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Medicare Physician Fee Schedule · Q3 2026 release

CPT 64721 in San Jose, CA 01112-09

Open carpal tunnel release in ZIPs including 95113, 94086, and 95050

64721 2026 C · San Jose, CA flag01112-09 A Active
Allowed amount
$607.63
in a doctor’s own office or clinic

125.9% of the $482.64 national baseline

Medicare payment
$486.10
Patient / secondary
$121.53
Expected total to provider
$607.63

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 64721 in San Jose, CA? Copy link

The Medicare allowed amount is $607.63 in the office (non-facility) setting and $521.90 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 25.9% above the national baseline, and the facility amount is 23.3% above 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 San Jose, CA in? Copy link

CMS payment locality San Jose-Sunnyvale-Santa Clara (Santa Clara County). The same amount applies across the whole locality, including Sunnyvale and Santa Clara.

CMS splits this metro across more than one payment locality

The amount above covers only the counties in San Jose-Sunnyvale-Santa Clara (Santa Clara 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.

Why San Jose, CA differs from the national amount Copy link

San Jose, CA (this locality)
$607.63
National PFS baseline (GPCI 1.000)
$482.64

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 San Jose, CA at 25.9% above the national baseline.

Work GPCI
1.110
Practice expense GPCI
1.442
Malpractice GPCI
0.397
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 64721 in San Jose, CA: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the San Jose, CA allowed amount for 64721
Component RVU × GPCI = Adjusted RVU
Work 4.85 1.110 5.3835
Practice expense 8.61 1.442 12.4156
Malpractice 0.99 0.397 0.3930
Sum of adjusted RVUs 18.1921
× $33.4009 2026 conversion factor $607.63

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), San Jose, CA allows $521.90 for 64721, versus $607.63 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 San Jose, 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 64721 in San Jose, CA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $607.63
Non-participating allowed amount 95% of the participating amount. $577.25
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $663.84
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $486.10
Beneficiary coinsurance The remaining 20%. $121.53
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $9.72
Medicare pays after sequestration Program payment net of the sequestration reduction. $476.38

Contracted rate: % of Medicare in San Jose, 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 — $607.63 in the office (non-facility) setting — not the $482.64 national baseline.

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

The CMS ZIP-to-locality crosswalk maps 116 ZIP codes to this payment locality. 64721 prices identically in every one of them. 2 of them span more than one locality and need ZIP+4 for an exact match.

94022 94023 94024 94035 94039 94040 94041 94042 94043 94085 94086 94087 94088 94089 94090 94301 94302 94303 94304 94305 94306 94309 94310 95002 95008 95009 95011 95013 95014 95015 95020 95021 95026 95030 95031 95032 95033 95035 95036 95037 95038 95042 95044 95046 95050 95051 95052 95053 95054 95055 95056 95070 95071 95101 95102 95103 95106 95108 95109 95110 95111 95112 95113 95114 95115 95116 95117 95118 95119 95120 95121 95122 95123 95124 95125 95126 95127 95128 95129 95130 95131 95132 95133 95134 95135 95136 95137 95138 95139 95140 95141 95142 95148 95150 95151 95152 95153 95154 95155 95156

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

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

64721 in nearby payment localities Copy link

Payment localities in the same region as San Jose, CA, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 64721. Proximity doesn't imply similar pricing — neighbouring localities often differ.

64721 allowed amount in payment localities near San Jose, CA
Metro Allowed amount vs. San Jose, CA
San Francisco, CA $596.93 -1.8%
Sacramento, CA $520.01 -14.4%
Fresno, CA $497.66 -18.1%
Bakersfield, CA $500.40 -17.6%
Ventura County, CA $527.05 -13.3%
Los Angeles, CA $530.80 -12.6%

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

Other codes priced in San Jose, CA Copy link

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

Other curated codes and their allowed amounts in San Jose, CA
Code Service San Jose, CA vs. national
66984 Cataract Surgery $568.72 +22.9%
27447 Knee Replacement $1,319.55 +13.8%
66982 Complex Cataract Surgery With Lens Implant $770.98 +22.3%
27130 Total Hip Arthroplasty $1,322.36 +13.8%
29827 Arthroscopic Rotator Cuff Repair $1,132.83 +16.0%
47562 Outpatient surgery $704.85 +11.5%
29881 Outpatient surgery $618.83 +20.0%
23472 Total Shoulder Arthroplasty $1,483.54 +14.1%
49505 Outpatient surgery $574.97 +13.2%
58571 Outpatient surgery $929.05 +12.1%
19120 Outpatient surgery $711.90 +24.2%
43775 Outpatient surgery $1,038.10 +3.8%

Common questions Copy link

Which ZIP codes does the San Jose, CA rate for 64721 cover?
The CMS ZIP-to-locality crosswalk maps 116 ZIP codes to this payment locality, and every one of them prices 64721 identically. Examples include 94022, 94023, 94024, 94035, 94039, 94040. 2 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 64721 rate in San Jose, 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 1.110, practice expense 1.442, malpractice 0.397 — scale each RVU component before the conversion factor is applied, which is why San Jose, CA allows more than the $482.64 baseline.
Which cities does the San Jose, CA rate for 64721 cover?
This payment locality also covers Sunnyvale and Santa Clara. Every location in it prices 64721 identically — the label names the largest metro, not a city-specific amount.
What is the facility rate for 64721 in San Jose, CA?
$521.90 in a facility, versus $607.63 in the office (non-facility) setting — a $85.73 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 64721 in San Jose, CA?
A non-participating provider is paid $577.25 — 95% of the $607.63 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $663.84, which is 115% of the non-participating amount.
How much of the San Jose, CA 64721 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($486.10) once the annual Part B deductible is met, and the beneficiary owes 20% ($121.53). Sequestration reduces Medicare's share by about 2% ($9.72), leaving $476.38. 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 01112-09'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 7,150)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 28)
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 San Jose, CA against the release that governed that date. Past releases need a free account; today's rate does not.

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