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Medicare Physician Fee Schedule · Q3 2026 release

CPT 64721 in Philadelphia, PA 12502-01

Open carpal tunnel release in ZIPs including 19102, 19103, and 19106

64721 2026 C · Philadelphia, PA flag12502-01 A Active
Allowed amount
$503.73
in a doctor’s own office or clinic

104.4% of the $482.64 national baseline

Medicare payment
$402.98
Patient / secondary
$100.75
Expected total to provider
$503.73

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 Philadelphia, PA? Copy link

The Medicare allowed amount is $503.73 in the office (non-facility) setting and $441.84 in a facility, under the Q3 2026 Physician Fee Schedule. Both are 4.4% 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 Philadelphia, PA in? Copy link

CMS payment locality Metropolitan Philadelphia (12502-01). Every location in it is priced identically.

Why Philadelphia, PA differs from the national amount Copy link

Philadelphia, PA (this locality)
$503.73
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 Philadelphia, PA at 4.4% above the national baseline.

Work GPCI
1.018
Practice expense GPCI
1.041
Malpractice GPCI
1.193
2026 conversion factor
$33.4009

Formula and inputs Copy link

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

RVU and GPCI components of the Philadelphia, PA allowed amount for 64721
Component RVU × GPCI = Adjusted RVU
Work 4.85 1.018 4.9373
Practice expense 8.61 1.041 8.9630
Malpractice 0.99 1.193 1.1811
Sum of adjusted RVUs 15.0814
× $33.4009 2026 conversion factor $503.73

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Philadelphia, PA allows $441.84 for 64721, versus $503.73 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 Philadelphia, PA. 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 Philadelphia, PA
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $503.73
Non-participating allowed amount 95% of the participating amount. $478.54
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $550.32
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $402.98
Beneficiary coinsurance The remaining 20%. $100.75
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $8.06
Medicare pays after sequestration Program payment net of the sequestration reduction. $394.92

Contracted rate: % of Medicare in Philadelphia, PA 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 — $503.73 in the office (non-facility) setting — not the $482.64 national baseline.

Opens the calculator already set to Philadelphia, PA 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 Philadelphia, PA rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 363 ZIP codes to this payment locality. 64721 prices identically in every one of them. 11 of them span more than one locality and need ZIP+4 for an exact match.

18039 18041 18054 18070 18073 18074 18076 18077 18081 18084 18901 18902 18910 18911 18912 18913 18914 18915 18916 18917 18918 18920 18921 18922 18923 18924 18925 18926 18927 18928 18929 18930 18931 18932 18933 18934 18935 18936 18938 18940 18942 18943 18944 18946 18947 18949 18950 18951 18953 18954 18955 18956 18957 18958 18960 18962 18963 18964 18966 18968 18969 18970 18971 18972 18974 18976 18977 18979 18980 18981 18991 19001 19002 19003 19004 19006 19007 19008 19009 19010 19012 19013 19014 19015 19016 19017 19018 19019 19020 19021 19022 19023 19025 19026 19027 19028 19029 19030 19031 19032

263 more ZIP codes map to this locality. The Philadelphia, PA 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 Philadelphia, PA, 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 Philadelphia, PA
Metro Allowed amount vs. Philadelphia, PA
Northern New Jersey, NJ $541.11 +7.4%
Baltimore, MD $514.07 +2.1%
New York City, NY $558.98 +11.0%
Washington, DC $546.32 +8.5%
Pittsburgh, PA $457.24 -9.2%
Queens, NY $559.97 +11.2%

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

Other codes priced in Philadelphia, PA Copy link

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

Other curated codes and their allowed amounts in Philadelphia, PA
Code Service Philadelphia, PA vs. national
66984 Cataract Surgery $478.80 +3.5%
27447 Knee Replacement $1,212.61 +4.6%
66982 Complex Cataract Surgery With Lens Implant $652.80 +3.5%
27130 Total Hip Arthroplasty $1,215.54 +4.6%
29827 Arthroscopic Rotator Cuff Repair $1,020.14 +4.5%
47562 Outpatient surgery $663.57 +5.0%
29881 Outpatient surgery $538.70 +4.5%
23472 Total Shoulder Arthroplasty $1,359.17 +4.5%
49505 Outpatient surgery $533.30 +5.0%
58571 Outpatient surgery $866.49 +4.6%
19120 Outpatient surgery $599.59 +4.6%
43775 Outpatient surgery $1,052.46 +5.2%

Common questions Copy link

Which ZIP codes does the Philadelphia, PA rate for 64721 cover?
The CMS ZIP-to-locality crosswalk maps 363 ZIP codes to this payment locality, and every one of them prices 64721 identically. Examples include 18039, 18041, 18054, 18070, 18073, 18074. 11 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 64721 rate in Philadelphia, PA 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 1.018, practice expense 1.041, malpractice 1.193 — scale each RVU component before the conversion factor is applied, which is why Philadelphia, PA allows more than the $482.64 baseline.
What is the facility rate for 64721 in Philadelphia, PA?
$441.84 in a facility, versus $503.73 in the office (non-facility) setting — a $61.89 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 Philadelphia, PA?
A non-participating provider is paid $478.54 — 95% of the $503.73 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $550.32, which is 115% of the non-participating amount.
How much of the Philadelphia, PA 64721 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($402.98) once the annual Part B deductible is met, and the beneficiary owes 20% ($100.75). Sequestration reduces Medicare's share by about 2% ($8.06), leaving $394.92. 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 12502-01'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 89)
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 Philadelphia, PA against the release that governed that date. The last 12 months price without an account; older dates of service need a free account.

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