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Medicare Physician Fee Schedule · Q3 2026 release

CPT 64721 in Washington, DC

Open carpal tunnel release in ZIPs including 20001, 20004, and 22201

64721 Q3 2026 · Washington, DC flag12202-01
Locality-adjusted allowed amount
$546.32
in a doctor’s own office or clinic

113.2% of the $482.64 national baseline

( Work4.85 × 1.054 + Practice exp.8.61 × 1.178 + Malpractice0.99 × 1.113 ) × Conv. factor$33.4009 = $546.32

The Medicare allowed amount is $546.32 in the Office (non-facility) setting and $476.28 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 12202-01 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is Washington, DC in? Copy link

CMS prices all of District of Columbia as one Medicare payment locality (Dc + Md/Va Suburbs), so this amount applies statewide—not only in Washington, DC.

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

ZIP codes in this payment locality (591)

The CMS ZIP-to-locality crosswalk maps 591 ZIP codes to this payment locality, across DC, MD, VA. Use this amount only after you confirm the service location is in this locality. Of these, 7 span more than one locality and need ZIP+4 for an exact match.

20001 20002 20003 20004 20005 20006 20007 20008 20009 20010 20011 20012 20013 20015 20016 20017 20018 20019 20020 20022 20023 20024 20026 20027 20029 20030 20032 20033 20035 20036 20037 20038 20039 20040 20041 20042 20043 20044 20045 20046 20047 20049 20050 20051 20052 20053 20055 20056 20057 20058 20059 20060 20061 20062 20063 20064 20065 20066 20067 20068 20069 20070 20071 20073 20074 20075 20076 20077 20078 20080 20081 20082 20088 20090 20091 20097 20098 20099 20120 20121 20122 20124 20151 20153 20170 20171 20172 20190 20191 20192 20193 20194 20195 20196 20201 20202 20203 20204 20206 20207

491 more ZIP codes map to this locality. The Washington, DC locality page lists the full set.

Which ZIP codes does the Washington, DC rate for 64721 cover?

The CMS ZIP-to-locality crosswalk maps 591 ZIP codes to this payment locality, and 64721 has the same amount in every one of them. Examples include 20001, 20002, 20003, 20004, 20005, 20006. The locality spans DC, MD, VA. Of these, 7 span more than one payment locality and need ZIP+4 for an exact match.

Does this 64721 rate apply everywhere in District of Columbia?

Yes. CMS prices District of Columbia as a single Medicare payment locality, so the same GPCIs—and the same allowed amount—apply statewide, not only in Washington, DC. 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) · Q3 2026 · Participating · Whole service

Washington, DC (this locality)
$546.32
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 Washington, DC 13.2% above the national baseline.

Work GPCI
1.054
Practice expense GPCI
1.178
Malpractice GPCI
1.113
2026 conversion factor
$33.4009
Why is the 64721 rate in Washington, DC 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 1.054, practice expense 1.178, malpractice 1.113—scale each RVU component before the conversion factor is applied, which is why the Washington, DC 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 Washington, DC GPCI; the products are summed and multiplied by the conversion factor.

Code
64721
DOS
Not selected; uses this release’s rates
Locality
DC + MD/VA SUBURBS (DC)
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 Washington, DC allowed amount for 64721
Component RVU × GPCI = Adjusted
Work 4.85 × 1.054 5.1119
Practice expense · Office (non-facility) 8.61 × 1.178 10.1426
Malpractice 0.99 × 1.113 1.1019
Sum of adjusted RVUs 16.3564
× 33.4009 conversion factor = formula amount $546.32

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

  1. Locality-adjusted allowed amount $546.32

    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 39)
    mac (col 1)
    12202
    locality_code (col 3)
    01
    work_gpci (col 5)
    1.054
    pe_gpci (col 6)
    1.178
    mp_gpci (col 7)
    1.113

    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 Washington, DC is $476.28, versus $546.32 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 Washington, DC?

$476.28 in a facility, versus $546.32 in the Office (non-facility) setting—a $70.04 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 Washington, DC. 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 Washington, DC
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $546.32
Non-participating allowed amount 95% of the participating amount. $519.00
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $596.85
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $437.06
Patient coinsurance The remaining 20%. $109.26
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $8.74
Net Medicare payment Medicare's share after the sequestration reduction. $428.32
What is the non-participating amount and limiting charge for 64721 in Washington, DC?

A non-participating provider is paid $519.00—95% of the $546.32 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $596.85, which is 115% of the non-participating amount.

How much of the Washington, DC 64721 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($437.06) once the annual Part B deductible is met, and the beneficiary owes 20% ($109.26). Sequestration reduces Medicare's share by about 2% ($8.74), leaving $428.32. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in Washington, DC 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—$546.32 in the office (non-facility) setting—not the $482.64 national baseline.

Opens the calculator set to Washington, DC 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 Washington, DC, 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 Washington, DC
Metro Allowed amount vs. Washington, DC
Baltimore, MD $514.07 -5.9%
Richmond, VA $468.03 -14.3%
Philadelphia, PA $503.73 -7.8%
Pittsburgh, PA $457.24 -16.3%
Charlotte, NC $451.44 -17.4%
New York City, NY $558.98 +2.3%

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

Other codes priced in Washington, DC Copy link

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

Other curated codes and their allowed amounts in Washington, DC
Code and service Allowed vs. national
66984 Cataract Surgery $514.08 +11.1%
27447 Knee Replacement $1,277.83 +10.2%
66982 Complex Cataract Surgery With Lens Implant $699.77 +11.0%
27130 Total Hip Arthroplasty $1,280.92 +10.2%
29827 Arthroscopic Rotator Cuff Repair $1,080.52 +10.7%
47562 Outpatient surgery $696.35 +10.2%
29881 Outpatient surgery $576.10 +11.7%
23472 Total Shoulder Arthroplasty $1,432.91 +10.2%
49505 Outpatient surgery $561.87 +10.6%
58571 Outpatient surgery $909.14 +9.7%
19120 Outpatient surgery $648.14 +13.1%
43775 Outpatient surgery $1,084.31 +8.4%

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 12202-01'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 39)
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 Washington, DC 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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