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Medicare Physician Fee Schedule · Q4 2026 release

CPT 64721 in Phoenix, AZ

Open carpal tunnel release in ZIPs including 85004, 85251, and 85016

64721 Q4 2026 · Phoenix, AZ flag03102-00
Locality-adjusted allowed amount
$468.97
in a doctor’s own office or clinic

97.2% of the $482.64 national baseline

( Work4.85 × 1.000 + Practice exp.8.61 × 0.969 + Malpractice0.99 × 0.856 ) × Conv. factor$33.4009 = $468.97

The Medicare allowed amount is $468.97 in the Office (non-facility) setting and $411.36 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 03102-00 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Phoenix, AZ in? Copy link

CMS prices all of Arizona as one Medicare payment locality, so this amount applies statewide, including Tucson, Mesa, Scottsdale and Chandler—not only in Phoenix, AZ.

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

ZIP codes in this payment locality (571)

The CMS ZIP-to-locality crosswalk maps 571 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 1 span more than one locality and need ZIP+4 for an exact match.

85001 85002 85003 85004 85005 85006 85007 85008 85009 85010 85011 85012 85013 85014 85015 85016 85017 85018 85019 85020 85021 85022 85023 85024 85025 85026 85027 85028 85029 85030 85031 85032 85033 85034 85035 85036 85037 85038 85039 85040 85041 85042 85043 85044 85045 85046 85048 85050 85051 85053 85054 85055 85060 85061 85062 85063 85064 85065 85066 85067 85068 85069 85070 85071 85072 85073 85074 85075 85076 85077 85078 85079 85080 85082 85083 85085 85086 85087 85096 85097 85098 85099 85117 85118 85119 85120 85121 85122 85123 85127 85128 85130 85131 85132 85135 85137 85138 85139 85140 85141

471 more ZIP codes map to this locality. The Phoenix, AZ locality page lists the full set.

Which ZIP codes does the Phoenix, AZ rate for 64721 cover?

The CMS ZIP-to-locality crosswalk maps 571 ZIP codes to this payment locality, and 64721 has the same amount in every one of them. Examples include 85001, 85002, 85003, 85004, 85005, 85006. Of these, 1 span more than one payment locality and need ZIP+4 for an exact match.

Does this 64721 rate apply everywhere in Arizona?

Yes. CMS prices Arizona as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Phoenix, AZ. That includes Tucson, Mesa, Scottsdale and Chandler. 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

Phoenix, AZ (this locality)
$468.97
National PFS baseline (GPCI 1.000)
$482.64

Each of this locality's geographic practice cost indices (GPCIs) scales one RVU component before the conversion factor is applied. Together they put Phoenix, AZ 2.8% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.969
Malpractice GPCI
0.856
2026 conversion factor
$33.4009
Why is the 64721 rate in Phoenix, AZ 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 1.000, practice expense 0.969, malpractice 0.856—scale each RVU component before the conversion factor is applied, which is why the Phoenix, AZ amount is lower than the $482.64 baseline.

Formula and inputs Copy link

For the office (non-facility) amount, each of 64721's RVU components is multiplied by its Phoenix, AZ GPCI; the products are summed and multiplied by the conversion factor.

Code
64721
DOS
Not selected; uses this release’s rates
Locality
ARIZONA (AZ)
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 Phoenix, AZ allowed amount for 64721
Component RVU × GPCI = Adjusted
Work 4.85 × 1.000 4.8500
Practice expense · Office (non-facility) 8.61 × 0.969 8.3431
Malpractice 0.99 × 0.856 0.8474
Sum of adjusted RVUs 14.0405
× 33.4009 conversion factor = formula amount $468.97

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

  1. Locality-adjusted allowed amount $468.97

    After applicable fee-schedule adjustments; sequestration excluded

Citations

  • Supplies the RVUs and PFS status for this code and component.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 7,210)
    hcpcs (col 1)
    64721
    modifier (col 2)
    blank
    status_code (col 4)
    A
    work_rvu (col 6)
    4.85
    pe_rvu_nonfacility (col 7)
    8.61
    pe_rvu_facility (col 9)
    6.83
    mp_rvu (col 11)
    0.99

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

  • Supplies the geographic adjustment factors for this locality.

    Geographic practice cost indices (GPCI)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details GPCI2026.csv in rvu26d-updated-08-26-2026.zip (row 6)
    mac (col 1)
    03102
    locality_code (col 3)
    00
    work_gpci (col 5)
    1
    pe_gpci (col 6)
    0.969
    mp_gpci (col 7)
    0.856

    SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

    Original source file

  • Supplies the dollar conversion factor used in the formula.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 11)
    conversion_factor (col 26)
    33.4009

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 64721 in Phoenix, AZ is $411.36, versus $468.97 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 64721 in Phoenix, AZ?

$411.36 in a facility, versus $468.97 in the Office (non-facility) setting—a $57.61 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 Phoenix, AZ. 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 64721 in Phoenix, AZ
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $468.97
Non-participating allowed amount 95% of the participating amount. $445.52
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $512.35
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $375.18
Patient coinsurance The remaining 20%. $93.79
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $7.50
Net Medicare payment Medicare's share after the sequestration reduction. $367.68
What is the non-participating amount and limiting charge for 64721 in Phoenix, AZ?

A non-participating provider is paid $445.52—95% of the $468.97 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $512.35, which is 115% of the non-participating amount.

How much of the Phoenix, AZ 64721 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($375.18) once the annual Part B deductible is met, and the beneficiary owes 20% ($93.79). Sequestration reduces Medicare's share by about 2% ($7.50), leaving $367.68. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Phoenix, AZ 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—$468.97 in the office (non-facility) setting—not the $482.64 national baseline.

Opens the calculator set to Phoenix, AZ 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 64721 in nearby payment localities

Payment localities in the same region as Phoenix, AZ, nearest first. Each amount is that locality's own GPCI-adjusted Office (non-facility) figure for 64721. Neighboring localities often differ.

64721 allowed amount in payment localities near Phoenix, AZ
Metro Allowed amount vs. Phoenix, AZ
Albuquerque, NM $465.42 -0.8%
Las Vegas, NV $477.41 +1.8%
San Diego, CA $528.72 +12.7%
Riverside, CA $508.31 +8.4%
Los Angeles, CA $530.80 +13.2%
Salt Lake City, UT $462.02 -1.5%

Every payment locality nationwide is on the CPT 64721 rate map.

Other codes priced in Phoenix, AZ Copy link

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

Other curated codes and their allowed amounts in Phoenix, AZ
Code and service Allowed vs. national
66984 Cataract Surgery $453.65 -1.9%
27447 Knee Replacement $1,128.02 -2.7%
66982 Complex Cataract Surgery With Lens Implant $618.42 -1.9%
27130 Total Hip Arthroplasty $1,130.50 -2.7%
29827 Arthroscopic Rotator Cuff Repair $950.27 -2.7%
47562 Outpatient surgery $612.85 -3.0%
29881 Outpatient surgery $501.53 -2.7%
23472 Total Shoulder Arthroplasty $1,265.88 -2.6%
49505 Outpatient surgery $492.58 -3.0%
58571 Outpatient surgery $806.93 -2.6%
19120 Outpatient surgery $555.89 -3.0%
43775 Outpatient surgery $969.74 -3.0%

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 03102-00'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 7,210)
Geographic practice cost indices (Q4 2026) · rvu26d-updated-08-26-2026.zip (GPCI2026.csv row 6)
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 64721 in Phoenix, AZ against the release in effect on that date. Dates in the last 12 months don't need an account; older dates of service need a free account.

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