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Medicare Physician Fee Schedule · Q3 2026 release

CPT 64721 in Sacramento, CA

Open carpal tunnel release in ZIPs including 95814, 95661, and 95630

64721 Q3 2026 · Sacramento, CA flag01112-63
Locality-adjusted allowed amount
$520.01
in a doctor’s own office or clinic

107.7% of the $482.64 national baseline

( Work4.85 × 1.036 + Practice exp.8.61 × 1.163 + Malpractice0.99 × 0.536 ) × Conv. factor$33.4009 = $520.01

The Medicare allowed amount is $520.01 in the Office (non-facility) setting and $450.86 in a facility, under the Q3 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.

Q3 2026 · Locality 01112-63 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Sacramento, CA in? Copy link

Sacramento, CA is in CMS payment locality Sacramento-Roseville-Folsom. The same amount applies across the whole locality, including Roseville and Folsom.

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

ZIP codes in this payment locality (219)

The CMS ZIP-to-locality crosswalk maps 219 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.

94203 94204 94205 94206 94207 94208 94209 94211 94229 94230 94232 94234 94235 94236 94237 94239 94240 94243 94244 94245 94246 94247 94248 94249 94250 94252 94253 94254 94256 94257 94258 94259 94261 94262 94263 94267 94268 94269 94271 94273 94274 94277 94278 94279 94280 94282 94283 94284 94285 94286 94287 94288 94289 94290 94291 94293 94294 94295 94296 94297 94298 94299 95602 95603 95604 95605 95606 95607 95608 95609 95610 95611 95612 95613 95614 95615 95616 95617 95618 95619 95621 95623 95624 95626 95627 95628 95630 95631 95632 95633 95634 95635 95636 95637 95638 95639 95641 95645 95648 95650

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

Which ZIP codes does the Sacramento, CA rate for 64721 cover?

The CMS ZIP-to-locality crosswalk maps 219 ZIP codes to this payment locality, and 64721 has the same amount in every one of them. Examples include 94203, 94204, 94205, 94206, 94207, 94208. Of these, 9 span more than one payment locality and need ZIP+4 for an exact match.

Which cities does the Sacramento, CA rate for 64721 cover?

This payment locality also covers Roseville and Folsom. 64721 has the same amount everywhere in it—the label names the largest metro, not a city-specific amount.

How locality affects the amount Copy link

Office (non-facility) · Q3 2026 · Participating · Whole service

Sacramento, CA (this locality)
$520.01
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 Sacramento, CA 7.7% above the national baseline.

Work GPCI
1.036
Practice expense GPCI
1.163
Malpractice GPCI
0.536
2026 conversion factor
$33.4009
Why is the 64721 rate in Sacramento, 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 1.036, practice expense 1.163, malpractice 0.536—scale each RVU component before the conversion factor is applied, which is why the Sacramento, CA amount is higher 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 Sacramento, CA GPCI; the products are summed and multiplied by the conversion factor.

Code
64721
DOS
Not selected; uses this release’s rates
Locality
SACRAMENTO-ROSEVILLE-FOLSOM (CA)
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q3 2026, revision 1
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 Sacramento, CA allowed amount for 64721
Component RVU × GPCI = Adjusted
Work 4.85 × 1.036 5.0246
Practice expense · Office (non-facility) 8.61 × 1.163 10.0134
Malpractice 0.99 × 0.536 0.5306
Sum of adjusted RVUs 15.5687
× 33.4009 conversion factor = formula amount $520.01

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

  1. Locality-adjusted allowed amount $520.01

    After applicable fee-schedule adjustments; sequestration excluded

Citations

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

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 7,150)
    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: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

  • Supplies the geographic adjustment factors for this locality.

    Geographic practice cost indices (GPCI)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details GPCI2026.csv in rvu26c-updated-06-30-2026.zip (row 21)
    mac (col 1)
    01112
    locality_code (col 3)
    63
    work_gpci (col 5)
    1.036
    pe_gpci (col 6)
    1.163
    mp_gpci (col 7)
    0.536

    SHA-256: 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

    Original source file

  • Supplies the dollar conversion factor used in the formula.

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 11)
    conversion_factor (col 26)
    33.4009

    SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient department or ASC), the allowed amount for 64721 in Sacramento, CA is $450.86, versus $520.01 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 Sacramento, CA?

$450.86 in a facility, versus $520.01 in the Office (non-facility) setting—a $69.15 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 Sacramento, CA. 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 Sacramento, CA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $520.01
Non-participating allowed amount 95% of the participating amount. $494.01
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $568.11
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $416.01
Patient coinsurance The remaining 20%. $104.00
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $8.32
Net Medicare payment Medicare's share after the sequestration reduction. $407.69
What is the non-participating amount and limiting charge for 64721 in Sacramento, CA?

A non-participating provider is paid $494.01—95% of the $520.01 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $568.11, which is 115% of the non-participating amount.

How much of the Sacramento, CA 64721 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($416.01) once the annual Part B deductible is met, and the beneficiary owes 20% ($104.00). Sequestration reduces Medicare's share by about 2% ($8.32), leaving $407.69. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Sacramento, CA 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—$520.01 in the office (non-facility) setting—not the $482.64 national baseline.

Opens the calculator set to Sacramento, CA 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 Sacramento, CA, 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 Sacramento, CA
Metro Allowed amount vs. Sacramento, CA
San Francisco, CA $596.93 +14.8%
San Jose, CA $607.63 +16.8%
Fresno, CA $497.66 -4.3%
Bakersfield, CA $500.40 -3.8%
Los Angeles, CA $530.80 +2.1%
Ventura County, CA $527.05 +1.4%

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

Other codes priced in Sacramento, CA Copy link

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

Other curated codes and their allowed amounts in Sacramento, CA
Code and service Allowed vs. national
66984 Cataract Surgery $496.28 +7.3%
27447 Knee Replacement $1,183.07 +2.0%
66982 Complex Cataract Surgery With Lens Implant $674.48 +7.0%
27130 Total Hip Arthroplasty $1,185.55 +2.0%
29827 Arthroscopic Rotator Cuff Repair $1,007.10 +3.2%
47562 Outpatient surgery $635.73 +0.6%
29881 Outpatient surgery $541.39 +5.0%
23472 Total Shoulder Arthroplasty $1,329.40 +2.2%
49505 Outpatient surgery $514.99 +1.4%
58571 Outpatient surgery $839.49 +1.3%
19120 Outpatient surgery $611.74 +6.7%
43775 Outpatient surgery $968.58 -3.1%

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 01112-63's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 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 (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 7,150)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 21)
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 64721 in Sacramento, CA 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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