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Medicare Physician Fee Schedule · Q3 2026 release

CPT 64721 in New York City, NY

Open carpal tunnel release in ZIPs including 10001, 10036, and 10007

64721 Q3 2026 · New York City, NY flag13202-01
Locality-adjusted allowed amount
$558.98
in a doctor’s own office or clinic

115.8% of the $482.64 national baseline

( Work4.85 × 1.064 + Practice exp.8.61 × 1.162 + Malpractice0.99 × 1.586 ) × Conv. factor$33.4009 = $558.98

The Medicare allowed amount is $558.98 in the Office (non-facility) setting and $489.89 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 13202-01 · Participating · Whole service · Sequestration excluded

CMS sources and method · Calculation inputs

Calculate with this locality Check service-location ZIP

What Medicare locality is New York City, NY in? Copy link

New York City, NY is in CMS payment locality Manhattan (13202-01). The same amount applies everywhere in it.

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

ZIP codes in this payment locality (165)

The CMS ZIP-to-locality crosswalk maps 165 ZIP codes to this payment locality. Use this amount only after you confirm the service location is in this locality.

10001 10002 10003 10004 10005 10006 10007 10008 10009 10010 10011 10012 10013 10014 10015 10016 10017 10018 10019 10020 10021 10022 10023 10024 10025 10026 10027 10028 10029 10030 10031 10032 10033 10034 10035 10036 10037 10038 10039 10040 10041 10043 10044 10045 10046 10047 10048 10055 10060 10065 10069 10072 10075 10079 10080 10081 10082 10087 10090 10094 10095 10096 10098 10099 10101 10102 10103 10104 10105 10106 10107 10108 10109 10110 10111 10112 10113 10114 10115 10116 10117 10118 10119 10120 10121 10122 10123 10124 10125 10126 10128 10129 10130 10131 10132 10133 10138 10149 10150 10151

65 more ZIP codes map to this locality. The New York City, NY locality page lists the full set.

Which ZIP codes does the New York City, NY rate for 64721 cover?

The CMS ZIP-to-locality crosswalk maps 165 ZIP codes to this payment locality, and 64721 has the same amount in every one of them. Examples include 10001, 10002, 10003, 10004, 10005, 10006.

How locality affects the amount Copy link

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

New York City, NY (this locality)
$558.98
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 New York City, NY 15.8% above the national baseline.

Work GPCI
1.064
Practice expense GPCI
1.162
Malpractice GPCI
1.586
2026 conversion factor
$33.4009
Why is the 64721 rate in New York City, NY 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 1.064, practice expense 1.162, malpractice 1.586—scale each RVU component before the conversion factor is applied, which is why the New York City, NY 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 New York City, NY GPCI; the products are summed and multiplied by the conversion factor.

Code
64721
DOS
Not selected; uses this release’s rates
Locality
MANHATTAN (NY)
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 New York City, NY allowed amount for 64721
Component RVU × GPCI = Adjusted
Work 4.85 × 1.064 5.1604
Practice expense · Office (non-facility) 8.61 × 1.162 10.0048
Malpractice 0.99 × 1.586 1.5701
Sum of adjusted RVUs 16.7354
× 33.4009 conversion factor = formula amount $558.98

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

  1. Locality-adjusted allowed amount $558.98

    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 78)
    mac (col 1)
    13202
    locality_code (col 3)
    01
    work_gpci (col 5)
    1.064
    pe_gpci (col 6)
    1.162
    mp_gpci (col 7)
    1.586

    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 New York City, NY is $489.89, versus $558.98 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 New York City, NY?

$489.89 in a facility, versus $558.98 in the Office (non-facility) setting—a $69.09 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 New York City, NY. 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 New York City, NY
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $558.98
Non-participating allowed amount 95% of the participating amount. $531.03
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim—115% of the non-participating amount. $610.68
Medicare share 80% of the allowed amount, once the annual Part B deductible is met. $447.18
Patient coinsurance The remaining 20%. $111.80
Sequestration adjustment Reduces only Medicare's share—never the allowed amount or the patient's coinsurance. $8.94
Net Medicare payment Medicare's share after the sequestration reduction. $438.24
What is the non-participating amount and limiting charge for 64721 in New York City, NY?

A non-participating provider is paid $531.03—95% of the $558.98 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $610.68, which is 115% of the non-participating amount.

How much of the New York City, NY 64721 rate does Medicare actually pay?

Medicare pays 80% of the allowed amount ($447.18) once the annual Part B deductible is met, and the beneficiary owes 20% ($111.80). Sequestration reduces Medicare's share by about 2% ($8.94), leaving $438.24. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Contracted rate: % of Medicare in New York City, NY 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—$558.98 in the office (non-facility) setting—not the $482.64 national baseline.

Opens the calculator set to New York City, NY 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 New York City, NY, 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 New York City, NY
Metro Allowed amount vs. New York City, NY
Queens, NY $559.97 +0.2%
Long Island, NY $575.70 +3.0%
Northern New Jersey, NJ $541.11 -3.2%
Philadelphia, PA $503.73 -9.9%
Hartford, CT $514.97 -7.9%
Boston, MA $541.44 -3.1%

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

Other codes priced in New York City, NY Copy link

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

Other curated codes and their allowed amounts in New York City, NY
Code and service Allowed vs. national
66984 Cataract Surgery $521.72 +12.8%
27447 Knee Replacement $1,341.54 +15.7%
66982 Complex Cataract Surgery With Lens Implant $711.26 +12.8%
27130 Total Hip Arthroplasty $1,345.07 +15.8%
29827 Arthroscopic Rotator Cuff Repair $1,127.91 +15.5%
47562 Outpatient surgery $738.71 +16.9%
29881 Outpatient surgery $596.66 +15.7%
23472 Total Shoulder Arthroplasty $1,502.05 +15.5%
49505 Outpatient surgery $593.96 +16.9%
58571 Outpatient surgery $957.09 +15.5%
19120 Outpatient surgery $667.66 +16.5%
43775 Outpatient surgery $1,171.48 +17.1%

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 13202-01'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 78)
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 New York City, NY 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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