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Medicare Physician Fee Schedule · Q4 2026 release

CPT 64721 in San Francisco, CA

Open carpal tunnel release in ZIPs including 94102, 94609, and 94704

64721 Q4 2026 · San Francisco, CA flag01112-05
Locality-adjusted allowed amount
$596.93
in a doctor’s own office or clinic

123.7% of the $482.64 national baseline

( Work4.85 × 1.095 + Practice exp.8.61 × 1.410 + Malpractice0.99 × 0.425 ) × Conv. factor$33.4009 = $596.93

The Medicare allowed amount is $596.93 in the Office (non-facility) setting and $513.10 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 01112-05 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is San Francisco, CA in? Copy link

San Francisco, CA is in CMS payment locality San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County). The same amount applies across the whole locality, including Oakland and Berkeley.

CMS splits this metro across more than one payment locality

The amount above covers only the counties in San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa County). CMS prices another part of the same metro area separately, with its own GPCIs and its own amount. Check the service-location ZIP before applying this figure.

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

ZIP codes in this payment locality (254)

The CMS ZIP-to-locality crosswalk maps 254 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality. Of these, 2 span more than one locality and need ZIP+4 for an exact match.

94002 94003 94005 94010 94011 94012 94013 94014 94015 94016 94017 94018 94019 94020 94021 94025 94026 94027 94028 94029 94030 94031 94037 94038 94044 94045 94059 94060 94061 94062 94063 94064 94065 94066 94067 94070 94071 94074 94080 94083 94096 94098 94099 94101 94102 94103 94104 94105 94106 94107 94108 94109 94110 94111 94112 94114 94115 94116 94117 94118 94119 94120 94121 94122 94123 94124 94125 94126 94127 94128 94129 94130 94131 94132 94133 94134 94135 94136 94137 94138 94139 94140 94141 94142 94143 94144 94145 94146 94147 94150 94151 94152 94153 94154 94155 94156 94157 94158 94159 94160

154 more ZIP codes map to this locality. The San Francisco, CA locality page lists the full set.

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

The CMS ZIP-to-locality crosswalk maps 254 ZIP codes to this payment locality, and 64721 has the same amount in every one of them. Examples include 94002, 94003, 94005, 94010, 94011, 94012. Of these, 2 span more than one payment locality and need ZIP+4 for an exact match.

Which cities does the San Francisco, CA rate for 64721 cover?

This payment locality also covers Oakland and Berkeley. 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) · Q4 2026 · Participating · Whole service

San Francisco, CA (this locality)
$596.93
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 San Francisco, CA 23.7% above the national baseline.

Work GPCI
1.095
Practice expense GPCI
1.410
Malpractice GPCI
0.425
2026 conversion factor
$33.4009
Why is the 64721 rate in San Francisco, 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 1.095, practice expense 1.410, malpractice 0.425—scale each RVU component before the conversion factor is applied, which is why the San Francisco, 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 San Francisco, CA GPCI; the products are summed and multiplied by the conversion factor.

Code
64721
DOS
Not selected; uses this release’s rates
Locality
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)
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 San Francisco, CA allowed amount for 64721
Component RVU × GPCI = Adjusted
Work 4.85 × 1.095 5.3108
Practice expense · Office (non-facility) 8.61 × 1.410 12.1401
Malpractice 0.99 × 0.425 0.4208
Sum of adjusted RVUs 17.8716
× 33.4009 conversion factor = formula amount $596.93

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

  1. Locality-adjusted allowed amount $596.93

    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 24)
    mac (col 1)
    01112
    locality_code (col 3)
    05
    work_gpci (col 5)
    1.095
    pe_gpci (col 6)
    1.41
    mp_gpci (col 7)
    0.425

    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 San Francisco, CA is $513.10, versus $596.93 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 San Francisco, CA?

$513.10 in a facility, versus $596.93 in the Office (non-facility) setting—a $83.83 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 San Francisco, 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 San Francisco, CA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $596.93
Non-participating allowed amount 95% of the participating amount. $567.08
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $652.14
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $477.54
Patient coinsurance The remaining 20%. $119.39
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $9.55
Net Medicare payment Medicare's share after the sequestration reduction. $467.99
What is the non-participating amount and limiting charge for 64721 in San Francisco, CA?

A non-participating provider is paid $567.08—95% of the $596.93 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $652.14, which is 115% of the non-participating amount.

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

Medicare pays 80% of the allowed amount ($477.54) once the annual Part B deductible is met, and the beneficiary owes 20% ($119.39). Sequestration reduces Medicare's share by about 2% ($9.55), leaving $467.99. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in San Francisco, 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—$596.93 in the office (non-facility) setting—not the $482.64 national baseline.

Opens the calculator set to San Francisco, 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 San Francisco, 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 San Francisco, CA
Metro Allowed amount vs. San Francisco, CA
San Jose, CA $607.63 +1.8%
Sacramento, CA $520.01 -12.9%
Fresno, CA $497.66 -16.6%
Bakersfield, CA $500.40 -16.2%
Ventura County, CA $527.05 -11.7%
Los Angeles, CA $530.80 -11.1%

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

Other codes priced in San Francisco, CA Copy link

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

Other curated codes and their allowed amounts in San Francisco, CA
Code and service Allowed vs. national
66984 Cataract Surgery $559.07 +20.9%
27447 Knee Replacement $1,301.36 +12.2%
66982 Complex Cataract Surgery With Lens Implant $758.06 +20.2%
27130 Total Hip Arthroplasty $1,304.14 +12.2%
29827 Arthroscopic Rotator Cuff Repair $1,116.33 +14.3%
47562 Outpatient surgery $695.78 +10.1%
29881 Outpatient surgery $609.02 +18.1%
23472 Total Shoulder Arthroplasty $1,462.93 +12.5%
49505 Outpatient surgery $567.23 +11.7%
58571 Outpatient surgery $916.79 +10.6%
19120 Outpatient surgery $699.74 +22.1%
43775 Outpatient surgery $1,027.92 +2.8%

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 01112-05'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 24)
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 San Francisco, 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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