA $119.14 +18.5%
Ventura County, CA $106.08 +5.5%
Los Angeles, CA $106.93 +6.3%

Every payment locality nationwide is on the CPT 58100 rate map.

Other codes priced in Fresno, CA Copy link

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

Other curated codes and their allowed amounts in Fresno, CA
Code Service Fresno, CA vs. national
58558 Women's health $1,367.61 +7.7%
57455 Women's health $164.59 +2.2%
99213 Routine Follow-Up Office Visit $99.22 +4.2%
99214 Long Follow-Up Office Visit $140.94 +3.9%
66984 Cataract Surgery $477.99 +3.3%
92014 Full Eye Exam, Returning Patient $134.98 +6.1%
99204 Long New Patient Office Visit $183.04 +3.2%
99212 Brief Follow-Up Office Visit $62.19 +4.6%
99215 Longest Follow-Up Office Visit $199.54 +3.7%
97110 Physical Therapy Exercises $30.47 +4.9%
99203 New Patient Office Visit $121.64 +3.5%
93010 Heart Tracing Reading $8.52 +2.0%

Common questions Copy link

Which ZIP codes does the Fresno, CA rate for 58100 cover?
The CMS ZIP-to-locality crosswalk maps 105 ZIP codes to this payment locality, and every one of them prices 58100 identically. Examples include 93210, 93234, 93242, 93602, 93605, 93606. 11 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 58100 rate in Fresno, CA 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 1.017, practice expense 1.096, malpractice 0.536 — scale each RVU component before the conversion factor is applied, which is why Fresno, CA allows more than the $98.20 baseline.
What is the facility rate for 58100 in Fresno, CA?
$53.36 in a facility, versus $100.58 in the office (non-facility) setting — a $47.22 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 58100 in Fresno, CA?
A non-participating provider is paid $95.55 — 95% of the $100.58 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $109.88, which is 115% of the non-participating amount.
How much of the Fresno, CA 58100 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($80.46) once the annual Part B deductible is met, and the beneficiary owes 20% ($20.12). Sequestration reduces Medicare's share by about 2% ($1.61), leaving $78.85. 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 01112-56'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 6,456)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 11)
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 58100 in Fresno, CA against the release that governed that date. Past releases need a free account; today's rate does not.

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