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Medicare Physician Fee Schedule Effective Locality 04412-28 CMS RVU26D Updated

CPT 62323 Medicare rate in Fort Worth, TX

Lumbar or sacral epidural injection in ZIPs including 76102, 76107, and 76109

The Medicare allowed amount is $270.09 in the Office (non-facility) setting and $88.63 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.

62323 Q4 2026
Locality-adjusted allowed amount
$270.09
in a doctor’s own office or clinic

Fort Worth, TX flag Fort Worth, TX (Locality 04412-28)

1.1% below the national baseline ($273.22)

CMS RVU26DOctober 1 – December 31, 2026revision 2

( Work1.76 × 1.009 + Practice exp.6.25 × 0.986 + Malpractice0.17 × 0.871 ) × Conv. factor$33.4009 = $270.09

row 6,967

F Work RVU

1.76

G Non‑facility PE RVU

6.25

K MP RVU

0.17

Z Conversion factor

33.4009

row 100

E Work GPCI

1.009

F PE GPCI

0.986

G MP GPCI

0.871

The Medicare allowed amount is $270.09 in the Office (non-facility) setting and $88.63 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 Fort Worth, TX in? Copy link

Fort Worth, TX is in CMS payment locality Fort Worth (04412-28). 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 (98)

The CMS ZIP-to-locality crosswalk maps 98 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 9 span more than one locality and need ZIP+4 for an exact match.

76001 76002 76003 76004 76005 76006 76007 76010 76011 76012 76013 76014 76015 76016 76017 76018 76019 76020 76021 76022 76034 76036 76039 76040 76051 76052 76053 76054 76060 76063 76092 76094 76095 76096 76099 76101 76102 76103 76104 76105 76106 76107 76108 76109 76110 76111 76112 76113 76114 76115 76116 76117 76118 76119 76120 76121 76122 76123 76124 76126 76127 76129 76130 76131 76132 76133 76134 76135 76136 76137 76140 76147 76148 76150 76155 76161 76162 76163 76164 76166 76177 76178 76179 76180 76181 76182 76185 76190 76191 76192 76193 76195 76196 76197 76198 76199 76244 76248
Which ZIP codes does the Fort Worth, TX rate for 62323 cover?

The CMS ZIP-to-locality crosswalk maps 98 ZIP codes to this payment locality, and 62323 has the same amount in every one of them. Examples include 76001, 76002, 76003, 76004, 76005, 76006. Of these, 9 span more than one payment locality and need ZIP+4 for an exact match.

How locality affects the amount Copy link

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

Fort Worth, TX (this locality)
$270.09
National PFS baseline (GPCI 1.000)
$273.22

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Fort Worth, TX 1.1% below the national baseline.

Work GPCI
1.009
Practice expense GPCI
0.986
Malpractice GPCI
0.871
2026 conversion factor
$33.4009

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

Why is the 62323 rate in Fort Worth, TX 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 1.009, practice expense 0.986, malpractice 0.871—scale each RVU component before the conversion factor is applied, which is why the Fort Worth, TX amount is lower than the $273.22 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 62323's RVU components is multiplied by its Fort Worth, TX GPCI; the products are summed and multiplied by the conversion factor.

Code
62323
DOS
Not selected; uses this release’s rates
Locality
FORT WORTH (TX)
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 Fort Worth, TX allowed amount for 62323
Component RVU × GPCI = Adjusted
Work 1.76 × 1.009 1.7758
Practice expense · Office (non-facility) 6.25 × 0.986 6.1625
Malpractice 0.17 × 0.871 0.1481
Sum of adjusted RVUs 8.0864
× 33.4009 conversion factor = formula amount $270.09

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

  1. Locality-adjusted allowed amount $270.09

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • 62323’s RVUs, PFS status and conversion factor

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

    PPRRVU2026_Oct_nonQPP.csv row 6,967 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    62323
    B Modifier
    blank
    D Status code
    A
    F Work RVU
    1.76
    G Non-facility PE RVU
    6.25
    K MP RVU
    0.17
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 6,965–6,969 of PPRRVU2026_Oct_nonQPP.csv…

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

  • Locality 04412-28’s GPCIs

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

    GPCI2026.csv row 100 in rvu26d-updated-08-26-2026.zip

    A MAC
    04412
    C Locality number
    28
    E Work GPCI
    1.009
    F PE GPCI
    0.986
    G MP GPCI
    0.871
    In the CMS file

    Loading rows 98–102 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 62323 in Fort Worth, TX is $88.63, versus $270.09 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 62323 in Fort Worth, TX?

$88.63 in a facility, versus $270.09 in the Office (non-facility) setting—a $181.46 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 Fort Worth, TX. 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 62323 in Fort Worth, TX
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $270.09
Non-participating allowed amount 95% of the participating amount. $256.59
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $295.08
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $216.07
Patient coinsurance The remaining 20%. $54.02
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $4.32
Net Medicare payment Medicare's share after the sequestration reduction. $211.75
What is the non-participating amount and limiting charge for 62323 in Fort Worth, TX?

A non-participating provider is paid $256.59—95% of the $270.09 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $295.08, which is 115% of the non-participating amount.

How much of the Fort Worth, TX 62323 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($216.07) once the annual Part B deductible is met, and the beneficiary owes 20% ($54.02). Sequestration reduces Medicare's share by about 2% ($4.32), leaving $211.75. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Fort Worth, TX 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—$270.09 in the office (non-facility) setting—not the $273.22 national baseline.

Opens the calculator set to Fort Worth, TX 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.

62323 in nearby payment localities Copy link

Payment localities in the same region as Fort Worth, TX, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 62323. Neighboring localities often differ.

Percentages are against Fort Worth, TX. Every payment locality nationwide is on the CPT 62323 rate map.

Other codes priced in Fort Worth, TX Copy link

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

Other curated codes and their allowed amounts in Fort Worth, TX
Code and service Allowed vs. national
20610 Major Joint Injection or Aspiration $67.93 -1.3%
96372 Therapeutic Injection Administration $15.24 -0.8%
64483 Lumbar or Sacral Transforaminal Epidural Injection $261.93 -1.1%
20605 Injections and pain management $56.52 -1.1%
20600 Injections and pain management $55.51 -1.1%
99213 Routine Follow-Up Office Visit $94.51 -0.7%
99214 Long Follow-Up Office Visit $134.65 -0.7%
66984 Cataract Surgery $459.56 -0.7%
92014 Full Eye Exam, Returning Patient $126.41 -0.7%
99204 Long New Patient Office Visit $175.95 -0.8%
99212 Brief Follow-Up Office Visit $58.93 -0.9%
99215 Longest Follow-Up Office Visit $191.04 -0.7%

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 04412-28'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 6,967)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 100)
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 62323 in Fort Worth, TX 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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